Infection in haematological malignancy Flashcards
What is the function of neutrophils?
Bacterial and fungal infection
What is the function of monocytes?
Fungal infection
What is the function of eosinophils?
Parasitic infections
What is the function of T lymphocytes?
Fungal and viral infection
Pneumocystis
What is the function of B lymphocytes?
Bacterial infection
What drugs are used for prophylaxis of sepsis in haematological malignancy?
Antibiotics (ciprofloxacin)
Anti-fungal (fluconazole or itraconazole)
Anti-viral (aciclovir)
Pneumocystis (co-trimoxazole)
How is risk of sepsis reduced in haematological malignancy?
Prophylaxis Growth factors Stem cell rescue Protective environment IV immunoglobulin replacement Vaccination
What causes neutropenia?
Marrow failure
What level of neutropenia would deem someone at significant risk and high risk?
Significant risk <0.5x10^9
High risk <0.2x10^9
How long does neutropenia have to last for someone to be at high risk of sepsis?
7 days
What are additional risk factors for infection?
Disrupted skin/mucosal surfaces
Altered flora/antibiotic resistance
Lymphopenia
Monocytopenia
What can cause disrupted skin or mucosal surfaces?
Hickman line, venflons
Mucositis affecting GI tract
Graft versus Host Disease
What can cause altered flora/antibiotic resistance?
Prophylactic antibiotics
What can cause lymphopenia?
Disease process eg lymphoma
Treatment eg fludarabine
Stem cell transplantation
What can cause monocytopenia?
Hairy cell leukaemia
Chemotherapy
What gram-positive bacteria can cause sepsis?
Staph aureus - MSSA, MRSA Coagulase negative staphylococci Streptococci viridans - endocarditis Enterococcus faecalis/faecium Corynebacterium spp. Bacillus spp.
What gram-negative bacteria can cause sepsis?
E.coli Klebsiella spp. Pseudomonas aeruginosa Enterobacter spp. Acinetobacter spp. Citrobacter spp. Stenotrophomonas maltophilia
What are possible sites of infection during neutropenia?
Respiratory tract GI tract Dental sepsis Mouth ulcers Skin sores Exit site of central venous catheters Perianal
What sites of fungal infection are life threatening?
Lung
Liver
Sinuses
Brain
What is the main cause of fungal infection?
Monocytopenia
How does neutropenic sepsis present?
Fever with no localising signs Single reading of >38.5 or 2 readings apart Rigors Chest infection/pneumonia Skin sepsis - cellulitis UTI Septic shock
What is the sepsis 6?
Administer high flow oxygen
Take blood cultures, other cultures, consider source control
Give appropriate IV antibiotics within one hour
Measure serum lactate
Start IV fluid resuscitation
Assess/measure urine output
How should neutropenic fever be investigated?
History and examination Blood cultures CXR Throat swab and other sites of infection Sputum if productive FBC, renal and liver function, coagulation screen
How is neutropenic sepsis managed?
Resuscitation - ABC
Broad spectrum IV antibiotics - tazocin, gentamicin
If gram positive organism identified add vancomycin or teicoplanin
If no response at 72 hours at IV antifungal - caspofungin
CT chest/abdo/pelvis to look for source
Modify treatment based on culture results
What lymphopenic patients are at risk of infection?
Stem cell transplant recipients Recipients of total body irradiation Graft vs host disase Nucleoside analogues or ATG Lymphoid malignancy
What causes atypical pneumonia in lymphopenic patients?
Pneumocystis Jirovecii
CMV
RSV
What viral infections are lymphopenic patients at risk of?
Shingles - varicella zoster
Mouth ulcers - herpes simplex
Adenovirus
EBV
What fungal infections are lymphopenic patients at risk of?
Candida
Aspergillus
Mucormycosis
What are features of atypical mycobacteria infection in lymphopenic patients?
Skin lesions
Pulmonary and hepatic involvement
