Rosh Internal Medicine Boost Practice Exam

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What opportunistic infection are patients with a CD4 count below 50 cells/mcL prone to developing?

Histoplasmosis
Kaposi sarcoma
Mycobacterium avium complex
Toxoplasmosis

The correct answer is: Mycobacterium avium complex

Patients with a CD4 count below 50 cells/mcL are at high risk of developing Mycobacterium avium complex (MAC) infections. This is primarily due to the severely compromised immune system associated with such low CD4 counts, making it difficult for the body to fight off various infections, particularly those caused by atypical mycobacteria like MAC. MAC infections generally occur in individuals with advanced immunosuppression, particularly in the context of HIV/AIDS, and they can lead to systemic illness presenting with symptoms such as fever, weight loss, and diarrhea. The risk of MAC infection increases significantly as the CD4 count drops, particularly when it falls below the 50 cells/mcL threshold. While the other infections listed are also concerns for immunocompromised patients, they are associated with higher CD4 counts compared to MAC. For example, Toxoplasmosis typically occurs when CD4 counts are below 100 cells/mcL, and opportunistic infections such as Histoplasmosis or Kaposi sarcoma generally present with higher CD4 counts as well. Therefore, the specific risk associated with a CD4 count below 50 cells/mcL directly correlates with Mycobacterium avium complex.