Infection in Immunocompromised Host

Question 1

solid organ transplant

Care after solid organ transplant:
-Single room, no need for __ control
-Strict hand hygiene
-Strict infection control protocol
-No sick visitors
-Cooked food

-Safe living counselling
* Avoid activity prone to injury: __
* Inform when ___

Answer 1

Single room, no need for pressure control
Strict hand hygiene
Strict infection control protocol
No sick visitors
Cooked food
Safe living counselling
* Avoid activity prone to injury: gardening
* Inform when travelling abroad

Question 2

solid organ transplant

timeline of solid organ transplant:
1. Immediate Post-transplant
* Intense, high dose immunosuppression
* Intravenous
1st month: Post operative infection, Nosocomial infection

2. 90 days
   * Continuous intense immunosuppresion
   * Oral
3. After 90 days
   * Lowest maintenance
   immunosuppresion
   * Oral
   2nd to 6th mth: Impair cellular immunity (T-cell)
   severe
   >6 mths: Impair cellular immunity (T-cell)
   recovery

Answer 2

1. Immediate Post-transplant
   * Intense, high dose immunosuppression
   * Intravenous
   1st month: Post operative infection, Nosocomial infection
2. 90 days
   * Continuous intense immunosuppresion
   * Oral
3. After 90 days
   * Lowest maintenance
   immunosuppresion
   * Oral
   2nd to 6th mth: Impair cellular immunity (T-cell)
   severe
   >6 mths: Impair cellular immunity (T-cell)
   recovery

Question 3

Hematopoietic Stem Cell Transplantation

3 Phases after stem cell transplant
1. Pre-engraftment
* 3 weeks after stem cell infusion
* Neutropenia in 1st mth: low neutrophil count
Care after HSCT (uring pre-engraftment):
* Receive various ___ / antifungal prophylaxis
* Should be in ___ pressure single room
* Cooked food
* Avoid _ and dirt (fresh flower)
* No sick visitors
* Strict hand hygiene
* Strict infection control protocol

2. Immediate post-engraftment
   * 3 weeks to 3 months
   * Start to see increasing in blood cells
   * Impair cellular immunity (T-cell) severe ( in 2nd to 6th mth)
3. Late post-engraftment
   * After 3 months
   * Impair cellular immunity (T-cell) Recovery (slower) (>6 mths)

Engraftment is when your body accepts the transplanted bone marrow or stem cells and they begin to produce new blood cells and immune system cells.

Answer 3

3 Phases after stem cell transplant
1. Pre-engraftment
* 3 weeks after stem cell infusion
* Neutropenia in 1st mth: low neutrophil count
Care after HSCT (uring pre-engraftment):
* Receive various antibiotic / antifungal prophylaxis
* Should be in positive pressure single room
* Cooked food
* Avoid soil and dirt (fresh flower)
* No sick visitors
* Strict hand hygiene
* Strict infection control protocol

2. Immediate post-engraftment
   * 3 weeks to 3 months
   * Start to see increasing in blood cells
   * Impair cellular immunity (T-cell) severe ( in 2nd to 6th mth)
3. Late post-engraftment
   * After 3 months
   * Impair cellular immunity (T-cell) Recovery (slower) (>6 mths)

Engraftment is when your body accepts the transplanted bone marrow or stem cells and they begin to produce new blood cells and immune system cells.

Question 4

Hematopoietic Stem Cell Transplantation

put patient in __ pressure room:
- No fresh flowers
- Environmental cleaning – aircon, shower head
- No construction
- wear face mask, no visitors

Answer 4

put patient in positive pressure room:
- No fresh flowers
- Environmental cleaning – aircon, shower head
- No construction
- wear face mask, no visitors

Question 5

HIV

HIV Prevention
1. ___/___ (Bactrim)
* Prevent PCP and Toxoplasma

2. ___/___
   * Prevent Mycobacterium avium complex
   * If antiretroviral medication is initiated, no need to give prophylaxis

Answer 5

HIV Prevention
1. Trimethoprim/Sulfamethoxazole (Bactrim)
* Prevent PCP and Toxoplasma

2. Clarithromycin/Azithromycin
   * Prevent Mycobacterium avium complex
   * If antiretroviral medication is initiated, no need to give prophylaxis

Question 6

HIV

Care for HIV patient:
-MODE of HIV transmission (3)
-NO ISOLATION Unless there is other indication such as ___, __
-__ precaution for blood-borne pathogen: Proper discard of ___ object, No __ of needles
-IF HIV Viral load is undetectable=There is __ transmission (SEXUALLY)

Answer 6

Care for HIV patient:
-MODE of HIV transmission
* Blood
* Unprotected sexual contact
* Mother to child
-NO ISOLATION Unless there is other indication such as TB, COVID
-Universal precaution for blood-borne pathogen: Proper discard of sharp object, No recap of needles
-IF HIV Viral load is undetectable=There is NO transmission (SEXUALLY)