Care of Immunocompromised

Question 1

3 common infections in patients with defects in immunoglobulins or compliment proteins

Answer 1

Sinopulmonary infections

Chronic GI infections

Meningitis

Question 2

Organisms responsible in patients with immunoglobulin or compliment protein defects

Answer 2

Encapsulated bacteria

Giardia

Campylobacter

Question 3

10 encapsulated bacteria

Answer 3

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)

Question 4

Granulocyte defects common infection pattern

Answer 4

Recurrent skin and soft tissue infections/abscesses

Question 5

Glucocorticoids and immunosuppressants cause what type of immunodeficiency

Answer 5

cell-mediated immunity (similar to HIV)

Question 6

Causes of false positive galactomannan test

Answer 6

non invasive fungi (penicillium)

Food in the gut (pastas, breads, etc)

Plasmalyte

Question 7

Do zosyn and similar abx cause a false positive galactomannan?

Answer 7

No. Reformulations since the 90’s have removed that.

Question 8

Angle of branching for aspergillus

Answer 8

45

Question 9

Angle of branching for mucor

Answer 9

90

Question 10

Does mucor or aspergillus have hyphae?

Answer 10

Aspergillus

Question 11

Cause of infection in transplanted patient in < 1 month post transplant?

Answer 11

Drug resistant infections

Aspiration

CLABSI

CAUTI

Wound infection

Question 12

Cause of infection in a patient 1 - 6 months out from transplant

Answer 12

BK virus

Cryptococcus

M. Tuberculosis

Pneumocystis

Nocardia

Herpes virus

Question 13

Cause of infection in a patient > 6 months out from transplant

Answer 13

CAP

UTI

Aspergillus

Nocardia

Late viral infections

Question 14

Timeline for opportunistic infections to appear following hematopoetic stem cell transplant

Answer 14

> 100 days

Question 15

Infections possible in HIV with CD4 count below 500

Answer 15

Bacterial pneumonia

Reactivation of TB

Question 16

Infections possible in HIV with CD4 count below 200

Answer 16

Primary TB

PCP

Cryptococcus

Question 17

Infections possible in HIV with CD4 count below 100

Answer 17

Atypical TB

Nocardia

Aspergillus

Toxoplasma

Question 18

Infections possible in HIV with CD4 count below 50

Answer 18

CMV

NTM

Disseminated fungal

Question 19

Organism with “owls eye” which is a basophilic inclusion in the nucleus

Answer 19

CMV

Question 20

Treatment for CMV

Answer 20

Ganciclovir (causes bone marrow suppression)

Foscarnet (causes renal failure)

Question 21

Treatment for nocardia

Answer 21

Bactrim

Question 22

Treatment for actinomyces

Answer 22

penicillin

Question 23

main side effect of TNF-apha drugs

Answer 23

granuloma formation

Question 24

Immunocompromised patient that develops headache, encephalopathy, visual changes, seizures, and HTN

Answer 24

PRESS syndrome

Question 25

5 immunosuppressants that can cause PRESS syndrome

Answer 25

tacrolimus

cyclosporine

sirolimus

cisplatin

interferon

Question 26

Press syndrome classic finding on MRI

Answer 26

Hyperintense lesions on T2 and flair that do not have the same vascular distribution

Question 27

Fever, rash, and joint pain in the fingers and toes on someone on antithymocyte globulin (ATG) for immunosuppression

Answer 27

Serum sickness

Question 28

Calcinurin inhibitor that can cause pneumonitis even in lung transplant patients

Answer 28

Sirolimus