Infections Among Immunocompromised Flashcards
pathogens in humoral defects
SIN
s pneumoniae
h influenza
neisseria sp
pathogens in cellular defects
human herpesvirus
adenovirus
listeria, hpv, tb,
nocardia, p pneumonia
pathogens in phagocytic defects
s aureus coagulase negatve staph s viridans e coli p aeruginosa k pneumoniae
why do cancer patients get fever and infection
disruptions in the barriers
splenectomized patients
infections associated with specific types of cancer
table 3
hosts with mm have hypogammaglobulinemia which predisposes them to __
encapsulated bacterial infections
what is the clinical presentation of fever in neutropenic patient with an uncontrolled neoplasm involving the bone marrow or pt with cytotoxic agent therapy
febrile neutropenia
what is fever and neutropenia
fever: >/= 38.5 C or three >/= 38 C but less/= 38.5C per 24 hrs
neutropenia: ANC <500 c/mm3
t/f fever during chemotherapy induced neutropenia may be the only indication of a severe underlying disorder
true
timeline of neutropenia
day 0: chemo, normal wbc
1st week: decline in wbc, inc mucositis
after: recovery of wbc, dec mucositis and fever
algorithm for the approach to neutropenic fevers
figure 8
monotherapy for high risk cancer patients
iv anti-pseudomonal b-lactam agent (cefepime, carbapenem, piptazo)
indications to add other antimicrobials for cancer patients
- complications
- antimicrobial resistance is suspected or proven
t/f vancomycin is recommended as a standard part of initial antibiotic regimen for fever and neutropenia
false
read figure 12
ok
when do most infections occur in sot
first few months after transplant
most common virus in sot
herpesvirus (table 4)
cmv most notorious
when do donor derived infections usually occur
within 1 month of transplant (ddx: hai)
type of infection which can affect brain, heart, and liver in recipients
strongyloides
timeline of infections in sot
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
t/f the longer the transplant surgery, the higher risk of infection
true
drug for prophylaxis for utis and opportunistic infections
cotrimoxazole (trimetoprim-sulfamethoxazole)
common infections after sot by site of infection
figure 12
timing of hema transplant
pre-engraftment 0-30 d (bacterial, hsv reactivation)
engraftment 30-100 d (viral)
post engraftment >100 d
t/f hsct are higher risk for fungal infections than sot
true
in the first month after hsct, infectious complications are similar to ___
granulocytopenic patients on chemo for acute leukemia (febrile neutropenia)
common sources of infection after hsct by infection site
table 6
timing of infections in hsct
I: febrile neutropenia = bacterial
II: herpesvirus, cmv
t/f empiric treatment in hsct infections is encouraged
false
ways to reduce the risk of infection for sot patients
donor selection
vaccination
pre-emptive treatment (for cmv)
universal prophylaxis (before infection)
prophylaxis regimens to reduce infections in transplants
table 8
do not give vaccine with live attenuated virus/organisms in __
the first 6 mos
hsct take vaccines ___
sot patients take vaccines ___
hasct = after sot = before
vaccination of hsct and sot recipients
table 9
