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Immunology and Haematology > Infection in Patients with Haematological Malignancy > Flashcards

Infection in Patients with Haematological Malignancy Flashcards

1
Q

What are some examples of immune cells, and what is each important for?

A
  • Neutrophils
    • Bacterial and fungal infection
  • Monocytes
    • Fungal infection
  • Eosinophils
    • Parasitic infections
  • T lymphocytes
    • Fungal and viral infection
  • B lymphocytes
    • Bacterial infection
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2
Q

What are the following important for:

  • neutrophils
  • monocytes
  • eosinophils
  • T cells
  • B cells
A
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3
Q

What immune cells are most important in terms of prevention of opportunistic infections?

A

Neutrophils and T lymphocytes are most important in terms of prevention of opportunistic infections

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4
Q

Describe supportive measures to reduces the liklihood of sepsis in people with haematological malignancy?

A
  • Prophylaxis
    • Antibiotics
      • Ciprofloxacin
    • Anti-fungal
      • Fluconazole or itrazonazole
    • Anti-viral
      • Aciclovir
    • PJP
      • Co-trimoxazole
  • Growth factors
  • Stem cell rescue/transplant
  • Protective environment
    • Such as laminar flow rooms
  • IV immunoglobulin replacement
  • Vaccination
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5
Q

How does chemotherapy affect neutrophils?

A

After chemotherapy neutropenia occurs (low concentration of neutrophils)

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6
Q

What are important factors of the neutropenia after chemotherapy in terms of risk of infection?

A
  • 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
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7
Q

Is bone marrow failure or immune destruction as a cause of neutropenia greater risk for infection?

A
  • Bone marrow failure higher risk than immune destruction
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8
Q

As well as neutropenia after chemotherapy, what are some additional risk factors for infection?

A
  • 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
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9
Q

What is febile neutropenia?

A

Is the development of fever in patients who are neutropenic

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10
Q

What are the most common causes of febile neutropenia?

A
  • Gram positive bacteria (60-70%)
    • Staphylococci
      • MSSA, MRSA, coagulase negative
    • Streptococci
      • Viridans
    • Enterococcus faecalis
  • Gram negative bacilli (30-40%)
    • Escherichia coli
    • Klebsiella spp
    • Pseudomonas aeruginosa
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11
Q

Is febile neutropenia usually caused by gram positive or negative bacteria?

A
  • Gram positive bacteria (60-70%)
    • Staphylococci
      • MSSA, MRSA, coagulase negative
    • Streptococci
      • Viridans
    • Enterococcus faecalis
  • Gram negative bacilli (30-40%)
    • Escherichia coli
    • Klebsiella spp
    • Pseudomonas aeruginosa
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12
Q

What are some possible sites of infection for febile neutropenia?

A
  • Respiratory tract
  • GI
  • Dental sepsis
  • Mouth ulcers
  • Skin sores
  • Exit site of central venous catheters
  • Perianal
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13
Q

Describe the presentation of neutropenic sepsis?

A
  • 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
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14
Q

What temperature is to be recorded for diagnosis of neutropenic sepsis?

A
  • Single reading of >38.5 degrees or 38 on two readings 1 hour apart
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15
Q

What are the sepsis 6?

A
  • Administer high flow oxygen
  • Blood cultures
  • IV antibiotics
    • Within1 hour
  • Serum lactate
  • IV fluid resuscitation
  • Measure urine output
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16
Q

Describe the treatment of sepsis?

A

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
17
Q

What antibiotics should be given for sepsis?

A
  • 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
18
Q

Describe the management of sepsis?

A

Deliver the sepsis 6:

  • Administer high flow oxygen
  • Blood cultures
  • IV antibiotics
    • Within 1 hour
  • Serum lactate
  • IV fluid resuscitation
  • Measure urine output
19
Q

What fungal infections are most common in immunocompromised?

A
  • Candida species
  • Aspergillus
20
Q

What are additional risk factors for fungal infection in immunocompromised?

A
  • Monocytopenia and monocyte dysfunction
21
Q

Describe the management of fungal infections?

A
  • Empirical
    • Echinocandins such as caspofungin and anidulafungin
  • For aspergillus infection
    • Voriconazole, isavuconazole
  • For mould infections
    • Liposomal amphotericin
22
Q

What anti-fungals should be used to treat aspergillus infection?

A
  • Voriconazole, isavuconazole
23
Q

What anti-fungals should be used to treat mould infections?

A
  • Liposomal amphotericin
24
Q

Describe the possible aetiology of severely lymphopenic patients?

A
  • 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
25
Q

What are examples of infections that typically infect severely lymphopenic patients?

A
  • 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
26
Q

What anti-viral medication is used for the following:

  • PJP
  • CMV
  • HSV1
  • VZV
  • Influenza A and B
  • Adenovirus
  • RSV
A

Immunology and Haematology (23 decks)

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