infections in immunocompromised Flashcards
identify 3 immunocompromised infections?
Pneumocystis jirovecii
Cryptococcus neoformans
Fungal infections other than tinea and thrush
Absence of neutrophils (
Kostmann’s, congenital neutropenia)
immunocompromised often infected with?
Characterized by recurrent bacterial infections and Aspergillus infection
defects in phagocyte function:
often infected with 3 bugs here:
Characterized by recurrent bacterial infections (especially S. aureus and other catalase positives), Aspergillus, and Candida sp. Infections
missing C5-C9 what are you going to be infected with?
neisseria
x-linked agammaglobulinemia- due to defect in what?
X-linked agammaglobulinemia – due to defect in Bruton tyrosine kinase
when does CVID present?
Common variable immunodeficiency – presents age 2 to 20, typically early teens, due to various genetic defects; may have autoimmune disorders
what is the most common immunodeficiency?
IgA deficiency – most common immunodeficiency
all manifesations of:
Clinical manifestations
Recurrent bacterial (especially encapsulated organisms like S. pneumoniae, H. influenzae) and viral infections
Recurrent sinopulmonary infections or otitis
Giardiasis
Some may be associated with autoimmune disorders or increased risk of malignancy
immunoglobulin deficiencies
what is defect in SCID?
how do you tx?
absence of T cells; impacts B cell function and B cells may also have functional deficiencies
Treated with stem cell transplantation
what is DiGeorge?
Congenital thymic hypoplasia, heart disease, hypoparathyroidism, neonatal hypocalcemia
May develop autoimmune disorders in later life
what is the disorder in Wiscott-Aldridge syndrome?
TIE
X-linked: in WAS gene on X-chromosome–>T cells unable to reorganize actin cytoskeleton
Thrombocytopenia, severe eczema
Treated with stem cell transplantation
High risk to develop malignancies (especially lymphoma)
phagocyte deficiencies: which organisms
you need PLACESS for you cats.
Catalase positive bacteria and fungi
S. aureus, Nocardia species, P. aeruginosa, Serratia species, enteric gram-negative bacilli, Candida species, Aspergillus species
complement deficiencies:
which organsism?
Neisseria infections
S. pneumoniae, H. influenzae, Neisseria species
Antibody deficiencies (B cell) which organsisms?
SHiN
SKiS
Organisms with polysaccharide capsules
Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Pseudomonas aeruginosa, Mycoplasma species, Salmonella species, Shigella species, Campylobacter species, rotavirus, enteroviruses, Giardia species
which organisms commonly infect?
Cellular and combined immuno-deficiencies
Opportunistic infections, fungi, viruses
what are 3 aquired immunodeficiencies?
Chemotherapy
Bone marrow and solid organ transplant
Immunosuppressive therapies
Splenectomy and Sickle Cell Disease
increased risk for which two organsims?
Increased risk for sepsis with encapsulated bacteria, especially S. pneumoniae and H. influenzae type b
Antibiotic prophylaxis and empiric therapy indicated
3 diseases of pregnancy?
UTIs
Hepatitis E: 15 -25% mortality
H1N1 influenza associated with increased morbidity and mortality
chemotherapy-induced neutropenia/immunodeficiency
what are the clinical manifestations? (4 bugs here)
clinical manifesations
Bacterial and candidal sepsis
Aspergillosis
Pneumocystic pneumonia
Disseminated varicella
3 ways to manage chemotherapy induced neutropenia/immunodeficiency?
Prophylaxis – bacterial and fungal, based on risk assessment for type of underlying malignancy
Aggressive use of empiric antimicrobial therapy at first sign of infection
G-CSF
which procedure brings these about?
Risk of neutropenia plus profound lymphocytic dysfunction plus, in some patients, graft-versus-host
Pattern of infection varies with the length of time from transplant
Bone Marrow and Solid Organ Transplantation
child w/albinism +
a phagocyte functional disorder characterized by large leukocyte granules
Chediak-Higashi syndrome
what type of disorder is chronic mucocutaneous candidiasis?
T-cell disorder
in myeloperoxidase deficiency, which bug commonly afflicts patient?
candida
in complement deficiency, what do ppl with C1-C4 suffer from?
recurrent bacterial infections, autoimmune disorders
how do you manage complement deficiency pts?
immunizations + prohylactic antibiotics if needed
immunoglobulin deficiencies:
- which infections?
- are they at increased risk for cancer/ autoimmune disorder?
- how do you dx?
how do you manage?
- recurrent bacerial infection ( S. pneumo + H. influenza) + viral infections , recurrent sinopulmonary infections or otitis, giradiasis
- yes, at increased risk for autoimmune disorders or increased risk for malignancy
- dx: quantitaive immunoglobulin measurement
- IgG replacement if deficient (do NOT use in IgA defiinecy), give prophylacit Abx.
what is SCID and how do you tx?
SCID = absece of T cells; impacts B cell function and B cells may also have functional deficiencies
tx: stem cell transplantation
what is DiGeorge?
what may these kids develop later in life?
-congenital thymic hypoplasia, heart disease, hypoparathyroidism, neonatal hypocalcemia
may develop autoimmune disorders later in life
what do kids with wiscott-aldridge syndrome present with?
how do you tx?
what are they at risk of developing?
- TIE: thrombocytopenia, eczema, infections
- tx w/stem cell transplantation
- high risk to develop malingancies (esp. lymphoma)
what are kids with lymphocytic disorders at risk for? (3)
- opportunistic infections (pneumocystis pneumonia; fungal infections, protozoa; disseminated viral)
- recurrent bacterial infection:
- increased risk for malignancy
KNOW: kid with phagocyte def at risk for??
catalase + and bacteria and fungi
kids with complement deficiencies at risk for?
neiserria infections
kids with antibody deficiencies (B cell)
organisms with polysaccharide capsule
cellular and combined immuno deficiencies at risk for?
opportunistic infections, fungi, viral infections
what are the five indications for immmune evaluation?
- opportunistic infection
- recurrent infection other than URIs in the young child at a day care center
- failure to thrive
- persistent infection despite therapy
- hx of recurrent infections w/a defined cause is more meaningful than a hx of frequent, self-limiting infections of presumed viral cause
what are the three evaluations for possible immunodef:
1
- history
- CBC, differential and platelet count (neutropenia and thrombocytopenia)
- Hgb electrophoresis (sickle cell disease), HIV, serology/PCR, sweat test (cystic fibrosis)
- addl testing based on prelim ddx
what is basic work up of possible immunodef
genomic analysis (for 120+ genes_
2 bugs with big impact on ppl w/splenectomy and sickle cell disease
sespis w/encapuslaed bacteria esp: s. pneumo and H. influenza type B
antibiotic prophylaxis and empiric therapy indicated
3 infections with pregnancys
UTIs
hepatitis E: 15-25% mortality
H1N1 influenza associated with increased morbidity and mortality
what is the risk of infection proprotional to in ppl w/chemo induced neutropenia?
proportional to degree and duration of neutropenia
t/f. in ppl wht chemo induced neutropenia, lymphocytic dysfunction is present and may also manifest as infection
true
what are 4 bugs that affect ppl with chemo induced neutropenia/immunodef
bacteria and candidal sespis
aspergillosis
pneuomycsitc pneumonia
disseminated varicella
