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Rosens > 182. Immunocompromised Pt > Flashcards

182. Immunocompromised Pt Flashcards

1
Q

Innatve vs acquired immunity basic differences?

A

innate - occur regardless o fhow often infection and get activated immediately

acquired - take some time after repeat exposure and 3-5d to mount

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2
Q

Nonmicrobe sp immunity: Physical barrier examples

A

skin
mucosa
cilia
biofilm
gastric acid
antimicrobial peptides
pro on skin and mm

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3
Q

Nonmicrobe sp immunity: Physical barrier what impairs these?

A

smoking
pulmonary disease
mechanical ventilation
tracheostomy
abnormal peristalsis

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4
Q

Initial inflammatory response and innate immunity: goal of this and microbes to do it?

A

promote phagocytosis and microbial killing while activating the immune system

inflammatory response to release CK - cause migration and adhesion of PMN and monocyte to bacterial invasion

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5
Q

Nonmicrobe sp immunity: Reticuloendothelial system

A

composed of tissue macrophages and blood borne counterparts, monocytes - removes particulate matter from lmph and blood

particlarly LN, spleen, liver, marrow, lung

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6
Q

Nonmicrobe sp immunity: Reticuloendothelial system - particular good for which bacteria?

A

encapsulated
pneumococci, meningococci, H influ

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7
Q

Adaptive/Microbe specific Immunity: Humoral: Antibody - which cells are these and what can they do?

A

B cell, also help to present to T cell

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8
Q

Adaptive/Microbe specific Immunity: Humoral: immunoglobulins: which is first to appear in system in response to new Ag?

A

IgM

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9
Q

Adaptive/Microbe specific Immunity: Humoral: immunoglobulins: IgM vs IgG

A

IgM: first, less affinity but provides some recognition to b cell prolif prior to making IgG

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10
Q

Adaptive/Microbe specific Immunity: Humoral: immunoglobulins: IgA - where do you typically find this one?

A

GI
nasal and oral secretions
tears
other mucous fluids

bacterial, viral and protozoan

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11
Q

Adaptive/Microbe specific Immunity: Humoral: immunoglobulins: IgE.- where is this?

A

mast cell surface, basophils
hypersen responses

particular helminth

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12
Q

Adaptive/Microbe specific Immunity: Humoral: immunoglobulins: IgG - how much accounts for total Ig mass?

A

75%

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13
Q

Adaptive/Microbe specific Immunity: Humoral: immunoglobulins: IgG - can it cross the placenta?

A

yes

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14
Q

Adaptive/Microbe specific Immunity: Humoral: immunoglobulins: IgG - how long does fetus have mums IgG?

A

first 6mo

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15
Q

Adaptive/Microbe specific Immunity: Humoral: immunoglobulins: IgG - G2 subtype has sp affinity for polysacc of bacterial cell capsules of which 2 bacteria in paritcular?

A

strep pneumoni
H influ

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16
Q

Adaptive/Microbe specific Immunity: Humoral: Complement: what is this?

A

cascade of interaction of 30 PRO to produce inflamm, leukoctyosis, recruite leukocytes to sites of infection
neutralize viruses
enhances binding of opsonin
lyses bacteria cell walls and membranes

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17
Q

Adaptive/Microbe specific Immunity: Humoral: Complement: which Ig activate this? (2)

A

IgM
IgG

classical pathway

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18
Q

Adaptive/Microbe specific Immunity: Humoral: Complement: what activates the alternative pathway?

A

repeating chemical structure molecules like bact cell wall and capsulse

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19
Q

Adaptive/Microbe specific Immunity: Humoral: Complement: what is the merging point of classic and alt paths?

A

C3

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20
Q

Adaptive/Microbe specific Immunity: Humoral: Complement: terminal leg of this includes C5-c9 forming the membrane attack complex - what does this do?

A

cell wall and membranes insertion, leads to death

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21
Q

In pt with mild complement deficiencies, is risk of disease with Niesseria meningitidis and gonorrhea worse or better?

A

milder

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22
Q

Adaptive/Microbe specific Immunity: In cell mediated immunity - what cells does this include?

A

T ymphocytes
NK
mononuclear phagocytes

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23
Q

Adaptive/Microbe specific Immunity: cell mediated immunity - where are most T cells?

A

marrow, thymus, spleen, LN

spleen and LN are where see antigens

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24
Q

CD4 vs CD8 roll of T cells?

