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HD > Immunology 16: Immunocompromised Host > Flashcards

Immunology 16: Immunocompromised Host Flashcards

1
Q

Definition: a state in which a person’s immune system is weakened or absent.

A

Immunocompromised host.

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2
Q

Definition: people with one or more defects in their defense against microbial invaders?

A

Compromised hosts.

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3
Q

What happens to immunocompromised hosts?

A

1- suffer severe or life threatening infections.
2- they are also more prone to getting opportunistic infections.

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4
Q

List the 2 factors that make a host compromised?

A

1- defects in innate immunity: A- primary defects (congenital). B- secondary defects.
2- defects in adaptive immunity: A- primary defects (congenital). B- secondary defects.

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5
Q

List primary defects in innate immunity?

A

1- congenital defects in phagocytic cells.
2- inherited complement deficiencies.

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6
Q

What happens in congenital defects in phagocytic cells? And give examples?

A
  • Repeated pyogenic infections e.g. S.aureus.
  • examples: chronic granulomatous disease (phagocytes cannot produce bactericidal O2 radicals), Chediak Hegashi syndrome (inability of phagosome and lysosome fusion and proteinase deficiency).
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7
Q

What happens in inherited complement deficiencies?

A

Repeated pyogenic infections. Neisseria infections.

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8
Q

List secondary defects in innate immunity?

A

1- disruption of body mechanical barriers.
2- defective phagocytic functions.

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9
Q

List types of disruption of body mechanical barriers due to secondary defects in innate immunity? And give examples

A

1- skin damage by burns, trauma, surgery etc.
- P.aeruginosa infection in burns.
- S.aureus and gram-negative infections in wound.
2- mucosa damage by instrumentation.
3- devices (catheters, prostheses, shunts) > allow organisms to bypass defenses and enter sterile sites, eg. S.epidermidis infection.

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10
Q

Give an example of defective phagocytic functions due to secondary defects in innate immunity?

A

Diabetes mellitus.

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11
Q

List primary defects in adaptive immunity?

A

1- congenital B cell deficiencies.
2- congenital T cell deficiencies.
3- congenital B & T cells deficiencies.

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12
Q

Give examples of congenital B cell deficiencies due to primary defects in adaptive immunity?

A
  • Bruton’s diseases > pyogenic infections.
  • IgA deficiency > sinus and lung infections.
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13
Q

Give examples of congenital T cell deficiencies due to primary defects in adaptive immunity?

A
  • DiGeorge syndrome > viral, fungal, protozoal infections.
  • chronic mucocutaneous candidiasis > widespread candidal infection.
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14
Q

Give examples of congenital B & T cell deficiencies due to primary defects in adaptive immunity?

A

Severe combined immunodeficiency (SCID) > repeated bacterial (pyogenic), fungal, viral, and protozoal infections.

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15
Q

List secondary defects in adaptive immunity?

A

1- malnutrition (protein deficiency).
2- infections (HIV).
3- neoplasia (nutritional competition between normal and cancerous cells).
4- medical treatment: organ transplant, immunosuppressant therapy, radiotherapy affects proliferation of T cells.
5- splenectomy (impaired humoral responses): severe infections with capsulated bacteria.

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16
Q

List opportunistic pathogens caused by fungi (list the micro-organism, and disease)?

A

Fungi opportunistic infections.
Micro-organism: cryptococcus neoformans
Disease: meningitis, pneumonia (one of the AIDS defining illness).

Micro-organism: pneumocystis jerovecii.
Disease: severe pneumonia (important in AIDS patients).

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17
Q

List opportunistic pathogens caused by parasites (list the micro-organism, and disease)?

A

Parasitic opportunistic infections.
Micro-organism: toxoplasma gondii.
Disease: retinitis, encephalitis, pneumonia (important in AIDS patients).

Micro-organism: cryptosporidium parvum.
Disease: diarrhea in AIDS patients.

Micro-organism: isospora belli.
Disease: diarrhea in AIDS patients.

