Infection in haem malignancies Flashcards
What supportive measures are used in the immunocompromised to prevent infection?
Prophylaxis- antibiotics, anti-fungals, antivirals, PJP Growth factors in neutropenia Stem cell transplant IVIg Vaccination
What are the risk factors for infection?
Neutropenia Lymphopenia Monocytopenia Disrupted skin/mucosal surface Altered flora/antibiotic resistance
What are the common causative organisms of infection in haem malignancies?
Staph- MSSA, MRSA, coagulase - Strep viridian's E. coli Klebsiella Pseudomonas aeruginosa
What are the less common causative organisms of infection in haem malignancies?
Enterococcus faecalis Corynebacterium species Bacillus species Enterobacter Acinebacter Citrobacter Stenotrophomonas maltophlia
What are the common sites of infection in haem malignancies?
Dental Mouth sores Skin sores Exit site of central venous catheters Resp tract GI Perianal
What is the most common location of fungal infection in haem malignancy?
Lungs
Where are the less common locations of fungal infections in haem malignancies?
Liver
Sinuses
Brain
What are the risk factors for fungal infection in haem malignancies?
Monocytopenia and monocyte dysfunction
What is the presentation of neutropenic sepsis?
Fever- single >38.5 or 2 readings >38
Tachycardia, hypotension
Localising signs- dysuria, abdominal pain…
What investigations are done for suspected neutropenic sepsis?
History and exam Blood cultures Serum lactate Urine output CXR Throat/other infection site swab Sputum culture/stain if productive FBC, renal and liver function, coagulation screen
What is the management of neutropenic sepsis?
Sepsis 6
- take blood cultures, serum lactate and urine output
- give oxygen, IV fluids and antibiotics
What antibiotics are given in neutropenic sepsis?
Trazocin and gentamicin
Add vancomycin if gram +
If no response t 72 hours, add anti fungal
What are the risk factors for infection in lymphopenia?
Stem cell transplant
Toal body irradiation
Lymphoid malignancies
Neucleoside analogues
What are the common infections in lymphopenia?
Atypical pneumonia
Viral
Fungal
Atypical mycobacteria