A

cd4 help other cells including enh b cell antibody production, production of CK

cd8 kill virally infected target cells themselves

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25
Q

Defects in cell mediated immunity (T cells) are at risk for which disseminated infections by bacteria?

A

TB
Listeria
Salmonella

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26
Q

Defects in cell mediated immunity (T cells) are at risk for which disseminated infections by viruses?

A

cmv
herpses
varicella

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27
Q

Defects in cell mediated immunity (T cells) are at risk for which disseminated infections by fungi?

A

candida
cypto
aspergillus
pneumocystis

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28
Q

Defects in cell mediated immunity (T cells) are at risk for which disseminated infections by protozoa?

A

toxoplasma

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29
Q

2 major granulocytic phagocytes?

A

neutrophils
macrophages

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30
Q

Eosinophils are particular helpful for which bugs?

A

helminths

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31
Q

Half of neutrophils in BM circulate where? and other half ?

A

plasma

lungs, liver, spleen, endothelium

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32
Q

What bugs are particularly well opsonized by neutrophils?

A

s pneumo
gas
h influ
staph aureus

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33
Q

Which bacteria does crp opsonize?

A

one of initial inflamm response PRO
opsonizes s pneumo

34
Q

Splenectomy or functional asplenia concerning bacrteria

A

s pneumonia
h influ
n meningitid
canpcytophaga canimorsus
bordetella

35
Q

Key antibiotics for immunocompromised pt

A

aminoglycosides
ext sepctrum pen - piptazo
cephalo: cefepime
carbapenem: imi, mero
other: vanco
amphotericin B
acyclovir

36
Q

Acyclovir dose for a mucocutaneous herpes zoster in an immunocomp pt:

A

5mg/kg IV q8h or 400mg PO daily

37
Q

Acyclovir dose for a mild vs seve herpes zoster in an immunocomp pt:

A

mild: 800mg PO five times daily or 10mg/kg IV q8h

38
Q

Acyclovir dose for a primary varicella in an immunocomp pt:

A

10mg/kg IV q8h

39
Q

What are unique considerations for febrile neutropenia evaluation and management in children?

A

-IV cath common site - swab all sources
-peripheral culture if possible
-urine culture and urinalysis given ++ common
-cxr only if sx
-initiate monotherapy as soon as culture done - piptazo, penem
-transfer of ped ca pt to hospital with experienced management when available

40
Q

Solid organ ca pt - often febrile neutropenia?

A

no

41
Q

If suspected listeria, how to tx?

A

ampicillin

42
Q

If worried about salmonella, tx with which abx?

A

third gen cephalosporin or FQ

43
Q

Pt with solid tumors, lymphoma and leukemia are at risk of pneumonia from what sp?
tx with?

A

legionella
resp FQ or azithromycin

44
Q

Nocardiosis - what is this?

A

severe bact infection with weakly acid fast gram +, filamentous rod, branching

45
Q

MC manifestation nocardiosis?

A

nodular infiltrates pneumonia
no fever

46
Q

Tx nocardia?

A

sulonamides with other agents

47
Q

What immunocomp pt are at risk for cryptococcus infection?

A

lymphomas
CLL and CML
HIV
solid organ transplant
db
renal insuff
cirrhosis

48
Q

MC manifestation of cryptococcus?

A

meningitis

49
Q

Meningitis secondary to cryptococcus dx?

A

crypto angtigen in serum and csf, fungal culture, tissue biopsy

often high opening pressure and can cause obstr hydrocephalus

50
Q

Which pt are at risk from pneumocystis jirovecii pneumonia?

A

AIDS
leukemia
lymphoma
solid tumors taking high dose CS

51
Q

What abx is prophylactic for PJP?

A

septra

52
Q

What parasitic infection is the only helminthis organism producing severe infection in pt with deficient cell mediated immunity?

A

strongyloides

53
Q

strongyloides - sx

A

cns, skin
can have wheeze cough dyspnea, hemoptysis, hemorrhagic rash

54
Q

top 3 viruses causing serious infecton in cancer pt?

A

varicella zoster
herepes simplex
cmv

55
Q

What tx can pt with decreasedm cellulular mediated immunity get for influenza?

A

oseltamivir

56
Q

Hypogammaglobulinemia is common in which 2 ca?

A

CLL
MM

57
Q

What opportunistic infections can mimic cancer spread?

A

nocardia, toxo in brain
Budd chiari mimic: asperigllus, mucor, rhizopus –> causing thrombus
Renal vein thrombosis: gram neg bacilli
candida - ureter like post obstr uropathy
Pulmonary nodules - histo pneumocystitis, legionella, aspergilus, nocardia

58
Q

What are diabetes pt incr risk of infection?

A

defect in imm function, excess substrate for bacteria and fungal growth, vascular insuff - microangiopathy and AS, sensory neuropathy to wound neglect
neutrophils and monocyte impaired
cellular immunity has decr prolif response

59
Q

Why does etoh use/cirrhosis incr risk of infection?

A

suppression immune system
altered blood flow
depression mental status
delay in seeking medical care
malnutrition
cig smike
chronic lung disease
complement deficiency secondary to loss of C3 (made by liver)
IgM bactericidal decrease
granulocytopenia and dminished leukocyte mobilization

60
Q

Spont bacteremia and sepsis infections in pt with cirrhosis: caused by which bugs?

A

ecoli
K pneumoniae
salmonella
streptococci
vibrio vulnifivus
aeromonas

61
Q

SBP infections in pt with cirrhosis: caused by which bugs?

A

ecoli
k pneumoniae
s pneumo
enterococci

62
Q
A
63
Q

etoh pt: PMN count 250 cells/mm3 - tx with?

A

ceftriaxone or cipro until cultures return

64
Q

Additionally, patients receiving treatment for SBP have been shown to have increased survival and decreased inci- dence of hepatorenal syndrome when administered albumin 1.5 g/kg at ?d and 1 g/kg on day ? of treatment.

A

on presentation
d3

65
Q

Why do pt with renal failure get more infections?

A

often concomittent diabetes
sites of infection at breaks in skin from vascular access, peritoneal dialysis
uremic pruritis
reduced renal clearance
CKD - general immune hyporesponsiveness: neutrophils slow, CMI imapired, leukopenia common. Humoral imm: lower IgG response, inadequate response to vaccines

66
Q

Renal failure pt - often assume ? + and tx as such

A

MRSA

67
Q

What bugs predominate in perionteal dialysis pt perionitis?

A

s aures, s epidermidis
strep
gram - bacilli
candida

68
Q

What bug specifically does asplenia put you at risk for?

A

s pneumo

69
Q

Bugs from asplenia (list 6)

A

s pneumo
H influ
n meningitidis
gram - bacilli: ecoli, pseudomonas
babesia
ehrlichiosis - tick borne
bordetella

70
Q

Diseases causing functional hyposplenism

A

sickle cell
ulcerative colitis
celiac
sarcoidosis
amyloidosis
RA
SLE

71
Q

What finding on blood smear indicates hyposplenism?

A

howell jolly bodies

72
Q

For pt with asplenia, may not find a source. What abx should you give?

A

ceftriaxone at meningitic dosing
vanco if R prevalent to penicillin

73
Q

What immunizations does an asplenia person need?

A

pneumococcus
h influ type B
N meningitidis
influenza

74
Q

Asplenia: rule for children receiving prophylaxis with oral ? or ? up to age of _ and for at least ?-? years after splenectomy

A

pen or amox
age 5
1-2y

75
Q

How to steroids effect the immune system?

A

alter distribution and function of neutrophils, monocytes, lymphocytes
difficulty to mobilize them and neutrophil adherence
inhibit phagocytosis and IC killing (CMI impaired)
complement cannot activate
hyperglycemia also contributes

76
Q

MC sources of infection when on high dose steroids?

A

s aureus
streptococci
gram neg bacilli

77
Q

At what dose of predn does adrenal suppression increase?

A

> 7.5mg/day

78
Q

Use of CS increases risk of complications from what abdominal disease?

A

diverticular

79
Q

List 5 immunosuppressive drugs other CS?

A

cyclosporine
tacrolimus
mycophenolate
azathioprine
methotrexate
cyclophosphamide

80
Q

tumor necrossi factor inhibitors are at incr susecptibility of what kind of infections?

A

disseminated
- tb, non tb mycoplasma, histo, coccidiodomyocisis

81
Q

What is mucositis?

A

Mucositis is a frequent prelude to viridans streptococcal bacte- remia, which can produce sudden onset of acute respiratory distress syndrome, a toxic shock–like syndrome, rash, and pneumonia. Impor- tantly, mucositis predisposes the patient to gram-positive infections, and vancomycin is appropriate in addition to a broad-spectrum gram- negative agent.

Rosens (40 decks)

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