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18
Q

List opportunistic pathogens caused by others (list the micro-organism, and disease)?

A

Other opportunistic infections.
Micro-organism: mycobacterium avium.
Disease: severe diarrhea and pneumonia in AIDS patients.

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19
Q

List the 2 ways infection can transmit in immunocompromised host? And give examples?

A

1- Endogenous infections: patients own microbial flora.
2- Exogenous infections: infection enters the body through any of the exogenous routes (respiratory, feco-oral, sexual, contact).

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20
Q

List 4 specific immunocompromised conditions?

A

1- severe immunocompromise (non-HIV).
2- severe immunocompromise due to symptomatic HIV AIDS.
3- severe immunocompromise due to asymptomatic HIV AIDS.
4- chronic diseases with limited immune deficits.

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21
Q

List 7 severe immunocompromised (Non-HIV)?

A

1- congenital immunodeficiency.
2- active leukemia.
3- lymphoma.
4- solid organ transplant or bone marrow transplant within 2 years of transplantation; or persons whose transplants are of longer duration but who are still taking immunosuppressive drugs.
5- generalized malignancy.
6- aplastic anemia.
7- graft versus host disease.

22
Q

What happens in severe immunocompromise due to Symptomatic HIV AIDS?

A
  • HIV-infected person with CD4 counts lower than 200 cells/mm3.
  • history of an AIDS-defining illness, or
  • clinical manifestations of symptomatic HIV.
23
Q

What happens in severe immunocompromise due to Asymptomatic HIV AIDS?

A

Asymptomatic HIV-infected persons with CD4 counts from 200 to 500 cells/mm3.
The CD4 count of an uninfected adult/adolescent who is generally in good health ranges from 500 cells/mm3 to 1,600 cells/mm3.

24
Q

List chronic diseases with limited immune deficits?

A

Asplenia, chronic renal disease, chronic hepatic disease (cirrhosis and alcoholism), diabetes, and nutritional deficiencies.

25
Q

List laboratory diagnosis of bacterial infections in immunocompromised patients?

A

1- microscopy: gram stain.
2- cultural and sensitivity.
3- serology (Antigen/antibody detection).
4- PCR.

26
Q

List laboratory diagnosis of viral infections in immunocompromised patients?

A

1- serology.
2- PCR, RT-PCR.
3- viral cultures.

27
Q

List laboratory diagnosis of fungi infections in immunocompromised patients?

A

1- fungal cultures on saboraud agar.
2- microscopy: lactophenol blue stain and India ink (cryptococcus neoformans).

28
Q

List laboratory diagnosis of parasite infections in immunocompromised patients?

A

1- serology (toxoplasma).
2- modified acid fast stain (cryptosporidium parvum).

29
Q

List 4 ways prevention of infections in immunocompromised hosts?

A

1- immunization.
2- chemoprophylaxis.
3- personal hygiene.
4- transmission prevention.

30
Q

List live vaccines contraindications?

A

Not recommeneded in:
- severely immunocompromised.
- uncertain immune status.

31
Q

List types of immunization in patients with antibody defects (B cell defects)?

A

1- protected from infections by IV Ig.
2- vaccines which may be given: pneumococcal, meningococcal, Hib, annual influenza, NMR/Varicella.
3- all other LIVE vaccines CONTRAINDICATED.

32
Q

List types of immunization in patients with T-cell, NK, mixed cell mediated antibody defects?

A

1- ALL LIVE vaccines CONTRAINDICATED.
2- yearly influenza recommended.

33
Q

List types of immunization in patients with phagocytic defects?

A

1- LIVE vaccines are CONTRAINDICATED.
2- yearly influenza vaccines recommended.
3- NMR may be given.

34
Q

List types of immunization in patients with patients receiving high dose steroids?

A

1- wait at least 1 month after discontinuation of corticosteroids therapy before administering a live-virus vaccine.

35
Q

List types of immunization in patients with immunocompromised oncology patients?

