Exam 5 - Immunocompromised Host Flashcards

1
Q

Neutropenia = an ________ less than _______/mm3

A
an ANC (absolute neutrophil count)
less than 1000
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2
Q

how to find ANC?

A

WBC x (% polys + % bands)

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3
Q

what are important risk factors related to neutropenia

A

severity of neutropenia
rate of neutrophil decline
duration of neutropenia

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4
Q

High risk of infection in pts with ANC < _______

A

500 cells/mm3

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5
Q

Risk of infection and death are greatest in pts with ANC < ________

A

100 cells/mm3

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6
Q

Cell mediated or Humoral immunity defects?

defects in t lymphocyte and macrophage

A

cell mediated

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7
Q

Cell mediated or Humoral immunity defects?

defects in B cell function

A

humoral

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8
Q

Cell mediated or Humoral immunity defects?

results in reduced ability of the host to defend against intracellular pathogens

A

cell mediated

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9
Q

Cell mediated or Humoral immunity defects?

common bacteria pathogens found include ATYPICALS! (listeria, nocardia, legionella, mycobacteria)

A

cell mediated

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10
Q

Cell mediated or Humoral immunity defect?

common pathogen = fungi

A

cell mediated

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11
Q

Cell mediated or Humoral immunity defects?

common pathogens include S. pneumoniae, H. influenzae, N. meningitidis

A

humoral

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12
Q

most infections in cancer patients are caused by oraganisms that are colonized where?

A

skin
oropharynx
and GI tract

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13
Q

Clinical presentation in neutropenic patients?

A

presence of fever - probably ONLY clinical finding

wont see white cells because they are NEUTROPENIC!!

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14
Q

Patient factors for being low risk for infections:

  • neutropenic for < ____ days
  • no or few ____________
  • clinically stable at ________
  • no identified focus of infection/simple infection
A
  • neutropenic for < 7 days;
  • comorbidities
  • onset of fever
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15
Q

Patient factors for being high risk for infections:

  • profound/prolonged _________
  • significant ________
A
  • neutropenia = ANC < 100 and > 7 days

- comorbidities

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16
Q

If pt is low risk for infection and has neutropenia:

if pt has adequate outpt infrastructure (phone and transport) AND can do oral regimen…. what do you give them

A

cipro + amox/clav

17
Q

If pt is low risk for infection and has neutropenia:

if pt has INadequate outpt infrastructure (phone and transport) OR can NOT do oral regimen…. what do you give them

A

IV abx MONOTHERAPY

18
Q

what are the IV abx that are used in febrile neutropenic patients – LOW RISK

A

pip/tazo
antipseudomonal carbapenem (AKA not erta)
Cefepine
Ceftazidime

19
Q

If pt is high risk for infection and has febrile neutropenic: what do you give them?

A

IV abx (monotherpapy)

20
Q

what are the IV abx that are used in febrile neutropenic patients – HIGH RISK

A
same as LOW RISK!!
pip/tazo
antipseudomonal carbapenem (AKA not erta)
Cefepine
Ceftazidime
21
Q

when patient is high risk febrile neutropenia:

add Vanc when?

A

cellulitis, pneumonia, severe sepsis/shock
known colonization with MRSA or resistant streptococci, or gram POSITIVE bacteremia

*duh no vanc needed for gram -

22
Q

when patient is high risk febrile neutropenia:

if septic shock or gram - bacteremia or pneumonia add what drugs?

A

add aminoglycosides OR antipseudomonal FQ

consider anti fungal for septic shock

23
Q

if pt has MRSA: consider early addition of what drugs?

A

vanc, linezolid, or daptomycin

24
Q

if pt has VRE: consider early addition of what drugs?

A

early addition of linezolid or daptomycin

25
Q

if pt has ESBL: consider early addition of what drugs?

A

consider early use of carbapenem

26
Q

if pt has KPC producer: consider early addition of what drugs?

A

colistin in combo

or ceftazidime/avibactam

27
Q

when to add antifungal therapy to neutropenic patients?

A

when pts remains febrile with undocumented infection after 4 - 7 days of broad spec abx

28
Q

if pt has HSV/VZV — give what drug?

A

acyclovir

29
Q

if pt has CMV — give what drug?

A

ganciclovir

30
Q

what neutropenic people need antifungal prophylaxis

A

people getting allogenic HSCT (hematopoietic stem cell transplant)

pts undergoing intensive remission induction or salvage induction chemo for acute leukemia)

31
Q

when to do antiviral prophylaxis?

A

acyclovir prophylaxis in HSV seroPOSITIVE pts who are geting a HSCT or leukemia infuction therapy