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Year 3 > Infection in Patients with Haematological Malignancy > Flashcards

Infection in Patients with Haematological Malignancy Flashcards

1
Q

what kind of infections do you need neutrophils for?

A

bacteria

fungal

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2
Q

what kind of infections do you need monocytes for?

A

fungal

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3
Q

what kind of infections do you need eosinophils?

A

parasites

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4
Q

what kind of infections do you need T lymphocytes?

A

fungal and viral

PJP

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5
Q

what kind of infections do you need b lymphocytes for/

A

bacterial

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6
Q

supportive measures aimed at reducing risk of sepsis in haematological malignancy

A 
prophylaxis
growth factors
stem cell transplant
protective environment 
IV IG replacement
vaccination
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7
Q

describe the prophylaxis needed for reducing sepsis risk in haematological malignancy

A

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

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8
Q

name the 3 components important in assessing risk of neutropenic sepsis

A

cause of neutropenia
degree of neutropenia
duration of neutropenia

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9
Q

does marrow failure or immune destruction put you at higher risk of neutropenic sepsis?

A

marrow failure

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10
Q

neutrophils <0.5x10^9/l puts you at what level of risk for sepsis?

A

significant

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11
Q

neutrophils <0.2x10^9/l puts you at what level of risk for sepsis?

A

high risk

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12
Q

what duration of neutropenia puts you at high risk for sespsi?

A

> 7 days

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13
Q

prolonged neutropenia increases risk of what kind of infections?

A

fungal

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14
Q

apart from haematological malignancy, name the additional risk factors for infection

A 
• 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
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15
Q

gram + ve or -ve is the most common cause of neutropenic sepsis in haematological malignancies

A

+ve

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16
Q

gram -ve bacteria affecting patients with haematological malignancies

A
  • Escherichia coli
  • Klebsiella spp : ESBL
  • Pseudomonas aeruginosa
  • Enterobacter spp
  • Acinetobacter spp
  • Citrobacter spp
  • Stenotrophomonas maltophilia
17
Q

gram +ve bacteria affecting patients with haematological malignancies

A
  • Staphylococci: MSSA, MRSA, coagulase negative
  • Streptococci: viridans
  • Enterococcus faecalis/faecium
  • Corynebacterium spp
  • Bacillus spp
18
Q

possible sites of infection in patients with haematological malignancy

A
  • Respiratory tract
  • Gastrointestinal (Typhlitis)
  • Dental sepsis
  • Mouth ulcers
  • Skin sores
  • Exit site of central venous catheters
  • Perianal (avoid PRs!)
19
Q

most common cause of fungal infections in immunocompromised patients?

A

candida species

aspergillus

20
Q

where do fungal infections in immunocompromised patients tend to affect?

A

lung
liver
sinuses
brain

21
Q

what contributes to risk of fungal infection in immunocompromised patients?

A

monocytopenia

monocyte dysfunction

22
Q

presentation of neutropenic sepsis

A 
• 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
23
Q

investigation of neutropenic fever

A
  • 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
24
Q

management of neutropenic sepsis

A

• 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

25
Q

infection in severely lymphopenic patients

A

• 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

26
Q

causes of pneumonitis in severely lymphopenic patients

A

pneumocystis jirovecii
CMV
RSV

27
Q

causes of viral infections in severely lymphopenic patients

A

shingles (VZV)
HSV
adenovirus
EBV

28
Q

causes of fungal infections in severely lymphopenic patients

A

candida
aspergillus
mucormycosis

Year 3 (164 decks)

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