A

1- LIVE vaccines generally AVOIDED.
2- leukemia patients in remission may receive live virus vaccines 3 months after their last round of chemotherapy.
3- VZV INDICATED for children with ALL (in remission for at least 1 year, lymphocyte counts > 700 cells/mL, platelet counts > 100,000 cells/mL 24 hours before the immunization.

36
Q

List types of immunization in patients with chronic renal disease undergoing dialysis?

A

1- all standard immunization REQUIRED.
2- protection against; varicella, hepatitis B, influenza, pneumococcal infection.
3- yearly influenza immunization.

37
Q

List types of immunization in patients with chronic liver disease?

A

1- hepatitis A and B vaccines.
2- should be done yearly.

38
Q

List types of immunization in patients with transplant recipients?

A

1- vaccinate at least 2 WEEKS BEFORE transplantation.
2- LIVE vaccines are POSTPONED once transplant has been performed.
3- all inactivated vaccines RECOMMENDED plus those vaccines recommended for patients with chronic diseases.
4- household contacts should also be immunized.
5- post renal transplantation, immunization may not be effective for 6 to 8 months.
6- prophylactic antibiotic and antivirals can severe as valuable adjuncts.

39
Q

List types of immunization in patients with asplenic patients?

A

1- NO contraindication for any vaccines.
2- elective splenectomy immunized at least 2 weeks before operation.
3- emergency splenectomy, patients should receive the vaccines soon after acute recovery.

40
Q

List types of immunization in patients with bone marrow transplant (BMT) patients?

A

MMR: 24 months after BMT.
Influenza: 6 months after BMT and then annually.

41
Q

List types of immunization in patients with persons with chronic lymphocytic leukemia?

A

Poor humoral immunity.
Rarely respond to vaccines.

42
Q

List types of immunization in patients with household contacts?

A

May be given live-virus vaccines.
Yellow fever, MMR, or varicella vaccine.
Not: live intranasal influenza vaccine.

43
Q

List 4 chemoprophylaxis?

A

1- low risk.
2- high risk.
3- colony stimulating factors (G-CSF, GM-CSF).
4- prophylaxis for pneumocystis carinii.

44
Q

What is low risk chemoprophylaxis?

A

Antibacterial, antifungal, antiviral NOT routinely recommended.

45
Q

What is high risk chemoprophylaxis?

A

Antibacterial, antifungal, antiviral are RECOMMENDED.

46
Q

What is colony stimulating factors (G-CSF, GM-CSF) chemoprophylaxis?

A

Should not be administered alone, used as adjuncts to empiric antibiotics.

47
Q

What is pneumocystis carinii chemoprophylaxis?

A

Mandatory for patients with cancer and for those who are receiving glucocorticoid containing chemotherapy regimen.

48
Q

How is personal hygiene achieved?

A

1- elimination of sources of infection, mouth, throat, skin.
2- hand hygiene, is the best prevention against gastroenteritis.
3- education.

49
Q

List 5 ways of transmission prevention?

A

1- clean environmental: avoid dusty areas, crowds, sick people.
2- keep mouth and rectal areas clean after chemotherapy.
3- avoid raw or undercooked seafood or meat, unpasteurized milk and dairy products (containing as few germs as possible).
4- good nutrition: well balanced diet adapted to patient needs.
5- medical equipment must be disinfected before being taken in patient room.

50
Q

What of the following is considered as endogenous infection?
A. Patient own microbial flora
B. Sexual Interaction
C. Feco-oral route
D. Respiratory route

A

A. Patient own microbial flora.

51
Q

Distruption of body mechanical barriers belong to which catogory?
A. Primary defects in innate immunity
B. Secondary defect in innate immunity
C. Primary defect in adaptive immunity
D. Secondary defect in adaptive immunity

A

B. Secondary defect in innate immunity.

52
Q

Severe Immunocompromise due to symptomatic HIV AIDS have CD4 counts between:
A. 0 to 200 cells/mm3
B. 200 to 400 cells/mm3
C. 400 to 600 cells/mm3
D. 600 to 800 cells/mm3

A

A. 0 - 200

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