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Haematology and Immunology > Infection > Flashcards

Infection Flashcards

1
Q

Neutrophils

A

Bacterial and fungal infection

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2
Q

Monocytes

A

Fungal infection

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3
Q

Eosinophils

A

Parasitic infection

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4
Q

T lymphocytes

A

Fungal and viral infection, PJP

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5
Q

B lymphocytes

A

Bacterial infection

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6
Q

Prophylaxis in reducing sepsis in haematological malignancy

A 
Antibiotics (ciprofloxacin) 
Anti-fungal (fluconazole or itraconazole)
Anti-viral (aciclovir)
PJP (co-trimoxazole)
IV immunoglobulin replacement (CML)
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7
Q

G-CSF

A

Reduces the length of time patients are neutropenic

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8
Q

Vaccination in CLL

A

Pneumococcus and H.influenza, shouldn’t give patients live vaccines.

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9
Q

Neutropenia occurs

A

From 7-10 days after chemotherapy, usually lasts for about a week

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10
Q

Neutropenic Risk is determined by

A

Cause of neutropenia
- marrow failure higher risk than immune destruction

Degree of neutropenia

  • <0.5 there is significant risk
  • <0.2 there is a high risk

Duration of neutropenia
->7 days results in high risk

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11
Q

Additional Risk factors for infection

A

Disrupted skin/mucosal surfaces

  • venflons, hickman line
  • mucositis affecting GI tract
  • GVHD

Altered flora/antibiotic resistance
- prophylactic antibiotics

Lymphopenia

  • disease process (lymphoma)
  • treatment (fludarabine, ATG)
  • stem cell transplantation, GVHD

Monocytopenia

  • hairy cell leukaemia
  • chemotherapy
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12
Q

Febrile neutropenia

A

Gram-positive bacteria (60-70%) associated with lines

Gram-negative bacilli (30-40%)

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13
Q

Gram + bacteria

A 
Staphylococci:	 MSSA,MRSA, coagulase negative
Streptococci : viridans 
Enterococcus faecalis/faecium 
Corynebacterium spp 
Bacillus spp
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14
Q

Gram - bacteria

A 
Escherichia coli 
Klebsiella spp : ESBL 
Pseudomonas aeruginosa 
Enterobacter spp 
Acinetobacter spp 
Citrobacter spp 
Stenotrophomonas maltophilia
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15
Q

Possible sites of infection

A 
Respiratory tract
Gastrointestinal (Typhlitis)
Dental sepsis 
Mouth ulcers 
Skin sores 
Exit site of central venous catheters  
Perianal (avoid PRs!)
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16
Q

Fungal infections in immunocompromised patients

A

Candida
Aspergillus

This is a deep seated infection which infects the lung, liver, sinuses and brain, this is severely dangerous.

Monocytopenia and monocyte dysfunction. Neutropenia contributes to the risk of fungal infection.

17
Q

Presentation of Neutropenic Sepsis

A 
Fever with no localising signs
Single reading of >38.50C or 380C on two readings one hour apart
Rigors
Chest infection/ pneumonia
Skin sepsis - cellulitis
Urinary tract infection
Septic shock
18
Q

Sepsis 6

A

Administer high flow oxygen

Take blood cultures, other cultures, consider source control

Give appropriate IV antibiotics within ONE hour

Measure serum lactate concentration

Start IV fluid resuscitation

Assess/measure urine output

19
Q

Investigation of neutropenic fever

A

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

20
Q

Management of Neutropenic Sepsis

A

Broad spectrum I.V. antibiotics
- Tazocin and Gentamicin

If a gram positive organism is identified add vancomycin or teicoplanin

If no response at 72 hours add I.V. antifungal treatment e.g. Caspofungin - empiric therapy

CT chest/abdo/pelvis to look for source

Modify treatment based on culture results

21
Q

Severely lymphopenic patients

A

Stem cell transplant recipients, especially allogeneic
Recipients of Total Body Irradiation (TBI)
Graft vs Host disease
Nucleoside analogues (fludarabine) or ATG
Lymphoid malignancy e.g Lymphoma, CLL, ALL

22
Q

Infections that occur in severely lymphopenic patients

A

Atypical pneumonia

  • Pneumocystis Jirovecii (PJP)
  • CMV
  • RSV

Viral

  • Shingles (Varicella Zoster)
  • Mouth ulcers (Herpes simplex)
  • Adenovirus
  • EBV (PTLD)

Fungal
-candida, aspergillous, mucormycosis

Atypical mycobacteria
-skin lesions, pulmonary and hepatic involvement

Haematology and Immunology (20 decks)

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