Infection Flashcards
Neutrophils
Bacterial and fungal infection
Monocytes
Fungal infection
Eosinophils
Parasitic infection
T lymphocytes
Fungal and viral infection, PJP
B lymphocytes
Bacterial infection
Prophylaxis in reducing sepsis in haematological malignancy
Antibiotics (ciprofloxacin) Anti-fungal (fluconazole or itraconazole) Anti-viral (aciclovir) PJP (co-trimoxazole) IV immunoglobulin replacement (CML)
G-CSF
Reduces the length of time patients are neutropenic
Vaccination in CLL
Pneumococcus and H.influenza, shouldn’t give patients live vaccines.
Neutropenia occurs
From 7-10 days after chemotherapy, usually lasts for about a week
Neutropenic Risk is determined by
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
Additional Risk factors for infection
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
Febrile neutropenia
Gram-positive bacteria (60-70%) associated with lines
Gram-negative bacilli (30-40%)
Gram + bacteria
Staphylococci: MSSA,MRSA, coagulase negative Streptococci : viridans Enterococcus faecalis/faecium Corynebacterium spp Bacillus spp
Gram - bacteria
Escherichia coli Klebsiella spp : ESBL Pseudomonas aeruginosa Enterobacter spp Acinetobacter spp Citrobacter spp Stenotrophomonas maltophilia
Possible sites of infection
Respiratory tract Gastrointestinal (Typhlitis) Dental sepsis Mouth ulcers Skin sores Exit site of central venous catheters Perianal (avoid PRs!)
Fungal infections in immunocompromised patients
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.
Presentation of Neutropenic Sepsis
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
Sepsis 6
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
Investigation of neutropenic fever
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
Management of Neutropenic Sepsis
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
Severely lymphopenic patients
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
Infections that occur in severely lymphopenic patients
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
