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A Haematology and Immunology > Infection > Flashcards

Infection Flashcards

1
Q

What type of infections do neutrophils play a role in?

A
  • Bacterial
  • Fungal
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2
Q

What type of infections do monocytes play a role in?

A

Fungal

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3
Q

What type of infections do eosinophils play a role in?

A

Parasitic

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4
Q

What type of infections do T lymphocytes play a role in?

A
  • Fugal
  • Viral
  • PJP
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5
Q

What type of infections do B lymphocytes play a role in?

A

Bacterial

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6
Q

What supportive factors are aimed at reducing sepsis in haematological malignancy?

A
  • Prophylaxis
  • Growth factors e.g. G-CSF
  • Stem cell rescue/transplant
  • Protective environment e.g. laminar flow rooms
  • Intravenous immunoglobulin replacement
  • Vaccination
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7
Q

What prophylaxis can help reduce sepsis in haematological malignancy?

A
  • Antibiotics (ciprofloxacin)
  • Anti-fungal (fluconazole or itraconazole)
  • Anti-viral (aciclovir)
  • PJP (co-trimoxazole)
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8
Q

What is the cause of neutropenia?

A

Marrow failure proves a higher risk than immune destruction

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9
Q

How is the degree of neutropenic risk classified?

A

Neutrophils

  • <0.5x10^9 = significant risk
  • <0.2x10^9= high risk
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10
Q

What duration of neutropenia carries a high risk?

A
  • Neutropenic >7 days
  • In AML therapy and stem cell transplantation there is profound neutropenia ~14-21 days
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11
Q

What are additional risk factors for infection?

A
  • Disrupted skin / mucosal surfaces
    • Hickman line, venflons
  • Altered flora/ antibiotic resistance
    • Prophylactic antibiotics
  • Lymphopenia
    • Disease process e.g. Lymphoma
    • Treatment eg Fludarabine, ATG
    • Stem cell transplantation, GVHD
  • Monocytopenia
    • Hairy cell leukaemia
    • Chemotherapy
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12
Q

What is the pattern of bacterial causes of febrile neutropenia?

A
  • Gram-positive bacteria (60-70%)
  • Gram-negative bacilli (30-40%)
  • These patterns may now relate to antibiotic prophylaxis, emerging infections, use of lines etc
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13
Q

What gram positive bacteria are implicated in febrile neutropenia?

A
  • Staphylococci: MSSA, MRSA, coagulase negative
  • Streptococci: viridans
  • Enterococcus faecalis/faecium
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14
Q

What gram negative bacteria are implicated in febrile neutropenia?

A
  • Escherichia coli
  • Klebsiella spp: ESBL
  • Pseudomonas aeruginosa
  • Enterobacter spp
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15
Q

What are possible sites of infection in haematological patients?

A
  • Respiratory tract
  • Gastrointestinal (Typhlitis)
  • Dental sepsis
  • Mouth ulcers
  • Skin sores
  • Exit site of central venous catheters
  • Perianal (avoid PRs!)
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16
Q

What type of infection are immunocompromised patients particularly at risk of?

A

Fungal

17
Q

Give examples of fungal infections.

A
  • Candida
  • Aspergillus
18
Q

What can fungal infections in immunocompromised patients lead to?

A

Life threatening deep seated infection

19
Q

What contributes to the risk of fungal infection?

A

Monocytopenia and monocyte dysfunction

20
Q

Where are fungal infections likely to affect?

A
  • Lung
  • Liver
  • Sinuses
  • Brain
21
Q

How does neutropenic sepsis present?

A
  • Fever with no localised signs ( single reading of 38.5 or 2 readings of 38, 1 hour apart)
  • Rigors
  • Chest infection/ pneumonia
  • Skin sepsis - cellulitis
  • Urinary tract infection
  • Septic shock
22
Q

What is the timeline of sepsis?

A
  • Signs of systemic inflammation (SIRS)
  • Presumed infection and organ dysfunction
  • Severe sepsis/ septic shock
23
Q

What action should be taken for sepsis?

A

Sepsis 6

24
Q

What are the sepsis 6?

A
  • 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
25
Q

What does delay in sepsis treatment lead to?

A

Every hour’s delay in administering antibiotics increases chance of mortality by 8%

26
Q

How is neutropenic fever investigated?

A
  • History and examination Blood culture: Hickman line & peripheral
  • CXR
  • Throat swab & other clinical sites of infection
  • Sputum if productive
  • FBC, renal and liver function, coagulation screen
27
Q

How should neutropenic sepsis be managed?

A
  • ABC resuscitation
  • Broad spectrum IV antibiotics (tazocin, gentamicin)
  • If a gram positive organism is identified add vancomycin or teicoplanin
  • If no response at 72 hours add I.V. antifungal treatment e.g. Caspofungin - empiric therapy
  • CT chest/abdo/pelvis to look for source
  • Modify treatment based on culture results
28
Q

When may patients be severely lymphopenic?

A
  • Stem cell transplant recipients, especially allogeneic
  • Recipients of Total-Body Irradiation (TBI)
  • Graft vs Host Disease
  • Nucleoside analogues (fludarabine) or ATG
  • Lymphoid malignancy e.g Lymphoma, CLL, ALL
29
Q

What infections are severly lymphopenic patients at particular risk of?

A
  • Atypical pneumonia
    • Pneumocystis Jirovecii (PJP)
    • CMV
    • RSV
  • Viral
    • Shingles (Varicella Zoster)
    • Mouth ulcers (Herpes simplex)
    • Adenovirus
    • EBV (PTLD)
  • Fungal
    • Candida, aspergillus, mucormycosis
  • Atypical mycobacteria
    • Skin lesions, pulmonary and hepatic involvement

A Haematology and Immunology (20 decks)

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