Infection

Question 1

What neutrophils deal with

Answer 1

Bacteria + fungus

Question 2

What do monocytes deal with

Answer 2

Fungus

Question 3

What do eosinophils deal with

Answer 3

Parasites

Question 4

What do T-cells deal with

Answer 4

Fungus + viruses + PJP

Question 5

What do B-cells deal with

Answer 5

Bacteria

Question 6

What antibiotic + anti-fungal prophylaxis is given to reduce the risk of sepsis in haematological malignancy

Answer 6

• Ciprofloxacin (antibiotic)

- Fluconazole (anti-fungal)

Question 7

What anti-viral+ PJP prophylaxis is given to reduce the risk of sepsis in haematological malignancy

Answer 7

• Aciclovir (anti-viral)

- Co-trimoxazole

Question 8

5 supportive measures that reduce the risk of sepsis in haematological malignancy (not prophylactic therapy)

Answer 8

• Stem cell rescure/transplant
• Protective enviroment (laminar flow rooms)
• IV immunoglobulin replacement
• Vaccination
• Growth factors (G-CSF)

(and prophylactic therapy)

Question 9

What 3 components of neutropenia are important when determing the risk of sepsis

Answer 9

• Cause of neutropenia (marrow failure > risk than immune destruction)
• Degree of neutropenia (ie how low is the count)
• Duration of neutropenia (>7days = high risk)

Question 10

Bacterial causes of febrile neutropenia

Answer 10

• Gram +ve (70%)

- Gram -ve bacilli (30%)

Question 11

2 gram +ve bacteria

Answer 11

• Staph (MRSA)

- Streptococci (viridans)

Question 12

2 gram -ve bacteria

Answer 12

• E. coli

- Pseudomonas aeruginosa

Question 13

If a perianal infection site is suspected what is contraindicated

Answer 13

PRs

Question 14

What contribute to the risk of a fungal infection

Answer 14

Monocytopenia/monocyte dysfunction

Question 15

2 organisms associated with fungal infections

Answer 15

• Candida species (albicans?)

- Aspergillus

Question 16

How does neutropenic sepsis present

Answer 16

-FEVER WITH NO LOCALISING SIGNS
(single reading of >38.5 or 2 or 38 an hour apart)
-Rigors 
-Chest infection/pneumonia
-Skin sepsis (cellulitis)
-UTI
-Septic shock

Question 17

Define sever sepsis/septic shock

Answer 17

Signs of systemic inflammation + Presumued infection and organ dysfunction

Question 18

Describe the sepsis 6

Answer 18

Take 3 give 3

• High flow O2
• IV fluid resuscitation
• IV antibiotics within ONE HOUR
• Blood cultures
• Serum lactate
• Measure urine output

Question 19

A 1 hour delay in the appropriate antibiotics results in what

Answer 19

Increase of 8% in mortality

Question 20

Investigations of neutropenic fever

Answer 20

• Blood cultures
• CXR
• Throat swab + other clinical sites of infection
• Sputum (if productive)
• FBC
• U&Es + creatinine (eGFR?)
• LFTs
• Coagulation screen

Question 21

Management of neutropenic sepsis

Answer 21

• Broad spectrum IV antibiotics (Gentamicin + Tazocin)
• If no response in 72hrs add IV antifungal (Caspofungin)
• CT chest/abdo/pelvis to find source
• Modify Rx based on culture results

Question 22

In neutropenic sepsis, if a gram +ve organism is identified what should be added to the Rx

Answer 22

Vancomycin or Teicoplanin

Question 23

Causes of severe lymphopenia

Answer 23

• Stem cell transplant (esp. allogenic)
• Total body irradiation (TBI)
• Graft vs Host disease
• Lymphoid malignancy (lymphoma, CLL, ALL)
• Nucleoside analogues (fludarabine)

Question 24

What kind of pneumonia + viral infections do you get in severe lymphopenia

Answer 24

-Atypical pneumonia (PJP, CMV)

Viral

• Shingles (varicella zoster virus)
• Mouth ulcers (HSV)
• Adenovirus

Question 25

What kind of fungal + mycobacterua infections do you get in severe lymphopenia

Answer 25

Fungal
-Candida or Aspergillus

Atypical mycobacteria
-Skin lesions, pulmonary and hepatic involvement