Infection

Question 1

What infections do neutrophils fight

Answer 1

Bacterial and fungal

Question 2

What infections do monocytes fight

Answer 2

Fungal

Question 3

What infections do eosinophils fight

Answer 3

Parasitic

Question 4

What infections do T-lymphocytes fight

Answer 4

Fungal and viral

PJP

Question 5

What infections do B-lymphocytes fight

Answer 5

Bacterial

Question 6

How do you reduce risk of sepsis in haematological malignancy

Answer 6

Prophylactic antibiotics, viral and fungals
Growth factors e.g. G-CSF - used to increase neutrophil count
Stem cell rescue / transplant
Protective environment
IV Ig replacemenet
Vaccination but never live

Question 7

What infection is a big problem in CLL

Answer 7

HSV

Question 8

What Ax is given prophylactic

Answer 8

Ciprofloxacin

Question 9

What anti-fungal is given prophylactic

Answer 9

Fluconazole

Question 10

What anti-viral is given prophylactic

Answer 10

Acyclovir

Question 11

What is given against PJP

Answer 11

Co-trimoxazole

Question 12

What increases neutropenia risk

Answer 12

Bone marrow aplasia from chemo > immune
<0.5 = significant
<0.2 = high
>7 days = high

Question 13

What are additional infection RF

Answer 13

Disrupted skin / mucosal surface 
Hickman line / venflons / catheter / mucositis / GVHD 
Mucosal inflammation 
Antibiotic resistance 
Lymphopenia 
Monocytopenia

Question 14

What causes monocytopenia

Answer 14

Hairy cell leukopenia
Chemotherapy
Mycobacterium TB

Question 15

What causes lymphopenia

Answer 15

Bone marrow failure 
Drugs - ATG / nucleoside analogue 
Stem cell transplant - allogenic 
GVHD 
RT

Question 16

What are common gram +VE organism in febrile neutropenia

Answer 16

Come from skin
Staphlococci
MRSA / MSSA
Strep viridans
Strep pneumonia 
Enterococcus faecalis
Corynebacterium

Question 17

What are common gram-ve organisms in neutropenia

Answer 17

Come from gut 
E.coli
Klebsiella
Pseudomonas aeurigonsa
Fungi - candida aspergillus and enterococci also

Question 18

How does neutropenic sepsis present

Answer 18

Usually 7-14 days after chemo 
Fever with no localising sign
>38.5 = Dx or two readings >38 = treat 
Rigors
CHest infection
Pneumonia
Skin sepsis 
Cellulitis
UTI
Septic shock - tachy, tachypnoea, hypo, prolonged cap refil, reduced UO, metabolic acidosis

Question 19

What organisms are associated with fungal infection

Answer 19

Candida

Aspergillus

Question 20

What do fungal infections present with

Answer 20

Fever that doesn’t settle after Ax = CT Abdo / chest / pelvis
Abscess in lung = most common
Confusion
Liver / brain / sinus

Question 21

How does lympopenic sepsis present

Answer 21

Atypical pneumonia - PJP or CMV
Shingles - VZV
Mouth ulcers - HSV
Adenovirus 
EBV - PTLD 
Fungal infection 
Atypical mycobacteria

Question 22

What does PJP pneumonia look like

Answer 22

SOB no systemic or localising signs

Pulse oximetry drops on exercise

Question 23

How do you treat sepsis

Answer 23

SEPSIS 6
High flow O2
Blood culture
IV AX in 1 hour
Serum lactate
IV fluid resus
Assess urine output
May need inotropes and PICU

Question 24

How do you investigate neutropenic fever

Answer 24

History and exam
Blood culture - Hickman line and peripheral 
CXR 
Throat swab / other sites
Sputum  
FBC 
Renal function 
Coagulation screen - DIC
Lactate 
CT
Viral PCR
Urine

Question 25

What antibiotics do you give

Answer 25

GIVE IMMEDIATE DO NOT WAIT FOR BLOOD 
Tazobactam
Gentamicin - broad 
Vancomycin / Teicoplanin if gram +Ve
Start alternative if still fever after 48 hours - Meropenem

Question 26

What do you consider if no response

Answer 26

Fungal investigation

Question 27

What do you do

Answer 27

HRCT

Give IV anti-fungal

Question 28

When is G-CSF indicated

Answer 28

If high risk of neutropenia
Elderly
Specific malignancy - NHL
Previous neutropenic episode
Combination chemo and RT

Question 29

When is prophylactic Ax used

Answer 29

Acute leukaemia, stem cell transplant or solid tumour in whom significant neutropenia is anticipated