218.2 📚 國考版

218.2.0.1 必背 — CD4 Threshold for OIs

  • PJP < 200
  • Toxo, Crypto, MAC, PML, KS < 100
  • CMV retinitis < 50

218.2.0.2 必背 — Prophylaxis

CD4 Drug
< 200 + Toxo IgG+ TMP-SMX (covers PJP + Toxo)
< 100 + Toxo IgG+ TMP-SMX
< 100 CrAg+ Fluconazole (pre-emptive)

218.2.0.3 必背 — PJP

  • CD4 < 200, dry cough, hypoxia, bilateral CXR interstitial
  • TMP-SMX 15-20 mg/kg/d × 21 days
  • Steroid if A-a > 35 or PaO2 < 70
  • β-D-glucan elevated; BAL gold standard

218.2.0.4 必背 — Toxoplasma

  • CD4 < 100 + IgG+
  • MRI multi-ring enhancing
  • Sulfadiazine + pyrimethamine + leucovorin × 6 wk
  • TMP-SMX alt

218.2.0.5 必背 — Cryptococcus

  • CD4 < 100
  • Headache + fever + altered mental status
  • Serum CrAg + CSF CrAg + India ink
  • Repeated LPs for high pressure (mortality reduction)
  • AmB liposomal + flucytosine × 14d → fluconazole 800 × 8 wk → 200 maintenance
  • Delay ART 4-6 wk after cryptococcal meningitis treatment (COAT trial)

218.2.0.6 必背 — MAC

  • CD4 < 50
  • Fever + weight loss + anemia + LAP + splenomegaly
  • Blood culture (mycobacterial bottles)
  • Clarithromycin + ethambutol + rifabutin ≥ 12 mo + immune recovery

218.2.0.7 必背 — CMV Retinitis

  • CD4 < 50
  • “Pizza pie” fundus
  • Valganciclovir 900 PO bid × 21 d induction → 900 qd maintenance

218.2.0.8 必背 — Toxo vs PCNSL

  • Toxo: multi-ring enhancing, response to empirical therapy
  • PCNSL: single homogeneous enhancing, EBV PCR+, thallium SPECT+

218.2.0.9 必背 — PML

  • CD4 < 100, JC virus
  • MRI multifocal demyelination, NO enhancement
  • ART (immune reconstitution) primary

218.2.0.10 必背 — Discontinue Prophylaxis

  • PJP: CD4 > 200 for 3-6 months
  • Toxo: CD4 > 100 for 3 months
  • Crypto: complete maintenance + immune recovery
  • MAC: CD4 > 100 for 6 months + 12 mo treatment