Infection Flashcards
What infections do each of the following cells fight:
- Neutrophils
- Monocytes
- Eosinophils
- T lymphocytes
- B lymphocytes
- Neutrophils - bacterial and fungal infections
- Monocytes - fungal infections
- Eosinophils - parasitic infections
- T lymphocytes - fungal, viral infection,
- B lymphocytes - bacterla infections
What are the prophylactic measures to prevent sepsis in Haem. malignancy?
- Antibiotics (ciprofloxacin)
- Anti-fungals (fluconazole)
- Anti-virals (aciclovir) - against HSV
- PJP - pneumocysitis jirovecii ??
Apart from prophylaxis what are the supportive measures aimed at reducing sepsis in haem. malignancy.
- Growth factors - G-CSF
- Stem cell rescue/ transplants
- Protective environment
- IV immunoglobulin replacement
- Vaccination - never live vaccinations though
What are the different aspcets of neutropenic risk?
-
Cause of neutropenia
- marrow failure higher risk than immune destruction
- cytotoxic chemotherapy
-
Degree of neutropenia
- <0.5 - significant risk
- <0.2 - high risk
-
Duration of neutropenia
- >7 days - high risk
- AML therapy and stem cell transplant produces profound neutropenia ~14-21 days)
- >7 days - high risk
What are some of the additional reisk factors for infection patinets can be exposed to?
- Disrupted skin/mucosal surfaces
- Hickman lines/ venflon
- Mucositis affecting GI tract
- Altered flora/AntiB Resistance
- propylatics antibiotics
- Lymphopenia
- Disease processes - eg lymphoma
- Treatment
- Stem cell transplant, GVHD (Graft v host)
- Monocytopenia
- Chemotherapy
What are the more common division of bacteria which cause infection in haem malignancy?
- Gram positive - 69-70% - these come from skin
- Gram-negative bacilli (30-40%) – Gut flora
Infection patterns relate to antibiotics prop, use of lines etc.
Important Gram-positive bacteria
- Staph - MRSA, MSSA,
- Stept. - viridans
- E. faecalis
Important gram-negatiev bacteria
- E. Coli
- Klebsiella
- Pseudomonas aeruginosa
What are the possible sites of infection in these patients?
- Respiratory tract
- Gastrointestinal (Typhlitis)
- Dental sepsis
- Mouth ulcers
- Skin sores
- Exit site of central venous catheters
- Perianal (avoid PRs!)
What are the common fungal infections in these patients?
Candida species
Aspergillus
These are often deep-seated and life-threatening.
With the lung liver, sinuses and brain the commonly affected sites.
Monocytopenia and monocyte dysfunction contributes to risk of fungal infection.
What is the 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
Outline the sepsis six.
- 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
What are the investigations of choice in neutropenic sepsis?
- H & E
- Blood cultures - hickamn line & peripheral
- CXR
- Throat swab & other clinical sites of infection
- Sputum culture if productive
- FBC, renal and liver function, coagulation screen.
What is the management of neutropenic sepsis?
- Resuscitation - ABC
- Broad spectrum IV antibiotics (gentamicin)
- If gram + identified give - vancomycin and teicoplanin
- If no response at 72 hours
- Add antifungal
- CT chest/abdo/pelvis loking for source
- mod treatment depending on culture results.
What are some of the causes of lymphopenia?
- Stem cell transplant recipients
- esp. allogenic
- Recipients of Total Body Irradiation (TBI)
- Graft V Host Disease
- Nucleoside Analogues
- Lymphoid Malignancy
