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Haematology and immunology > Infection in haematological malignancy > Flashcards

Infection in haematological malignancy Flashcards

1
Q

What is the function of neutrophils?

A

Bacterial and fungal infection

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2
Q

What is the function of monocytes?

A

Fungal infection

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3
Q

What is the function of eosinophils?

A

Parasitic infections

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4
Q

What is the function of T lymphocytes?

A

Fungal and viral infection

Pneumocystis

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5
Q

What is the function of B lymphocytes?

A

Bacterial infection

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6
Q

What drugs are used for prophylaxis of sepsis in haematological malignancy?

A

Antibiotics (ciprofloxacin)
Anti-fungal (fluconazole or itraconazole)
Anti-viral (aciclovir)
Pneumocystis (co-trimoxazole)

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7
Q

How is risk of sepsis reduced in haematological malignancy?

A 
Prophylaxis
Growth factors
Stem cell rescue
Protective environment
IV immunoglobulin replacement
Vaccination
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8
Q

What causes neutropenia?

A

Marrow failure

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9
Q

What level of neutropenia would deem someone at significant risk and high risk?

A

Significant risk <0.5x10^9

High risk <0.2x10^9

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10
Q

How long does neutropenia have to last for someone to be at high risk of sepsis?

A

7 days

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11
Q

What are additional risk factors for infection?

A

Disrupted skin/mucosal surfaces
Altered flora/antibiotic resistance
Lymphopenia
Monocytopenia

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12
Q

What can cause disrupted skin or mucosal surfaces?

A

Hickman line, venflons
Mucositis affecting GI tract
Graft versus Host Disease

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13
Q

What can cause altered flora/antibiotic resistance?

A

Prophylactic antibiotics

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14
Q

What can cause lymphopenia?

A

Disease process eg lymphoma
Treatment eg fludarabine
Stem cell transplantation

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15
Q

What can cause monocytopenia?

A

Hairy cell leukaemia

Chemotherapy

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16
Q

What gram-positive bacteria can cause sepsis?

A 
Staph aureus - MSSA, MRSA
Coagulase negative staphylococci
Streptococci viridans - endocarditis
Enterococcus faecalis/faecium
Corynebacterium spp.
Bacillus spp.
17
Q

What gram-negative bacteria can cause sepsis?

A 
E.coli
Klebsiella spp.
Pseudomonas aeruginosa
Enterobacter spp.
Acinetobacter spp.
Citrobacter spp.
Stenotrophomonas maltophilia
18
Q

What are possible sites of infection during neutropenia?

A 
Respiratory tract
GI tract
Dental sepsis
Mouth ulcers
Skin sores
Exit site of central venous catheters
Perianal
19
Q

What sites of fungal infection are life threatening?

A

Lung
Liver
Sinuses
Brain

20
Q

What is the main cause of fungal infection?

A

Monocytopenia

21
Q

How does neutropenic sepsis present?

A 
Fever with no localising signs
Single reading of >38.5 or 2 readings apart
Rigors
Chest infection/pneumonia
Skin sepsis - cellulitis
UTI
Septic shock
22
Q

What is the sepsis 6?

A

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

23
Q

How should neutropenic fever be investigated?

A 
History and examination
Blood cultures
CXR
Throat swab and other sites of infection
Sputum if productive
FBC, renal and liver function, coagulation screen
24
Q

How is neutropenic sepsis managed?

A

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

25
Q

What lymphopenic patients are at risk of infection?

A 
Stem cell transplant recipients
Recipients of total body irradiation
Graft vs host disase
Nucleoside analogues or ATG
Lymphoid malignancy
26
Q

What causes atypical pneumonia in lymphopenic patients?

A

Pneumocystis Jirovecii
CMV
RSV

27
Q

What viral infections are lymphopenic patients at risk of?

A

Shingles - varicella zoster
Mouth ulcers - herpes simplex
Adenovirus
EBV

28
Q

What fungal infections are lymphopenic patients at risk of?

A

Candida
Aspergillus
Mucormycosis

29
Q

What are features of atypical mycobacteria infection in lymphopenic patients?

A

Skin lesions

Pulmonary and hepatic involvement

Haematology and immunology (19 decks)

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