Infection

Question 1

What immune cells target bacterial infections?

Answer 1

Neutrophils

B lymphocytes

Question 2

What immune cells target fungal infections?

Answer 2

Neutrophils
Monocytes
T lymphocytes

Question 3

What immune cells target parasitic infections?

Answer 3

Eosinophils

Question 4

What immune cells target viral infection?

Answer 4

T lymphocytes

Question 5

What are the supportive measures aimed at reducing risk of sepsis in haematological malignancy?

Answer 5

Prophylaxis (antibiotics, anti fungal, antiviral, PJP)
Growth factors
Stem cell rescue/transplant
Protective environment (laminar flow rooms)
IV immunoglobulin replacement
Vaccination

Question 6

What factors influence neutropenic risk?

Answer 6

Cause of neutropenia
Degree of neutropenia
Duration of neutropenia

Question 7

What are the additional risk factors for infection?

Answer 7

Disrupted skin/mucosal surfaces (hickman line, venflons)
Altered flora/antibiotic resistance
Lymphopenia
Monocytopenia

Question 8

What gram-positive bacteria are mainly responsible for causing infections?

Answer 8

Staphylococci (MSSA,MRSA, coagulase negative)
Streptococci (viridans) 
Enterococcus faecalis/faecium 
Corynebacterium spp 
Bacillus spp

Question 9

What gram-negative bacteria are mainly responsible fro causing infections?

Answer 9

Escherichia coli 
Klebsiella spp (ESBL)
Pseudomonas aeruginosa 
Enterobacter spp 
Acinetobacter spp 
Citrobacter spp 
Stenotrophomonas maltophilia

Question 10

Where are the possible sites of infection?

Answer 10

Respiratory tract
Gastrointestinal (Typhlitis)
Dental sepsis 
Mouth ulcers 
Skin sores 
Exit site of central venous catheters  
Perianal (avoid PRs!)

Question 11

What fungi are mainly responsible for infection?

Answer 11

Candida species

Aspergillus

Question 12

Where are fungal infections commonly found?

Answer 12

Lung
Liver
Brain
Sinuses

Question 13

What is the presentation of neutropenic sepsis?

Answer 13

Fever with no localising signs 
Rigors 
Chest infection/pneumonia
Skin sepsis (cellulitis) 
Urinary tract infection 
Septic shock

Question 14

What action should be taken for sepsis?

Answer 14

Administer high flow oxygen 
Take blood cultures
Give appropriate antibiotics within 1 hour 
Measure serum lactate concentration 
Start IV fluid resuscitation 
Assess/measure urine output

Question 15

What investigations should be done for neutropenic shock?

Answer 15

History and examination
Blood cultures- Hickman line and peripheral
CXR
Throat swab and other sites of infection
Sputum if productive
FBC, renal and liver function, coagulation screen

Question 16

What is the management for neutropenic shock?

Answer 16

Resuscitation (ABC)
Broad spectrum antibiotic (gentamicin, tazocin)
if gram positive, add vancomycin or teicoplanin
If no response at 72hrs add IV anti fungal treatment
Chest/abdo/pelvis CT to look for source
Modify treatment based on culture results

Question 17

What lymphopenic patients are more at risk of infections?

Answer 17

Stem cell transplant recipients, especially allogeneic 
Recipients of total body irradiation 
Graft versus host disease (GVHD)
Lymphoid malignancy 
Nucleoside analogues or ATG

Question 18

What infections commonly cause atypical pneumonia in severely lymphopenic patients?

Answer 18

Pneumocystis Jirovecii (PJP)
CMV
RSV

Question 19

What are common viral infections in severely lymphopenic patients?

Answer 19

Shingles (varicella zoster)
Mouth ulcers (herpes simplex)
Adenovirus
EBV (PTLD)

Question 20

What are the features of an atypical mycobacteria?

Answer 20

Skin lesions

Pulmonary and hepatic involvement