Infection in patients with Haematological Malignancy

Question 1

Which immune cells will be used in bacterial infections?

Answer 1

1 - Neutrophils

2 - B-lymphocytes

Question 2

What immune cells will be used in fungal infections?

Answer 2

1 - Neutrophils

2 - Monocytes

3 - T-lymphocytes

Question 3

What immune cells will be used in parasitic infections?

Answer 3

Eosinophils

Question 4

What immune cells will be used in viral infections?

Answer 4

T lymphocytes

Question 5

What supportive measures will help reduce the risk of a patient acquiring sepsis in Haematological malignancy?

Answer 5

1 - Prophylactic ciprofloxacin

2 - G-CSF (Granulocyte - colony stimulating factor)

3 - Stem cell transplant

Question 6

Why is G-CSF an important treatment to prevent infection in patients with haematological malignancy?

Answer 6

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

Question 7

What factors control the risk of a patient acquiring neutropenia?

Answer 7

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

Question 8

Apart from the severity, duration and cause of the neutropenia, what are additional risk factors for infection in haematological malignancy patients?

Answer 8

1 - Breaks in the skin - Hickman line, venflons etc.

2 - Altered gut flora - prophylactic antibiotics

3 - Lymphopenia - e.g. lymphoma

4 - Monocytopenia

Question 9

What is the most likely type of infecting organism in febrile neutropenia?

Answer 9

Gram +ve bacteria

Question 10

What are common gram +ve bacteria found in neutropenic infections?

Answer 10

MRSA

Streptococci Viridans

Question 11

What are common gram -ve bacteria found in neutropenic infections?

Answer 11

1 - E.Coli

2 - Pseudomonas Aeruginosa

3 - Klebsiella

Question 12

What are the most common sites of infection in neutropenic infections?

Answer 12

1 - Respiratory tract

2 - GI

3 - Dental sepsis

4 - Mouth ulcers

Question 13

What is a life-threatening fungal infection that can occur in immunocompromised patients?

Answer 13

Aspergillus - lung, liver, sinuses, brain

Question 14

How does neutropenic sepsis present?

Answer 14

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

Question 15

What is the sepsis 6?

Answer 15

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

Question 16

For every 1 hour delay in administering IV antibiotics in septic patients, what is the increase in mortality rate?

Answer 16

8%

Question 17

How are neutropenic fevers investigated?

Answer 17

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

Question 18

What is a good antibiotic to administer in neutropenic sepsis?

Answer 18

Tazocin

Question 19

What are common infecting organisms in pneumonia in lymphopenic patients?

Answer 19

Pneumocystitis

Question 20

What are common infecting viral organisms in lymphopenic patients?

Answer 20

Varicella Zoster

Herpes simplex

Adenovirus

EBV

Question 21

What are common fungal organisms in lymphopenic patients?

Answer 21

1 - Candida

2 - Aspergillus