Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3 immunology and haematology > infections in patients w/ haematological malignancy > Flashcards

infections in patients w/ haematological malignancy Flashcards

1
Q

cause of death after stem cell transplants

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

supportive measures aimed at reducing risk of sepsis in haematological malignancy

A 
prophylaxis
growth factors e.g. G-CSF
stem cell rescue/transplant
protective environment e.g. laminar flow rooms 
IV immunoglobulin replacement 
vaccination
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

prophylaxis to reduce risk of sepsis in haematological malignancy

A

abx - ciprofloxacin
anti-fungal - fluconazole, itraconazole
anti-viral - aciclovir
PJP - co-trimoxazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

who is at highest risk of neutropenic infection

A

cause of neutropenia (marrow failure > immune destruction)

degree of neutropenia

  • <0.5x10^9/L - significant risk
  • <0.2x10^9/L - highest risk

duration of neutropenia
- >7days - high risk
(AML therapy and stem cell transplantation produces profound neutropenia ~14-21 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

why do marrow failure pts have higher risk of neutropenic infection than immune destruction pts

A

bone marrow failure = failure of production
- only neutrophils left are old and dying and less functional

immune destruction - bone marrow is still able to respond to infection and produce more neutrophils which are able to fight the infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

additional risk factors for infection

A

disrupted skin/mucosal surfaces

altered flora/abx resistance

lymphopenia

monocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

disrupted skin/mucosal surfaces examples

A

hickman line, venflons

mucositis affecting GI tract

GVHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

altered flora and antibiotic resistance - how can it occur

A

prophylactic abx can save lives in severe neutropenia but also have -ve side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

lymphopenia as an additional risk factor for infection - what causes it

A

common in lymphoma

result of treatment e.g. fludarabine, ATG

stem cell transplantation, GVHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what causes monocytopenia

A

hairy cell leukaemia

chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

bacterial causes of febrile neutropenia

A

gram +ve - 60-70%
gram -ve bacilli - 30-40%

patterns may now relate to abx prophylaxis, emerging infections, use of lines etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what types of gram +ve bacteria infections are seen

A

staphylococci: MSSA, MRSA, coagulase -ve
streptococci: viridans

enterococcus faecalis/faecium
corynebacterium spp
bacillus spp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what types of gram -ve bacterial infections are seen

A

escherichia coli

Klebsiella spp: ESBL

psuedomonas aeruginosa

enterobacter spp
acinetobacter spp
citrobacter spp
stenotrophomonas maltophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

possible sites of infection

A 
resp tract
GI - typhlitis 
dental sepsis 
mouth ulcers
skin sores
exit site of central venous catheters
perianal (avoid PRs)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

presentation of neutropenic sepsis

A

fever w/ no localising signs - single reading of >38.5 or 38 on two readings 1hr apart

rigors
chest infection/pneumonia 
skin sepsis - cellulitis
UTI
septic shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is crucial in sepsis

A

early recognition and treatment

consider it in any one who has recently had chemotherapy (even up to 6 weeks after last dose)

17
Q

what is severe sepsis/septic shock

A

signs of systemic inflammation (SIRS) AND presumed organ infection and organ dysfunction

18
Q

what is the sepsis 6

A

GIVE:

  • high flow oxygen
  • appropriate IV abx within 1hr
  • IV fluid resus

TAKE:

  • blood cultures, other cultures, consider source control
  • serum lactate concentration
  • UO
19
Q

why is important to administer abx early in sepsis

A

every hr delay increases chance of mortality by 8%

20
Q

investigation of a neutropenic fever

A

hx and examination

blood cultures - hickman line and peripheral

CXR

throat swab and other clinical sites of infection

sputum if productive

FBC, renal function, LFTs, coagulation screen

21
Q

management of neutropenic sepsis

A

resus - ABC and sepsis 6

broad spectrum IV abx

  • tazocin and gentamicin
  • if gram +ve identified: add vancomycin or

if no response at 72hrs: add IV antifungal treatment
- capsofungin (empiric therapy)

CT chest/abdo/pelvis to look for source

modify treatment based on culture results

22
Q

fungal infection in immunocompromised patients

A

candida spp e.g. aspergillus

life threatening, deep seated infection

lung, liver, sinuses, brain

23
Q

what contributes to the risk of fungal infection

A

monocytopenia and monocyte dysfunction

24
Q

where is fungal infection most commonly seen

A

in pts who’ve either had transplant or treatment for acute leukaemia

25
Q

therapy of fungal infections

A

empirical - echinocandins e.g. capsofungin, anidulafungin

aspergillus - voriconazole, isavuconazole (can both be given IV/oral)

moulds - liposomal amphotericin (ambisome)

26
Q

infections in severely lymphopenic patients - when does it happen

A

stem cell transplant recipients, esp allogenic

recipients of total body irradiation

GVHD

use of nucleoside analogues (fludarabine) or ATG

lymphoid malignancy e.g. lymphoma, CLL, ALL

27
Q

types of infections seen in severely lymphopenic patients

A

pneumonitis

viral

fungal

atypical mycobacteria

28
Q

pneumonitis infections seen in severely lymphopenic patients

A
  • pneumocystis jirovecii (PJP)
  • CMV - can also cause GI infection
  • RSV
29
Q

viral infections seen in severely lymphopenic patients

A
  • shingels (VZV)
  • mouth ulcers (HSV)
  • adenovirus
  • EBV (PTLD)
  • SARS-CoV2
30
Q

what is PTLD

A

post-transplantive lymphoproliferative disorders

driven entirely through activation of EBV

happens in pts who are immunocompromised after transplants (bone marrow/stem cell)

31
Q

fungal infections seen in severely lymphopenic patients

A

candida

aspergillus

murormycosis

32
Q

atypical mycobacteria infections seen in severely lymphopenic patients

A

skin lesions

pulmonary and hepatic involvement

33
Q

therapy for viral infections - PJP

A

high dose trimoxazole

IV initially then switch to oral if patients can tolerate it

34
Q

therapy for viral infections - CMV

A

ganciclovir, foscarnet

both IV

oral preparation: valganciclovir (mostly for post-allogenic transplant pts where you are monitoring for CMV reactivation)

35
Q

therapy for viral infections - HSV1, VZV

A

aciclovir

treat promptly to reduce risk of postherpetic neuralgia

36
Q

therapy for viral infections - influenza A/B

A

oseltamivir

zanamivir

37
Q

therapy for viral infections - adenovirus

A

cidofovir

IV

38
Q

therapy for viral infections - RSV

A

ribavirin

39
Q

therapy for viral infections - not anti-viral

A

immunoglobulin replacement e.g. post alloSCT

Y3 immunology and haematology (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions