infection in immunosuppressed pt's

Question 1

type of infection fought by Neutrophils

Answer 1

bacterial and fungal

Question 2

type of infection fought by Monocytes

Answer 2

fungal

Question 3

type of infection fought by eoisinophils

Answer 3

parasitic

Question 4

type of infection fought by T lymphocytes

Answer 4

fungal and viral, PJP

Question 5

type of infection fought by B lymphocytes

Answer 5

bacterial

Question 6

what supportive measures are taken to reduce the risk of sepsis in haematological malignancy?

Answer 6

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

Question 7

what are the factors for neutropenia that need to be considered?

Answer 7

cause, degree, duration

Question 8

what is the cause of neutropenia?

Answer 8

marrow failure higher risk than immune destruction.

Question 9

classify high risk neutropenia

Answer 9

< 0.2 x 109/l - high risk

Question 10

classify low risk neutropenia

Answer 10

< 0.5 x 109/l - significant risk

Question 11

what is classified as the duration for high risk neutropenia?

Answer 11

> 7 days

Question 12

what are additional rf’s for infection?

Answer 12

disruted skin/mucosal surfaces, altered flora, antibiotic resistance, lymphopenia, monocytopenia (hairy cell leukaemia and chemotherapy)

Question 13

Name the common Gram Positive bacteria which cause febrile neuropenia

Answer 13

staph, strep.v, enterococcus, corynebacterium, bacillus

Question 14

Name the common Gram Negative bacteria which cause febrile neutropenia

Answer 14

escherichia coli, klebsiella spp, pseudomonas aeruginose, enterobacter, acinetobacter, cutrobacter, stenotrophomonas maltophilia

Question 15

what are the causes of fungal infection?

Answer 15

candida, aspergillus. - look in the lung, liver, sinuses and the brain. Monocytopenia contributes to the risk of fungal infection. Can see Hyphae.

Question 16

Px of neurogenic sepsis

Answer 16

fever with no localisung signs, pyrexial, rigors, chest infection, skin sepsis - cellulitis, uti, septic shock.

Question 17

what are the SEPSIS 6?

Answer 17

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%

Question 18

Ix of neutropenic fever…

Answer 18

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

Question 19

Mx of neutropenic sepsis

Answer 19

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

Question 20

Infection in severely lymphopenic patients

Answer 20

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

Question 21

Infection in severely lymphopenic patients type of infection?

Answer 21

atypical pneumonia (pjp), viral

Question 22

how does atypical mycobacteria present?

Answer 22

hepatic involvement and skin lesions.