Infection in those with haematological malignancy

Question 1

Know which infections can occur in different forms of immunosuppression

Know the principles of treatment of each of these infections

Answer 1

.

Question 2

What WBC causes bacterial + fungal infection

Answer 2

Neutrophils

Question 3

What WBC causes fungal infection

Answer 3

Monocytes

Question 4

What WBC causes parasitic infections

Answer 4

Eosinophils

Question 5

What lymphocyte causes fungal (e.g. PJP) + viral infection

Answer 5

T lymphocytes

Question 6

What lymphocyte causes bacterial infection

Answer 6

B lymphocytes

Question 7

Name a prophylactic drug that can be used in the following for reducing risk of sepsis in haematological malignancies

• bacterial infection
• fungal infection
• viral infection
• a specific fungal infection called PJP (those with HIV are susceptible)

Answer 7

Ciprofloxacin

Fluconazole

Aciclovir

Co-trimoxazole

Question 8

Causes of neutropenia (low neutrophils)

Answer 8

Bone marrow failure –> reduced neutrophil production
-MOST LIKELY

Neutrophil destruction outwith bone marrow

Question 9

Febrile neutropenia* (commonest life threatening complication of cancer therapy, esp for haematological malignancies) is predominantly caused by what kind of bacteria

*when a patient with neutropenia develops an infection

Answer 9

Gram +ve

-e.g. coagulase negative staph, staph aureus, strep viridans

Question 10

If immunosuppressed from monocytopenia or monocyte dysfunction, what type of infection does this increase risk of?

Answer 10

Fungal

Question 11

Presentation of febrile neutropenia (potentially –> neutropenic sepsis)

Answer 11

FEVER >38
Tachycardia - sepsis sign
Hypotension - sepsis sign

Symptoms/signs of PNEUMONIA (common)
Skin infection - biopsy sites, IV sites
Symptoms/signs of UTI

Question 12

Investigations of febrile neutropenia

Answer 12

FBC - low neutrophils
U&Es
LFTs - low albumin, aminotranferases high

BLOOD CULTURES - peripheral & central venous catheter sites

CXR - pneumonia infiltrates

Question 13

Treatment of neutropenic sepsis

Answer 13

ABC RESUSCITATION

IV broad spectrum antibiotics
-if culture reveals MRSA or strep viridians, ADD VANCOMYCIN
gif no response after 3 days, switch/add antibiotics or add anti fungal

Question 14

Infections as a result of low lymphocytes can arise from what causes

Answer 14

Post stem cell transplant
-can get GRAFT VS HOST DISEASE

Post total body irradiation

Drugs - nucleoside analogues

Lymphoid malignancies

Question 15

What infections can low lymphocytes predispose to

Answer 15

Atypical pneumonia (mycoplasma, chlamydophila, legionella, PJP)

Viral

• shingles
• mouth ulcers (from HSV)

Fungal
-candida, aspergillus