infection Flashcards
immune cells
Neutrophils – bacterial & fungal infection
Monocytes – fungal infection
Eosinophils – parasitic infections
T lymphocytes – fungal & viral infection, PJP (Pneumocystis jiroveci pneumonia)
B lymphocytes – bacterial infection
supportive measures at reducing risk of sepsis
Prophylaxis Antibiotics (ciprofloxacin) Anti-fungal (fluconazole or itraconazole) Anti-viral (aciclovir) PJP (co-trimoxazole)
Growth factor stem cell vaccination protective enviroment Ig IV replacement
neutropenia risk
> 7 days
<0.2 x 109
additional risks
Disrupted skin / mucosal surfaces Altered flora/ antibiotic resistance -Lymphopenia Disease process e.g. Lymphoma Treatment eg Fludarabine, Anti thymocyte globulin Stem cell transplantation, GVHD Monocytopenia Hairy cell leukaemia Chemotherapy
febrile neutropenia bacterial causes
gram+ve majority Staphylococci: MSSA,MRSA, coagulase negative Streptococci : viridans Enterococcus faecalis/faecium Corynebacterium spp Bacillus spp
Gram negative (30% Escherichia coli Klebsiella spp : ESBL Pseudomonas aeruginosa Enterobacter spp Acinetobacter spp Citrobacter spp
possible sites of infection
respiratory tract gastrointestinal dental sepsis mouth ulcers skin sores exit site of central venous catheters
Infection in immunocompromised
Monocytopenia and monocyte dysfunction contributes to risk of fungal infection Candida species Aspergillus Life threatening deep seated infection Lung, liver, sinuses, brain
presentation of neutropenic sepsis
Fever with no localising signs Single reading of >38.50C Rigors Chest infection/ pneumonia Skin sepsis - cellulitis Urinary tract infection Septic shock
severe sepsis/septic shock
signs of systemic inflammation+ presumed infection and organ dysfunction
Sepsis six
administer high flow oxygen take blood cultures, other cultures Give appropriate IV antibiotics within ONE hour measure serum lactate concentration start IV fluid resuscitation assess/measure urine output
investigations
History and examination
Blood cultures -Hickman line & peripheral
CXR
Throat swab & other clinical sites of infection
Sputum if productive
FBC, renal and liver function, coagulation screen
management
Broad spectrum I.V. antibiotics
- Tazocin and 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
infection in severely lymphopenic patients
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
summary
recognise and treat possible infection early in post chemo
immunity can be suppressed for long time
much lower threshold for antibiotics and hospitalisation in immunocompromised
