Infections in haematological malignancies

Question 1

Primary immune cells in…

Bacterial and fungal infection

Fungal infection

Parasitic infections

Fungal and viral infection, PJP

Bacterial infection

Answer 1

Question 2

Aim: reduce risk of sepsis in hematological malignancy

Supportive care to prevent infections in haematological malignancies [4]

Answer 2

Prophylaxis, vaccination, IvIg

Growth factors - GCSF

Stem cell rescue or transplant

Protective environment - laminar flow room

Question 3

Neutropenic risk determinants

Cause [1]

Degree [2]

Duration [1]

Answer 3

Cause: marrow failure higher risk than immune destruction

Degree

• < 0.5 x 109/l - significant risk
• < 0.2 x 109/l - high risk for sepsis

Duration: >7 days is high risk

Question 4

Risk determinants for infection [4]

Answer 4

Disrupted skin/mucosal surfaces

Altered flora/ab resistance

Lymphopenia

Monocytopenia

Question 5

Causes of monocytopenia in the context of haematological malignancies [3]

Answer 5

Hairy cell leukemia

Chemotherapy

Mycobacterium

Question 6

Fungal infections in immunocompromised patients

Give 2 species that are common in immunocompromised

What factor contributes to risk of fungal infection

Answer 6

Candida and aspergillus

Monocytopenia - increases risk of fungal infection

Question 7

Febrile neutropenia are caused by bacterial infecitons

Give 2 examples of gram positive bacteria

Give 3 examples of gram negative bacilli

Answer 7

Gram positive bacteria

• Staphylococci: MSSA, MRSA, coagulase negative
• Streptococci: viridans

Gram negative bacilli

• Escherichia coli
• Klebsiella spp
• Pseudomonas aeruginosa

Question 8

Presentation of neutropenic sepsis [5]

Answer 8

Fever with rigors

Chest infection/pneumonia

Skin sepsis - cellulitis

UTI

Septic shock

Question 9

Treatment of neutropenic sepsis [2]

What 2 broad spectrum IV abs to use

What to add in gram positive infections [2]

If no response in 72 hours…

What imaging needs to be done to look for source

Answer 9

Resuscitation ABC and SEPSIS 6

Tazocin and gentamicin to start off

Gram positive identified: add vancomycin, teicoplanin

No response in 72 hrs add IV antifungal caspofungin

Look for source - CT chest/abdo/pelvis

Question 10

Infection in severely lymphopenic patients causes [5]

Answer 10

Stem cell transplant recipients especially allogeneic

Recipients of total body irradiation

GVHD

Nucleoside analogues or ATG

Lymphoid malignancy