infection

Question 1

what do each immune cell type fight ?

Answer 1

neutrophils - bacterial + fungal
monocytes - fungal
eosinophils - parasitic 
T cells - fungal + viral 
B cells - bacterial

Question 2

what are the supportive measures to reduce sepsis risk in haematological cancers ?

Answer 2

prophylaxis - Abx (ciprofloxacin), anti fungals (fluconazole), anti-viral (aciclovir), PJP (co-trimoxazole)
growth factors - G-CSF
stem cell transplant
protective environment
IV Ig replacement
vaccination

Question 3

what are the different degrees of neutropenia ?

Answer 3

significant risk - <0.5
high risk - <0.2

> 7 days is also high risk

Question 4

what are additional risk factors for infection ?

Answer 4

disrupted skin
altered flora - prophylactic abx
lymphopenia - disease, treatment, stem cell
monocytopenia - hairy cell leukaemia, chemo

Question 5

what is the most common bacterial febrile neutropenia ?

Answer 5

Gram-positive 60-70% - MSSA, MRSA, strep viridian’s

gram negative bacilli 30-40% - E.coli, klebsiella, pseudomonas

Question 6

what are common infections in immunocompromised patients ?

Answer 6

fungal - candida, aspergillus, sedating infection in lung, liver, brain
monocytopenia and monocyte dysfunction contribute to risk of fungal infection

Question 7

what is the presentation of neutropenic sepsis ?

Answer 7

fever no localising signs >38.5
riggers
chest infection
cellulitis
UTI
septic shock

Question 8

what is the sepsis 6 ?

Answer 8

blood culture
urine output measured 
fluids IV
antibiotics
lactate concentration
oxygen

Question 9

how do you investigate neutropenic fever ?

Answer 9

hx and exam
blood cultures
CXR
throat swab and other infection site
sputum sample
FBC, renal and liver function, coagulation screen

Question 10

how do you manage neutropenic sepsis ?

Answer 10

resus ABC
broad spectrum abs - gentamicin
if gram +ve add vancomycin
if no response at 72 hours add iv anti fungal caspofungin
CT look for source

Question 11

what causes infection in severely lymphopenic patients ?

Answer 11

stem cell transplants - allogeneic
total body irradiation
graft vs host disease
nucleoside analogues or ATG
lymphoid malignancy - lymphoma, CLL, ALL

Question 12

what sort of infections do you get in a severely lymphopenic patient ?

Answer 12

atypical pneumonia - PJP, CMV, RSV
viral - shingles, ulcers HSV, adenovirus, EBV
fungal - candida, aspergillus
atypical mycobacteria - skin lesions, resp + hep involve