Infection

Question 1

What type of infection do neutrophils fight?

Answer 1

Bacterial and fungal

Question 2

What type of infection do monocytes fight?

Answer 2

Fungal infection

Question 3

What type of infection do eosinophils fight?

Answer 3

Parasitic infections

Question 4

What type of infection do T lymphocytes fight?

Answer 4

Fungal
viral
PJP

Question 5

What type of infection do B lymphocytes fight?

Answer 5

Bacterial infection

Question 6

Supportive measures aimed at reducing the risk of sepsis in haematological malignancy

Answer 6

Prophylaxis 
- antibiotics (ciprofloxacin)
- anti fungal (fluconazole)
- anti viral (aciclovir)
- PJP ( co - trimoxazole) 
Growth factors e.g. G-CSF
Stem cell rescue / transplant 
Protective environmental e.g. laminar flow rooms
IV immunoglobulin replacement
Vaccination

Question 7

Neutropenic risk is based on…..

Answer 7

Causes of neutropenia 
- Marrow failure higher risk than immune destruction 
Degree of neutropenia 
- < 0.5 x10 9/L = significant risk 
- < 0.2 x10 9/L = high risk 
Duration of neutropenia
- > 7 = high risk 
- AML therapy and stem cell transplantation produce profound neutropenia approx. 14-21 days

Question 8

Additional risk factors for infection

Answer 8

Disrupted skin / mucosal surfaces 
- hickman line, venflons 
- mucositis affecting GI tract 
- GVHD
Altered flora / antibiotic resistance 
- prophylactic antibiotics
Lymphopenia 
- disease process e.g. lymphoma 
Monocytopenia 
- hairy cell leukaemia 
- chemotherapy

Question 9

Bacterial causes of febrile neutropenia

Answer 9

Gram + ve 60-70% 
- staphylococcal ; MSSA, MRSA
- streptococci 
Gram -ve 
- E coli 
- Pseudonomas aerugonisa 
- Enterobacter

Question 10

Possible sites of infection

Answer 10

Resp tract 
GI (typhilitis)
Dental sepsis
Mouth ulcers
Skin sores
Exit site of central venous catheters
Perianal (avoid PRs)

Question 11

What contributes to risks of fungal infection?

Answer 11

Monocytopenia and monocyte dysfunction

Question 12

Presentation of neutropenic sepsis

Answer 12

FEVER WITH NO LOCALISING SIGNS 
Rigors
Chest infection / pneumonia
Skin sepsis - cellulitis 
UTI
Septic shock

Question 13

The Sepsis 6

Answer 13

High flow O2
Blood cultures
IV Ax within 1 HOUR
Serum  lactate 
Start IV fluids 
Assess measure urine output

Question 14

What indicates severe sepsis / septic shock?

Answer 14

Signs of SIRS + presumed infection and organ dysfunction

Question 15

investigations of neutropenic fever

Answer 15

History and exam 
Blood cultures
- hickman line
- peripheral 
CXR
Throat swab and other clinical sites of infection 
Sputum if productive
FBC, renal and liver dysfunction , coagulation screen

Question 16

Management of neutropenic sepsis

Answer 16

Resus - ABC
Broad spectrum IV Antibiotics - tazocin and gentamicin
- if gram -ve add vancomycin or teicoplanin
If no response at 72 hours add IV antifungal treatment e.g. caprofungin
CT chest / abdo / pelvis to look for source

Question 17

Causes of infection in severely lymphopenic patients

Answer 17

Atypical pneumonia
- PJP
- CMV
- RSV 
Viral 
- Shingles
- mouth ulcers (HSV)
- Adenovirus 
- EBV (PTLD)
Fungal 
- candida
- aspergillus
Atypical mycobacteria
- skin lesions
- pulmonary and hepatic involvement

Question 18

Causes of severely lymphopenic patients

Answer 18

Stem cell transplant recipients, especially allogenic
Recipients of total body irritdation (TBI)
Graft vs host disease
Nucleoside analogues or ATG
Lymphoid malignancy e.g. lymphoma, CLL, ALL