Immunosuppression and infections

Question 1

Cryptococcus post liver transplant-

Answer 1

amphotericin B

and do an LP

Question 2

CMV post liver transplant-

Answer 2

ganciclovir

Question 3

Candidal infection post liver transplant-

Answer 3

As a general rule, if candidal species grow from 2 or more sites, even if not from blood (eg, urine, wound), the condition should be managed as a systemic infection.

Traditional treatment for systemic candidiasis has been intravenous amphotericin B. Amphotericin must be administered intravenously and has synergistic renal toxicity with cyclosporine.

Ketoconazole is avoided because it can cause a dramatic increase in cyclosporine levels and may be hepatotoxic.

Question 4

Aspergillos isinfection post liver transplant-

Answer 4

Voriconazole
or
Amphotericin B

Question 5

Legionella and pneumocystis infection post liver transplant:

Answer 5

o pulmonary infiltrate of unknown etiology erythromycin (1 g IV q6h) forLegionellainfections + trimethoprim-sulfamethoxazole forPCP
o commonly manifest as dyspnoea and hypoxemia before the chest radiographs show a significant infiltrate.

Question 6

Strongyloides stercoralis: what is the source?

Answer 6

Moist faecally contaminated soil with INTACT ckin

Question 7

What does strongyloides look like clinically?

Answer 7

Diarrhoea, abdominal pain, rash urticarial

Hyperinfection in immunocompromised

Question 8

How do you treat strongyloides?

Answer 8

Ivermectin or albendazole

Question 9

Thalassaemia predisposes to what infection?

Answer 9

Yersinia enterocolitica

Looks like acute abdomen
Happens in other iron overloaded people, people getting chelated

Question 10

Candida sepsis?

Answer 10

anidulafungin or caspofungin

If stable, non neutropaenic, no azole exposure- can give fluconazole

Question 11

EBV acute infection serology

Answer 11

VCA IgM positive (1-3 months)
VCA IgG positive (stays for life)
EBNA IgG not positive until at least a month so excludes acute infection. Stays positive for life