Infection in haematological malignancies

Question 1

what measures can be taken to try and reduce risk of sepsis in patients with haematological malignancies?

Answer 1

protective environment
vaccinations
prophylaxis
growth factors e.g. G-CSF
stem cell rescue/transplant 
IV immunoglobulin replacement

Question 2

what prophylaxis treatment is given to reduce risk of bacterial, fungal and viral infections in patients with haematological malignancies?

Answer 2

bacterial - ciprofloxacin
fungal - fluconazole
viral - acyclovir

Question 3

what prophylaxis is given o patient with haematological malignancies to prevent pnuemocystitis jiroveci pneumonia?

Answer 3

co-trimoxazole

Question 4

at what neutrophil count is someone at high risk of sepsis?

Answer 4

< 0.5 x10 (9) /L

< 0.2 x10(9) /L

Question 5

for how long is a patient with neutropenia at high risk of sepsis?

Answer 5

neutropenia for > 7 days puts them at high risk

Question 6

is gram positive or gram negative bacteria most common cause for febrile neutropenia?

Answer 6

gram positive bacteria

Question 7

what organisms are the most common cause of febrile neutropenia in patients with haematological malignancies?

Answer 7

gram positive;

• staph aureus
• strep viridans

gram negative;

• e.coli
• klebsiella species - ESBL
• pseudomonas

Question 8

what increases a patients risk of fungal infection?

Answer 8

monocytopenia

monocyte dysfunction

Question 9

what is the presentation of neutropenic sepsis?

Answer 9

fever with no localising signs
(single reading of >38.5 OR >38 on two readings one hour apart)

rigors
chest infection/pneumonia
skin sepsis - cellulitis 
UTI 
septic shock

Question 10

a patient has neutropenic sepsis. you dont know the cause yet.
how would you treat?

Answer 10

broad spectrum antibiotics (IV)

- tazocin & gentamicin

Question 11

a patient has neutropenic sepsis. it is identified that MRSA is the causative organism.
how would you treat?

Answer 11

vancomycin or teicoplanin

Question 12

a patient has neutropenic sepsis. you treat with broad spectrum IV antibiotics as there is no identifiable cause yet.
It has been 72 hours and there is still no improvement .
how would you treat?

Answer 12

add anti fungal (IV)

- caspofungin

Question 13

what is isolated monocytopenia a sign of?

Answer 13

hairy cell leukaemia

Question 14

what puts patients with haematological malignancies at risk of infection?

Answer 14

disrupted skin / mucosal surfaces 
altered flor / antibiotic resistance 
neutropenia 
lymphopenia 
monocytopenia

Question 15

how would you investigate a fever in a neutropenic patient?

Answer 15

history and examinaion
blood cultures - and from hitman line
CXR
throat swab and other sites of infection
sputum culture 
FBC, U & E, creatinine, LFT's, coagulation screen

Question 16

what are the main infections patients with severe lymphopenia at risk of?

Answer 16

atypical pneumonia;
- PJP

Viral;

• shingles (VZV)
• mouth ulcers (HSV)
• adenovirus
• EBV

fungal;
- candida, aspergillus, mucor mycosis

atypical mycobacterium