Care of Immunocompromised Flashcards
3 common infections in patients with defects in immunoglobulins or compliment proteins
Sinopulmonary infections
Chronic GI infections
Meningitis
Organisms responsible in patients with immunoglobulin or compliment protein defects
Encapsulated bacteria
Giardia
Campylobacter
10 encapsulated bacteria
YES Some Nasty Killers Have Pretty Big Capsules
Yersinia Pestis E. Coli Salmonella typhi Strep pneumonia or pyogenes Neisseria meningitidis Klebsiella pneumoniae Haemophilus influenzae Pseudomonas aeruginosa Bordetella pertussis and Bacillus anthracis Cryptococcus neoformans (only fungal pathogen in list)
Granulocyte defects common infection pattern
Recurrent skin and soft tissue infections/abscesses
Glucocorticoids and immunosuppressants cause what type of immunodeficiency
cell-mediated immunity (similar to HIV)
Causes of false positive galactomannan test
non invasive fungi (penicillium)
Food in the gut (pastas, breads, etc)
Plasmalyte
Do zosyn and similar abx cause a false positive galactomannan?
No. Reformulations since the 90’s have removed that.
Angle of branching for aspergillus
45
Angle of branching for mucor
90
Does mucor or aspergillus have hyphae?
Aspergillus
Cause of infection in transplanted patient in < 1 month post transplant?
Drug resistant infections
Aspiration
CLABSI
CAUTI
Wound infection
Cause of infection in a patient 1 - 6 months out from transplant
BK virus
Cryptococcus
M. Tuberculosis
Pneumocystis
Nocardia
Herpes virus
Cause of infection in a patient > 6 months out from transplant
CAP
UTI
Aspergillus
Nocardia
Late viral infections
Timeline for opportunistic infections to appear following hematopoetic stem cell transplant
> 100 days
Infections possible in HIV with CD4 count below 500
Bacterial pneumonia
Reactivation of TB
Infections possible in HIV with CD4 count below 200
Primary TB
PCP
Cryptococcus
Infections possible in HIV with CD4 count below 100
Atypical TB
Nocardia
Aspergillus
Toxoplasma
Infections possible in HIV with CD4 count below 50
CMV
NTM
Disseminated fungal
Organism with “owls eye” which is a basophilic inclusion in the nucleus
CMV
Treatment for CMV
Ganciclovir (causes bone marrow suppression)
Foscarnet (causes renal failure)
Treatment for nocardia
Bactrim
Treatment for actinomyces
penicillin
main side effect of TNF-apha drugs
granuloma formation
Immunocompromised patient that develops headache, encephalopathy, visual changes, seizures, and HTN
PRESS syndrome
5 immunosuppressants that can cause PRESS syndrome
tacrolimus
cyclosporine
sirolimus
cisplatin
interferon
Press syndrome classic finding on MRI
Hyperintense lesions on T2 and flair that do not have the same vascular distribution
Fever, rash, and joint pain in the fingers and toes on someone on antithymocyte globulin (ATG) for immunosuppression
Serum sickness
Calcinurin inhibitor that can cause pneumonitis even in lung transplant patients
Sirolimus
