Infection in Patients with Haematological Malignancy Flashcards
What are some examples of immune cells, and what is each important for?
- Neutrophils
- Bacterial and fungal infection
- Monocytes
- Fungal infection
- Eosinophils
- Parasitic infections
- T lymphocytes
- Fungal and viral infection
- B lymphocytes
- Bacterial infection
What are the following important for:
- neutrophils
- monocytes
- eosinophils
- T cells
- B cells
What immune cells are most important in terms of prevention of opportunistic infections?
Neutrophils and T lymphocytes are most important in terms of prevention of opportunistic infections
Describe supportive measures to reduces the liklihood of sepsis in people with haematological malignancy?
- Prophylaxis
- Antibiotics
- Ciprofloxacin
- Anti-fungal
- Fluconazole or itrazonazole
- Anti-viral
- Aciclovir
- PJP
- Co-trimoxazole
- Antibiotics
- Growth factors
- Stem cell rescue/transplant
- Protective environment
- Such as laminar flow rooms
- IV immunoglobulin replacement
- Vaccination
How does chemotherapy affect neutrophils?
After chemotherapy neutropenia occurs (low concentration of neutrophils)
What are important factors of the neutropenia after chemotherapy in terms of risk of infection?
- Cause of neutropenia
- Bone marrow failure higher risk than immune destruction
- Degree of neutropenia
- <0.5x109/L significant risk
- <0.2x109 high risk
- Duration of neutropenia
- >7 days high risk
Is bone marrow failure or immune destruction as a cause of neutropenia greater risk for infection?
- Bone marrow failure higher risk than immune destruction
As well as neutropenia after chemotherapy, what are some additional risk factors for infection?
- Disrupted skin/mucosal surfaces
- Cannulas
- Mucositis due to chemotherapy
- Graft versus host disease (GVHD)
- Altered flora/antibiotic resistance
- Prophylactic antibiotics
- Lymphopenia
- Could be due to disease process, treatment or stem cell transplantation
- Monocytopenia
What is febile neutropenia?
Is the development of fever in patients who are neutropenic
What are the most common causes of febile neutropenia?
- Gram positive bacteria (60-70%)
- Staphylococci
- MSSA, MRSA, coagulase negative
- Streptococci
- Viridans
- Enterococcus faecalis
- Staphylococci
- Gram negative bacilli (30-40%)
- Escherichia coli
- Klebsiella spp
- Pseudomonas aeruginosa
Is febile neutropenia usually caused by gram positive or negative bacteria?
-
Gram positive bacteria (60-70%)
- Staphylococci
- MSSA, MRSA, coagulase negative
- Streptococci
- Viridans
- Enterococcus faecalis
- Staphylococci
- Gram negative bacilli (30-40%)
- Escherichia coli
- Klebsiella spp
- Pseudomonas aeruginosa
What are some possible sites of infection for febile neutropenia?
- Respiratory tract
- GI
- Dental sepsis
- Mouth ulcers
- Skin sores
- Exit site of central venous catheters
- Perianal
Describe the presentation of neutropenic sepsis?
- Fever with no localising signs
- Single reading of >38.5 degrees or 38 on two readings 1 hour apart
- Rigors
- Chest infection/pneumonia
- Skin sepsis – cellulitis
- Urinary tract infection
- Sepsis shock
What temperature is to be recorded for diagnosis of neutropenic sepsis?
- Single reading of >38.5 degrees or 38 on two readings 1 hour apart
What are the sepsis 6?
- Administer high flow oxygen
- Blood cultures
- IV antibiotics
- Within1 hour
- Serum lactate
- IV fluid resuscitation
- Measure urine output
Describe the treatment of sepsis?
Diagnose severe sepsis/septic shock early:
- Signs of systemic inflammation (SIRS)
- Presumed infection and organ dysfunction
Deliver the sepsis 6
Further investigations of neutropenic fever
Management:
- Resuscitation – ABC
- Broad spectrum IV antibiotics
- Tazocin and gentamicin
- If gram positive organism identified add vancomycin or teicoplanin
- If no response at 72 hours add IV antifungal therapy
- Such as caspofungin
What antibiotics should be given for sepsis?
- Broad spectrum IV antibiotics
- Tazocin and gentamicin
- If gram positive organism identified add vancomycin or teicoplanin
- If no response at 72 hours add IV antifungal therapy
- Such as caspofungin
Describe the management of sepsis?
Deliver the sepsis 6:
- Administer high flow oxygen
- Blood cultures
- IV antibiotics
- Within 1 hour
- Serum lactate
- IV fluid resuscitation
- Measure urine output
What fungal infections are most common in immunocompromised?
- Candida species
- Aspergillus
What are additional risk factors for fungal infection in immunocompromised?
- Monocytopenia and monocyte dysfunction
Describe the management of fungal infections?
- Empirical
- Echinocandins such as caspofungin and anidulafungin
- For aspergillus infection
- Voriconazole, isavuconazole
- For mould infections
- Liposomal amphotericin
What anti-fungals should be used to treat aspergillus infection?
- Voriconazole, isavuconazole
What anti-fungals should be used to treat mould infections?
- Liposomal amphotericin
Describe the possible aetiology of severely lymphopenic patients?
- Stem cell transplant recipients
- Especially allogeneic
- Recipients of total body irradiation (TBI)
- Graft vs host disease
- Nucleoside analogues or ATG
- Lymphoid malignancy
- Such as lymphoma, CLL and ALL
What are examples of infections that typically infect severely lymphopenic patients?
- Pneumonitis
- Pneumocystis jirovecii (PJP)
- CMV
- RSV
- Viral
- Shingles (Varicella Zoster)
- Mouth ulcers (Herpes simplex)
- Adenovirus
- EBV
- SARS-COV2
- Fungus
- Candida
- Aspergillus
- Mucormycosis
- Atypical mycobacteria
- Skin lesions, pulmonary and hepatic involvement
What anti-viral medication is used for the following:
- PJP
- CMV
- HSV1
- VZV
- Influenza A and B
- Adenovirus
- RSV
