infection in immunosuppressed pt's Flashcards
type of infection fought by Neutrophils
bacterial and fungal
type of infection fought by Monocytes
fungal
type of infection fought by eoisinophils
parasitic
type of infection fought by T lymphocytes
fungal and viral, PJP
type of infection fought by B lymphocytes
bacterial
what supportive measures are taken to reduce the risk of sepsis in haematological malignancy?
Prophylaxis - Antibiotics (ciprofloxacin), Anti-fungal (fluconazole or itraconazole), Anti-viral (aciclovir), PJP (co-trimoxazole)
Growth factors e.g. G-CSF
Stem cell rescue/transplant
Protective environment e.g. laminar flow rooms
Intravenous immunoglobulin replacement
Vaccination
what are the factors for neutropenia that need to be considered?
cause, degree, duration
what is the cause of neutropenia?
marrow failure higher risk than immune destruction.
classify high risk neutropenia
< 0.2 x 109/l - high risk
classify low risk neutropenia
< 0.5 x 109/l - significant risk
what is classified as the duration for high risk neutropenia?
> 7 days
what are additional rf’s for infection?
disruted skin/mucosal surfaces, altered flora, antibiotic resistance, lymphopenia, monocytopenia (hairy cell leukaemia and chemotherapy)
Name the common Gram Positive bacteria which cause febrile neuropenia
staph, strep.v, enterococcus, corynebacterium, bacillus
Name the common Gram Negative bacteria which cause febrile neutropenia
escherichia coli, klebsiella spp, pseudomonas aeruginose, enterobacter, acinetobacter, cutrobacter, stenotrophomonas maltophilia
what are the causes of fungal infection?
candida, aspergillus. - look in the lung, liver, sinuses and the brain. Monocytopenia contributes to the risk of fungal infection. Can see Hyphae.
Px of neurogenic sepsis
fever with no localisung signs, pyrexial, rigors, chest infection, skin sepsis - cellulitis, uti, septic shock.
what are the SEPSIS 6?
give = O2, iv antibiotics within one hour, iv fluid resus
take = blood cultures, serum lactate mesurement, measure urine output.
Every hour’s delay in administering antibiotics increases chance of mortality by 8%
Ix of neutropenic fever…
hx and examination, Blood cultures -Hickman line & peripheral, CXR, Throat swab & other clinical sites of infection, Sputum if productive, FBC, renal and liver function, coagulation screen
Mx of neutropenic sepsis
Resuscitation – ABC
Broad spectrum I.V. antibiotics - Tazocin and Gentamicin
If a gram positive organism is identified add vancomycin or teicoplanin
If no response at 72 hours add I.V. antifungal treatment e.g. Caspofungin - empiric therapy
CT chest/abdo/pelvis to look for source
Modify treatment based on culture results
Infection in severely lymphopenic patients
Stem cell transplant recipients, especially allogeneic
Recipients of Total Body Irradiation (TBI)
Graft vs Host Disease
Nucleoside analogues (fludarabine) or ATG
Lymphoid malignancy e.g Lymphoma, CLL, ALL
Infection in severely lymphopenic patients type of infection?
atypical pneumonia (pjp), viral
how does atypical mycobacteria present?
hepatic involvement and skin lesions.
