Infection Flashcards
Which WBC are key in fighting bacterial + fungal infections?
Neutrophils
Which WBC are key in fighting fungal infections?
Neutrophils
Monocytes
T-lymphocytes
Which WBC are key in fighting parasitic infections?
Eosinophils
Which WBC are key in fighting bacterial infections?
B lymphocytes
Neutrophils
Neutrophils are key in fighting what?
Bacteria
Fungi
Monocytes are key in fighting what?
Fungi
Eosinophils are key in fighting what?
Parasites
T lymphocytes are key in fighting what?
Fungi (PJP)
Viruses
B lymphocytes are key in fighting what?
Bacteria
How is risk of sepsis managed in patients with Haematological malignancy?
Prophylaxis Growth factors Stem cell transplant Protective environment IV Ig Vaccinations
What antibiotic is used for prophylaxis against Pneumocystis jiroveci pneumonia?
Co-trimoxazole
How is neutropenic risk assessed?
Cause of neutropenia Degree of neutropenia (<0.2x10^9/L = high risk) Duration of neutropenia (>7 days high risk) Disrupted skin Altered gut flora Lymphopenia Monocytopenia
What is the common bacterial cause of Febrile neutropenia?
Gram +bacteria (70%)
Gram -ve bacilli (30-40%)
What are the common gram +ve causes of febrile neutropenia?
MSSA, MRSA, Coagulase negative Staph
Streptococcus viridans
Enterococcus faecalis
What are the common gram -ve causes of febrile neutropenia?
E. coli
Klebsiella spp
Pseudomonas aeruginosa
What dysfunctions in immunocompromised patients contribute to risk of fungal infection?
Monocytopenia/monocyte dysfunction
How does neutropenic sepsis present?
Fever with NO localised signs Rigors Pneumonia Cellulitis UTI Septic shock
What is the sepsis six?
Take 3: Serum Lactate Blood culture Urine output Give 3 High flow Oxygen IV fluids IV Antibiotics (within 1 hr)
How should neutropenic fever be investigated?
History + examination Blood & sputum cultures CXR Throat swab FBC Renal, LFTs
How is neutropenic sepsis managed?
ABCDE
Broad spec antibiotics
CT chest/abdo/pelvis for source
Modify based on culture results
Outline the antibiotic use in neutropenic sepsis
Broad spec: Piperacillin/Tazobactam + Gentamicin If gram +ve add: Vancomycin or Teicoplanin If no response after 72hrs add: Caspofungin
What are the main causes of lymphopenia?
Stem cell tranplants (allogenic++) Total Body Irradiation Graft vs Host disease Nucleoside analogues Lymphoid malignancy
What infections are seen in severely lymphopenic patients?
Atypical pneumonia Shingles Mouth ulcers EBV Fungi - candida, aspergillus Atypical mycobacteria
What are the causes of atypical pneumonia in lymphopenic patients?
Pneumocystis jiroveci
CMV
Respiratory syncytial virus
