Immunocompromised pt Flashcards
what are Abs produced by
plasma cells
structure and subtypes of antibodies
immunoglobulins (proteins)
5: GAMDE
where is IgA secreted
exocrine glands
where are t lymphocytes produced
thymus
cycle of activity of t cells
T lymphocytes –> activated –> lymphokines –> modulate activity of macrophages, mop up invasive cells (funghi, bacteria, viruses)
examples of these causes of immune deficiency; which is more common
a. congenital 2
b. acquired 4
a. congenital 2 RARE:-cyclic neuropenia
- wiskott-aldrich syndrome
b. acquired 4: corticosteroid therapy
- malignancy (leukaemia/ myeloma)
- chemotherapy/ bone marrow/ organ transplantation
- viral eg HIV
7 side effects of long term steroids
- predisposition to diabetes mellitus
- cushingoid appearance (moon face)
- inc risk of fungal infections
- hypertension
- osteoporosis
- adrenal suppression
- gastric ulceration
6 orodental problems associated with steroids
- hypotensive crisis
- underlying disease process
- candidal infection
- delayed healing
- osteoporosis
- avoid aspirin and NSAIDs (cause gastric ulceration)
what axis does steroid crisis affect
hypothalamic-pituitary-adrenocortical axis
what causes suppression of HPA axis and outcome of this
oral corticosteroids
–> hypoadrenal crisis –> shock, circulatory collapse
BDH recommendations for pts currently taking steroids or who have had steroids in the last 3 months
- under 10 mgs prednisolone daily –> fine
- > 10mgs predisolone daily –> consider inc steroid dose pre-op. for immediate tx, give 100mg hydrocortisone hemisuccinate iv prior to procedure
4 reasons people have chemo
- have had surgery to remove malignancy
- may have received radiotherapy too
- malignancy of haemopoeitic tissue (eg leukemia)
- prior to bone marrow transplant
3 side effects of chemo on bone marrow
- dec WBC (leukopenia, neutropenia
- dec platelets (thrombocytopenia)
- dec RBCs (anaemia)
which of these causes coagulation defect
thrombocytopenia
value of
a. normal platelet count
b. normal bleeding time
c. inc bleeding time that needs transfusion
d. platelet count that risks spontaneous bleeding
value of
a. normal platelet count:150-400x10^9
b. normal bleeding time: 100-150
c. inc bleeding time that needs transfusion: 20-100
d. platelet count that risks spontaneous bleeding:
6 oral side effects of chemo
- mucositis
- oral ulceration superimposed with opportunistic infections
- pseudomonas
- candida inc pseudomembranous (white plaques that rub off)
- herpes simplex (both sides)
- herpes zoster (travels down dermatome, stops at midline)
what to prescribe chemo pt who is pyrexic and neutropenic
1st line ABs: fluconazole/ itraconazole
anti virals: acyclovir
2 reasons prophylactic AB cover is needed in chemo pts
- pt neutropenic at time of tx
- tx likely to induce bacteraemia
detail antibiotic prophylaxis
- amoxycillin 3g
- if allergic to penicillin –> clindamycin 600mg orally 1 hr before procedure
- in hospital –> IV 1g amoxicillin or 300mg clindamycin
2 best times in chemo cycle to give dental tx and why
-just before chemo
-2-3 days after chemo
highest neutrophil count
3 most common anti-rejection drugs for transplant pts
cyclosporin
azathioprin
prednisolone
2 complication of cyclosporin and management
- hypersensitive to UV light –> skin malignancies
- gingival hyperplasia –>refer to hosp for surgical removal
est number of people living with HIV
34 million
number of new HIV infections in 2010
2.7 million
number of deaths due to aids in 2010
1.8million
area of the world with most HIV/aids
subsaharan africa
% of undiagnosed HIV
25-30%
cellular change in HIV
dec CD4 helper cells
classical progression of HIV
initial infection-3 months: seroconversion illness (flulike symptoms)
3 months-8-10yrs: asymptomatic, HIV antibody positive, gradually decreasing numbers of CD4 cells
8-10yrs +: AIDS symptoms, gradual decline, death
CD4 cell count
a. normal count
b. initial immune suppression
c. severe immunosuppression
CD4 cell count
a. normal count: >600
b. initial immune suppression: 400-600
c. severe immunosuppression:
risk group of HIV
any sexually active male or female
explain HAART and 2 examples of drug types
Highly Active Anti Retroviral Therapy: triple therapy using different drugs which target different parts of viral replication cycle
eg -nucleoside analogues
-protease inhibitors
what CD4 count is required for triple therapy
3 oro-facial manifestations of HIV
- cervical lymph node enlargement
- salivary gland enlargement
- skin disorders (molluscum contagiosum, dermatitis, papillomas)
intra oral manifestations of HIV 7
- candidosis
- hairy leukoplakia
- kaposis sarcoma
- apthous and viral ulcers (HAVE HALOS, apthous angel)
- periodontal disease –> ANUG
- papillomavirus infections
- non hodgkins lymphoma
what virus is hairy leukoplakia associated with
epstein barr virus
symptoms and tx of hairy leukoplakia
hairy tongue, tiger stripes on lateral borders systemic acyclovir (only works sometimes)
cause of kaposis sarcoma and common site
HHV8
palate (can progress to black lesions on palate)
who has kaposis sarcoma
HIV pts WITHOUT ACTIVE TX
Progression of periodontal disease in HIV / AIDs pts
linear gingival erythema
- -> necrotising ulcerative gingivitis
- -> necrotising ulcerative periodontitis (ANUG)
- -> cancrum oris (untreated HIV and malnutrition only)
bacterial cause of ANUG/ cancrum oris
fusiform bacteria: fusobacterium nucleatum, treponema vincentii
3 types of immunodeficiency
- B cell / humoral (affects antibody production)
- T cell / cell mediated
- mixed deficiency
