Infection Flashcards
What infections do neutrophils fight
Bacterial and fungal
What infections do monocytes fight
Fungal
What infections do eosinophils fight
Parasitic
What infections do T-lymphocytes fight
Fungal and viral
PJP
What infections do B-lymphocytes fight
Bacterial
How do you reduce risk of sepsis in haematological malignancy
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
What infection is a big problem in CLL
HSV
What Ax is given prophylactic
Ciprofloxacin
What anti-fungal is given prophylactic
Fluconazole
What anti-viral is given prophylactic
Acyclovir
What is given against PJP
Co-trimoxazole
What increases neutropenia risk
Bone marrow aplasia from chemo > immune
<0.5 = significant
<0.2 = high
>7 days = high
What are additional infection RF
Disrupted skin / mucosal surface Hickman line / venflons / catheter / mucositis / GVHD Mucosal inflammation Antibiotic resistance Lymphopenia Monocytopenia
What causes monocytopenia
Hairy cell leukopenia
Chemotherapy
Mycobacterium TB
What causes lymphopenia
Bone marrow failure Drugs - ATG / nucleoside analogue Stem cell transplant - allogenic GVHD RT
What are common gram +VE organism in febrile neutropenia
Come from skin Staphlococci MRSA / MSSA Strep viridans Strep pneumonia Enterococcus faecalis Corynebacterium
What are common gram-ve organisms in neutropenia
Come from gut E.coli Klebsiella Pseudomonas aeurigonsa Fungi - candida aspergillus and enterococci also
How does neutropenic sepsis present
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
What organisms are associated with fungal infection
Candida
Aspergillus
What do fungal infections present with
Fever that doesn’t settle after Ax = CT Abdo / chest / pelvis
Abscess in lung = most common
Confusion
Liver / brain / sinus
How does lympopenic sepsis present
Atypical pneumonia - PJP or CMV Shingles - VZV Mouth ulcers - HSV Adenovirus EBV - PTLD Fungal infection Atypical mycobacteria
What does PJP pneumonia look like
SOB no systemic or localising signs
Pulse oximetry drops on exercise
How do you treat sepsis
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
How do you investigate neutropenic fever
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
What antibiotics do you give
GIVE IMMEDIATE DO NOT WAIT FOR BLOOD Tazobactam Gentamicin - broad Vancomycin / Teicoplanin if gram +Ve Start alternative if still fever after 48 hours - Meropenem
What do you consider if no response
Fungal investigation
What do you do
HRCT
Give IV anti-fungal
When is G-CSF indicated
If high risk of neutropenia Elderly Specific malignancy - NHL Previous neutropenic episode Combination chemo and RT
When is prophylactic Ax used
Acute leukaemia, stem cell transplant or solid tumour in whom significant neutropenia is anticipated
