Infections Among Immunocompromised

Question 1

pathogens in humoral defects

Answer 1

SIN

s pneumoniae
h influenza
neisseria sp

Question 2

pathogens in cellular defects

Answer 2

human herpesvirus
adenovirus
listeria, hpv, tb,
nocardia, p pneumonia

Question 3

pathogens in phagocytic defects

Answer 3

s aureus
coagulase negatve staph
s viridans
e coli
p aeruginosa
k pneumoniae

Question 4

why do cancer patients get fever and infection

Answer 4

disruptions in the barriers

splenectomized patients

Question 5

infections associated with specific types of cancer

Answer 5

table 3

Question 6

hosts with mm have hypogammaglobulinemia which predisposes them to __

Answer 6

encapsulated bacterial infections

Question 7

what is the clinical presentation of fever in neutropenic patient with an uncontrolled neoplasm involving the bone marrow or pt with cytotoxic agent therapy

Answer 7

febrile neutropenia

Question 8

what is fever and neutropenia

Answer 8

fever: >/= 38.5 C or three >/= 38 C but less/= 38.5C per 24 hrs
neutropenia: ANC <500 c/mm3

Question 9

t/f fever during chemotherapy induced neutropenia may be the only indication of a severe underlying disorder

Answer 9

true

Question 10

timeline of neutropenia

Answer 10

day 0: chemo, normal wbc
1st week: decline in wbc, inc mucositis
after: recovery of wbc, dec mucositis and fever

Question 11

algorithm for the approach to neutropenic fevers

Answer 11

figure 8

Question 12

monotherapy for high risk cancer patients

Answer 12

iv anti-pseudomonal b-lactam agent (cefepime, carbapenem, piptazo)

Question 13

indications to add other antimicrobials for cancer patients

Answer 13

• complications

- antimicrobial resistance is suspected or proven

Question 14

t/f vancomycin is recommended as a standard part of initial antibiotic regimen for fever and neutropenia

Answer 14

false

Question 15

read figure 12

Answer 15

ok

Question 16

when do most infections occur in sot

Answer 16

first few months after transplant

Question 17

most common virus in sot

Answer 17

herpesvirus (table 4)

cmv most notorious

Question 18

when do donor derived infections usually occur

Answer 18

within 1 month of transplant (ddx: hai)

Question 19

type of infection which can affect brain, heart, and liver in recipients

Answer 19

strongyloides

Question 20

timeline of infections in sot

Answer 20

day 0-30: donor derived infection or nosocomial infections
day 31-4 mos: reactivation of infection or opportunistic infections (viral pathogens), allograft infections,
>6 mos: community acquired pathogens

Question 21

t/f the longer the transplant surgery, the higher risk of infection

Answer 21

true

Question 22

drug for prophylaxis for utis and opportunistic infections

Answer 22

cotrimoxazole (trimetoprim-sulfamethoxazole)

Question 23

common infections after sot by site of infection

Answer 23

figure 12

Question 24

timing of hema transplant

Answer 24

pre-engraftment 0-30 d (bacterial, hsv reactivation)
engraftment 30-100 d (viral)
post engraftment >100 d

Question 25

t/f hsct are higher risk for fungal infections than sot

Answer 25

true

Question 26

in the first month after hsct, infectious complications are similar to ___

Answer 26

granulocytopenic patients on chemo for acute leukemia (febrile neutropenia)

Question 27

common sources of infection after hsct by infection site

Answer 27

table 6

Question 28

timing of infections in hsct

Answer 28

I: febrile neutropenia = bacterial
II: herpesvirus, cmv

Question 29

t/f empiric treatment in hsct infections is encouraged

Answer 29

false

Question 30

ways to reduce the risk of infection for sot patients

Answer 30

donor selection
vaccination
pre-emptive treatment (for cmv)
universal prophylaxis (before infection)

Question 31

prophylaxis regimens to reduce infections in transplants

Answer 31

table 8

Question 32

do not give vaccine with live attenuated virus/organisms in __

Answer 32

the first 6 mos

Question 33

hsct take vaccines ___

sot patients take vaccines ___

Answer 33

hasct = after
sot = before

Question 34

vaccination of hsct and sot recipients

Answer 34

table 9