Infection in Patients with Haematological Malignancy Flashcards
what kind of infections do you need neutrophils for?
bacteria
fungal
what kind of infections do you need monocytes for?
fungal
what kind of infections do you need eosinophils?
parasites
what kind of infections do you need T lymphocytes?
fungal and viral
PJP
what kind of infections do you need b lymphocytes for/
bacterial
supportive measures aimed at reducing risk of sepsis in haematological malignancy
prophylaxis growth factors stem cell transplant protective environment IV IG replacement vaccination
describe the prophylaxis needed for reducing sepsis risk in haematological malignancy
o Antibiotics (ciprofloxacin)
o Anti-fungal (fluconazole or itraconazole) – extended neutropenia, itraconazole
broader but more SE
§ Increased fungal spores in new builds as a result of disruption to old sites
o Anti-viral (aciclovir)
o PJP (co-trimoxazole) – co-tri is good at provoking allergies
name the 3 components important in assessing risk of neutropenic sepsis
cause of neutropenia
degree of neutropenia
duration of neutropenia
does marrow failure or immune destruction put you at higher risk of neutropenic sepsis?
marrow failure
neutrophils <0.5x10^9/l puts you at what level of risk for sepsis?
significant
neutrophils <0.2x10^9/l puts you at what level of risk for sepsis?
high risk
what duration of neutropenia puts you at high risk for sespsi?
> 7 days
prolonged neutropenia increases risk of what kind of infections?
fungal
apart from haematological malignancy, name the additional risk factors for infection
• Disrupted skin/mucosal surfaces o Hickman line, venflons o Mucositis affecting GI tract o GVHD • Altered flora/antibiotic resistance o Prophylactic antibiotics • Lymphopenia o Disease process e.g. lymphoma o Treatment e.g. fludarabine, ATG o Stem cell transplantation, GVHD • Monocytopenia o Hairy cell leukaemia o Chemotherapy
gram + ve or -ve is the most common cause of neutropenic sepsis in haematological malignancies
+ve
gram -ve bacteria affecting patients with haematological malignancies
- Escherichia coli
- Klebsiella spp : ESBL
- Pseudomonas aeruginosa
- Enterobacter spp
- Acinetobacter spp
- Citrobacter spp
- Stenotrophomonas maltophilia
gram +ve bacteria affecting patients with haematological malignancies
- Staphylococci: MSSA, MRSA, coagulase negative
- Streptococci: viridans
- Enterococcus faecalis/faecium
- Corynebacterium spp
- Bacillus spp
possible sites of infection in patients with haematological malignancy
- Respiratory tract
- Gastrointestinal (Typhlitis)
- Dental sepsis
- Mouth ulcers
- Skin sores
- Exit site of central venous catheters
- Perianal (avoid PRs!)
most common cause of fungal infections in immunocompromised patients?
candida species
aspergillus
where do fungal infections in immunocompromised patients tend to affect?
lung
liver
sinuses
brain
what contributes to risk of fungal infection in immunocompromised patients?
monocytopenia
monocyte dysfunction
presentation of neutropenic sepsis
• Fever with no localising signs o Single reading of >38.50C or 380C on two readings one hour apart • Rigors • Chest infection/ pneumonia • Skin sepsis - cellulitis • Urinary tract infection • Septic shock
investigation of neutropenic fever
- History and examination
- Blood cultures-Hickman line and peripheral – to determine if localised or generalised
- CXR
- Throat swab and other clinical sites of infection
- Sputum if productive
- FBC, renal and liver function, coagulation screen
management of neutropenic sepsis
• Resuscitation – ABC
• Broad spectrum I.V. antibiotics
o Tazocin and Gentamicin
• If a gram positive organism is identified add vancomycin or teicoplanin (if obvious skin or line
infection probably add straight away)
• 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
• Pneumonitis
viral
fungal
atypical mycobacteria
causes of pneumonitis in severely lymphopenic patients
pneumocystis jirovecii
CMV
RSV
causes of viral infections in severely lymphopenic patients
shingles (VZV)
HSV
adenovirus
EBV
causes of fungal infections in severely lymphopenic patients
candida
aspergillus
mucormycosis
