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Host And Defense Exam 4 > Cariello - Transplants > Flashcards

Cariello - Transplants Flashcards

1
Q

T/F - Infection is leading cause of death and/or transplant failure.

A

TRUE

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2
Q

When is a transplant pt any highest risk?

A

Very soon after transplant

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3
Q

What contributes to a net state of immunosuppression?

A

Immunosuppressive therapy

Mucocutaneous-barrier integrity

Neutropenia

Underlying diseases

Metabolic conditions

Infections

Nutritional status

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4
Q

HSCT phases of immunosuppression?

A

Induction/conditioning

Consolidation/intensification

Maintenance

GVHD tx

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5
Q

Autologous vs allogeneic?

A

Autologous
-Self to self
—Less immunosuppression
—Less chance to beat the disease

Allogeneic
-Other to self
—More immunosuppression
—More chance to beat the disease

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6
Q

Post HSCT phases?

A

I
-Day 0-30
—Prolonged neutropenia
—Damage to mucocutaneous barriers

II
-Day 31-100
—Impaired cell-mediated immunity
—GVHD

III
-Day 100+
—Depends on immunosuppression

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7
Q

What are common infectious complications?

Bacterial

Viral

A

Bacterial

  • Bacteremias and abscesses
  • C diff
  • Typhlitis - neutropenic enterocolitis
  • TB

Viral

  • EBV, PTLD
  • VZV
  • BK - Hemorrhagic cystitis and interstitial nephritis
  • JC virus
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8
Q

Common infections:

Fungal

Parasites

A 
Fungal
-Yeast
—Candida, cryptococcus, pneumocystis
-Mold
—Aspergillus and mucor
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9
Q

What care should be done pre-transplant?

A

Pt education

Prophy/Cleaning

Treat all active disease

Remove all potential sources of acute or chronic infection

Remove all non-restorable teeth

Reinforce oral hygiene and home care

Perform necessary denture adjustments

Daily abx mouthwash

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10
Q

4 indications for tooth extraction.

A

Tooth mobility (Pocket of 5-6+ mm)

Teeth with endo-perio problem

Teeth with periapical lesions

Teeth with very deep or extensive caries

*Postpone implant placement

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11
Q

Pre-transplant care?

A

Consult with MD

Educate pt about hygiene

Dental prophy

Careful with drugs

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12
Q

T/F - If pt has severe leukopenia and thrombocytopenia, then they should avoid flossing.

A

TRUE

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13
Q

What happens with radiation/chemotherapy?

A

Decreased production of saliva

Xerostomia promotes dental caries and increases risk of tooth decay

Mouth ulcers
-Difficult chewing, speaking and swallowing

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14
Q

Major risk factor for bacteremia is with what bug?

A

Strep viridans

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15
Q

Infectious complications due to chemotherapy?

Bacterial

Fungal

Viral

A

Bacterial

  • Dental abscess
  • Bacteremia

Fungal

  • Candidiasis
  • Aspergillus

Viral

  • HSV - More severe and slow healing
  • VSV
  • CMV
  • HHV8
  • EBV
  • HPV
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16
Q

Mucositis is most common when?

A

Post-HSCT tx

5 degrees

17
Q

Mucositis affects what surfaces?

A

Non-kera mucosal surfaces

  • Ventral and lateral tongue
  • Floor of mouth
  • Soft palate
  • Buccal mucosa
  • Inner lips

Discomfort and risk of infection

18
Q

T/F - 50% of pts that get an allogeneic transplant will get GVHD.

A

TRUE

19
Q

Non-infectious complications of grafting?

A

Medications

GVHD (Mostly from allogeneic HSCT)

Xerostomia

Taste alterations

Hemorrhage

Osteonecrosis of the jaw

20
Q

Manifestations of GVHD?

A

Xerostomia

Lichens

Popular lesions

Erythema

Tongue surface atrophy

Ulceration

Rash, jaundice, diarrhea, eyes, lungs

21
Q

What improves outcomes with GVHD?

A

Reducing the oral microbial load w/ tx of pre-existing conditions

22
Q

Gingival hyperplasia is due to what?

A

Cyclosporine
-Worse if combined with Ca-channel blockers

HLA-DR1 - Protective

HLA-DR2 and HLA-B37 - Increased risk

23
Q

When does gingival hyperplasia develop?

A

1-3 months after starting drugs

Begins at papilla

Epi invaded by candida hyphae

Cauliflower appearance

24
Q

What should be kept in mind with medications with gingival hyperplasia?

A

Renal fx

Cyclosporine

Avoid NSAIDS

Prolonged steroids

25
Q

Cyclosporine major toxicity?

A

Gingival hyperplasia

26
Q

Steroids major toxicity?

A

HTN, Cushing, DM, osteoporosis

27
Q

During the peak immunosuppression (3-6 months) post transplant, what dental work can/should be done?

A

Only emergency tx in a hospital environment

-Cleanings should be postponed for 6 months after transplant or periods of profound immunosuppression
—Wait for remission after chemotherapy for leukemia

28
Q

Antiplatelet hemorrhage recommendations for extractions?

A

Ok to extract up to 3 teeth

-Or 1 week off pre and post procedure

29
Q

General principles of prevention?

A

Vaccination

  • Update prior to transplant
  • NO live vaccines after transplant

Lifestyle changes

  • Hand washing
  • Avoid sick contacts
  • Masks and gloves
  • Avoid construction sites
  • Diet habits and food safety
30
Q

Infectious complications risk factors?

A

Presence of acute, chronic, and latent infections

Underlying disease

Use of prophylactic antimicrobials

Barrier loss

GVHD

Medications

*Bacteremia with viridans streptococci

Topical therapy alone often not efficacious

31
Q

What is the most frequent complication post HSCT?

A

Mucositis

32
Q

T/F - NSAIDs should be AVOIDED with HSCT.

A

TRUE

33
Q

T/F - ABx prophylaxis should be considered if the pt is profoundly immunosuppressed.

A

TRUE

34
Q

T/F - Dentures cause tissue trauma.

A

TRUE

  • Colonized with microbial pathogens
  • Remove and leave out until sores heal
  • Disinfect properly
35
Q

What are the 3 phases of HSCT infections?

A

I - Pre-engraftment
—Neutropenia, barrier breakdown, mucositits
—Acute GVHD

II - Post-engraftment
—Impaired cellular and humoral immunity, NK cells recover first, CD8 T cells increasing
—Acute GVHD and Chronic towards end of this phase

III - Late phase
—Impaired cellular and humoral immunity, B and CD4 T cells recover slowly
—Chronic GVHD

36
Q

T/F - As part of post-transplant care, you should rinse with mouthwash for 1 minute before anesthesia.

A

TRUE

Host And Defense Exam 4 (10 decks)

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