Infection Flashcards
What neutrophils deal with
Bacteria + fungus
What do monocytes deal with
Fungus
What do eosinophils deal with
Parasites
What do T-cells deal with
Fungus + viruses + PJP
What do B-cells deal with
Bacteria
What antibiotic + anti-fungal prophylaxis is given to reduce the risk of sepsis in haematological malignancy
- Ciprofloxacin (antibiotic)
- Fluconazole (anti-fungal)
What anti-viral+ PJP prophylaxis is given to reduce the risk of sepsis in haematological malignancy
- Aciclovir (anti-viral)
- Co-trimoxazole
5 supportive measures that reduce the risk of sepsis in haematological malignancy (not prophylactic therapy)
- Stem cell rescure/transplant
- Protective enviroment (laminar flow rooms)
- IV immunoglobulin replacement
- Vaccination
- Growth factors (G-CSF)
(and prophylactic therapy)
What 3 components of neutropenia are important when determing the risk of sepsis
- Cause of neutropenia (marrow failure > risk than immune destruction)
- Degree of neutropenia (ie how low is the count)
- Duration of neutropenia (>7days = high risk)
Bacterial causes of febrile neutropenia
- Gram +ve (70%)
- Gram -ve bacilli (30%)
2 gram +ve bacteria
- Staph (MRSA)
- Streptococci (viridans)
2 gram -ve bacteria
- E. coli
- Pseudomonas aeruginosa
If a perianal infection site is suspected what is contraindicated
PRs
What contribute to the risk of a fungal infection
Monocytopenia/monocyte dysfunction
2 organisms associated with fungal infections
- Candida species (albicans?)
- Aspergillus
How does neutropenic sepsis present
-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
Define sever sepsis/septic shock
Signs of systemic inflammation + Presumued infection and organ dysfunction
Describe the sepsis 6
Take 3 give 3
- High flow O2
- IV fluid resuscitation
- IV antibiotics within ONE HOUR
- Blood cultures
- Serum lactate
- Measure urine output
A 1 hour delay in the appropriate antibiotics results in what
Increase of 8% in mortality
Investigations of neutropenic fever
- Blood cultures
- CXR
- Throat swab + other clinical sites of infection
- Sputum (if productive)
- FBC
- U&Es + creatinine (eGFR?)
- LFTs
- Coagulation screen
Management of neutropenic sepsis
- 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
In neutropenic sepsis, if a gram +ve organism is identified what should be added to the Rx
Vancomycin or Teicoplanin
Causes of severe lymphopenia
- Stem cell transplant (esp. allogenic)
- Total body irradiation (TBI)
- Graft vs Host disease
- Lymphoid malignancy (lymphoma, CLL, ALL)
- Nucleoside analogues (fludarabine)
What kind of pneumonia + viral infections do you get in severe lymphopenia
-Atypical pneumonia (PJP, CMV)
Viral
- Shingles (varicella zoster virus)
- Mouth ulcers (HSV)
- Adenovirus
What kind of fungal + mycobacterua infections do you get in severe lymphopenia
Fungal
-Candida or Aspergillus
Atypical mycobacteria
-Skin lesions, pulmonary and hepatic involvement
