Infection in neutropenia

Question 1

MASCC score

high risk score?

Treatment based on low or high risk?

Answer 1

separates low and high risk patients with neutropenia

high risk = under 21 and treat with IV broad spec antibiotics

low risk = over 21 and oral antibiotics in some cases

Question 2

Bloodstream infections in neutropenic patients

Answer 2

• S. aureus
• Gram neg rods
• coagulase neg staph
• MDR Gram neg rods

Question 3

Fungal infections in neutropenic patients

(Candida)

dissemination appearance?

Answer 3

Most common: C. albicans, C. parapsilosis, C. glabrata

Most invasive: C. tropicalis

Most resistant: C. auras

Disseminated candidiasis –> can appear as a rash

Question 4

Fungal infections in neutropenic patients

non Candida

Answer 4

Aspergillus - can disseminate
- flowing with dichotomous branching

Zygomycetes

Fusarium (filamentous)

C. immitis

H. capsulatum (river valleys)

Question 5

Viruses and neutropenic patients

Answer 5

HSV 1 - looks like a fever blister gone rampant

VZV infection - dermatome

Question 6

P. aeruginosa in neutropenic patients

Answer 6

Causes gangrene and results in a black lesion under the skin

- painful and tender

Question 7

What is used to treat pneumonia in neutropenic patients?

Answer 7

voriconazole

if unknown = add echinocandin

• alternatives are LAmB or isavuconazole

Question 8

GI tract infections in neutropenic patients are most likely what and what are the symptoms?

Answer 8

Candida esphagitis (thrush) and Herpes espohagitis (ulcers) 
      - symptoms: dysphagia or odynophagia 

Typhlitis

• present with fever, pain, RLQ pain
• bowel wall thickening
• Treat with broad spec and surgery

Question 9

Main causative organisms of UTIs in neutropenic patients?

Answer 9

Enterobacteriaceae

Other gram neg rods or Candida might be a cause

Question 10

What do you give when you can’t determine source of infection?

Answer 10

Broad spec antibiotic ASAP