Infection in patients with Haematological Malignancy Flashcards
Which immune cells will be used in bacterial infections?
1 - Neutrophils
2 - B-lymphocytes
What immune cells will be used in fungal infections?
1 - Neutrophils
2 - Monocytes
3 - T-lymphocytes
What immune cells will be used in parasitic infections?
Eosinophils
What immune cells will be used in viral infections?
T lymphocytes
What supportive measures will help reduce the risk of a patient acquiring sepsis in Haematological malignancy?
1 - Prophylactic ciprofloxacin
2 - G-CSF (Granulocyte - colony stimulating factor)
3 - Stem cell transplant
Why is G-CSF an important treatment to prevent infection in patients with haematological malignancy?
G-CSF stimulates the bone marrow to produce granulocytes
- Granulocytes are normally suppressed in patients with haematological malignancies due to their chemotherapy treatments, so G-CSF helps them to fight off infections
What factors control the risk of a patient acquiring neutropenia?
Cause of their Neutropenia - Marrow failure carries higher risk than immune system destruction
Degree of Neutropenia - the fewer neutrophils the greater risk
Duration of the Neutropenia - more than 7 days of neutropenia increases risk
Apart from the severity, duration and cause of the neutropenia, what are additional risk factors for infection in haematological malignancy patients?
1 - Breaks in the skin - Hickman line, venflons etc.
2 - Altered gut flora - prophylactic antibiotics
3 - Lymphopenia - e.g. lymphoma
4 - Monocytopenia
What is the most likely type of infecting organism in febrile neutropenia?
Gram +ve bacteria
What are common gram +ve bacteria found in neutropenic infections?
MRSA
Streptococci Viridans
What are common gram -ve bacteria found in neutropenic infections?
1 - E.Coli
2 - Pseudomonas Aeruginosa
3 - Klebsiella
What are the most common sites of infection in neutropenic infections?
1 - Respiratory tract
2 - GI
3 - Dental sepsis
4 - Mouth ulcers
What is a life-threatening fungal infection that can occur in immunocompromised patients?
Aspergillus - lung, liver, sinuses, brain
How does neutropenic sepsis present?
1) Fever with no localising signs (temp > 38 on 2 seperate readings 1 hour apart)
2) Rigors
3) Pneumonia
4) Cellulitis
5) UTI
6) Septic shock
What is the sepsis 6?
Take 3:
1) Take blood cultures
2) Take serum lactate
3) Measure urine output
Give 3:
1) IV antibiotics (Amoxicilin, Metronidazole, Gentamicin)
2) IV fluids
3) Oxygen
For every 1 hour delay in administering IV antibiotics in septic patients, what is the increase in mortality rate?
8%
How are neutropenic fevers investigated?
1) Thorough history & examination
2) Blood cultures (take from hickman lines or peripheral lines if present)
3) CXR
4) Throat swab
5) Sputum sample
6) FBC
7) LFT’s
8) GFR
What is a good antibiotic to administer in neutropenic sepsis?
Tazocin
What are common infecting organisms in pneumonia in lymphopenic patients?
Pneumocystitis
What are common infecting viral organisms in lymphopenic patients?
Varicella Zoster
Herpes simplex
Adenovirus
EBV
What are common fungal organisms in lymphopenic patients?
1 - Candida
2 - Aspergillus
