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7. Microbiology II > Infections in the Immunocompromised Host > Flashcards

Infections in the Immunocompromised Host Flashcards

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1
Q

List the 4 types of immunodeficiency.

A

Neutropenia
Cellular immunodeficiency
Humoral immunodeficiency
Hyposplenism

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2
Q

List 5 other risk factors leading to infection in immunodeficiency.

A 
Breakdown of skin barriers
Breakdown of mucosal barriers
Altered microbiome
Impaired nutritional status
Organ dysfunction
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3
Q

List 4 causes of neutropenia.

A

Cytotoxic chemotherapy
Therapeutic irradiation
Steroids
Chronic granulomatous disease

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4
Q

List 7 causes of cellular immunodeficiency.

A 
DiGeorge syndrome
Malignant lymphoma
Chemotherapy
Irradiation
Immunosuppressive drugs
Allogenic stem cell transplant
Infections (e.g. HIV)
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5
Q

List 4 causes of humoral immunodeficiency.

A

Bruton agammaglobulinaemia
Lymphoproliferative disorders (e.g. CLL, multiple myeloma)
Radiotherapy
Chemotherapy

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6
Q

List 3 common organisms which cause infection in hyposplenism.

A

Pneumococcus (Strep. pneumoniae)
Haemophilus (H. influenzae type B)
Meningococcus (Neisseria meningitidis)

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7
Q

Define neutropenia.

A

<0.5 x10^9/L

1.0 x10^9/L and falling

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8
Q

Describe the pathophysiology of chronic granulomatous disease. (4)

A
  1. Defect in the NADPH oxidase gene, causing defective ROS formation
  2. This causes defective intracellular pathogen killing
  3. This results in the formation of abscesses throughout the body, e.g.
    a. Lungs
    b. Lymph nodes
    c. Skin
  4. This causes widespread inflammatory response
    a. This causes widespread granuloma formation
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9
Q

Describe the pathophysiology of neutropenia. (3)

A
  1. Decreased proliferation of haemopoietic progenitor cells
  2. This causes depletion of bone marrow reserves
    a. This causes development of neutropenia
  3. Neutrophil function is decreased, causing:
    a. Decreased chemotaxis
    b. Decreased phagocytic activity
    c. Decreased intracellular killing
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10
Q

What are the consequences of deficient cellular immunity? (1)

A

Increased susceptibility to infections by:

  • Viruses
  • Mycobacteria
  • Fungi
  • Protozoa
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11
Q

List 3 common causes of infection in humoral immunodeficiency.

A

Strep. pneumonia
Haemophilus influenzae B
Neisseria meningitis

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12
Q

Briefly describe the normal function of the spleen in immunity. (2)

A
  1. Primary immunoglobulin response: presence of specific antibody needed to opsonise encapsulated bacteria
  2. Splenic macrophages phagocytose encapsulated bacteria, e.g.
    - Pneumococcus
    - Haemophilus
    - Meningococcus
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13
Q

List 5 normal features of the skin which normally protect against infection.

A 
Desquamates
Dry
pH 5-6
Lower temperature (than inside body)
Secretory IgA in sweat
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14
Q

List 2 normal features of mucosal barriers which normally protect against infection.

A

High mitotic index

Lymphoid tissue

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15
Q

Describe the pathophysiology of mucosal barrier breakdown. (3)

A
  1. Disruption of normal mitosis causes inflammatory response in the mucosal lymphoid tissue
  2. This causes mucositis, causing:
    a. Pain
    b. Dysphagia
    c. Xerostomia (dry mouth)
    d. Ulceration
  3. This impairs GI function by altering mucosal permeability
    a. This can cause deficient nutritional status
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16
Q

What causes loss of normal colonisation resistance?

Give 4 examples.

A

Changes in the normal microbiome, e.g.

  • H2 antagonists
  • Proton pump inhibitors (PPIs)
  • Antibiotics
  • Diarrhoea
17
Q

How would you define severe nutritional deficiency? (3)

A

<75% of ideal body weight
Rapid weight loss
Hypoalbuminaemia

18
Q

Describe how nutritional deficiency causes immunodeficiency. (2)

A
  1. Compromise of integrity of host defences
  2. Causes iron deficiency, which further reduces immune function by:
    a. Decreased neutrophil function
    b. Decreased T cell function
19
Q

List 3 causes of organ dysfunction which may cause increased risk of infection.

A

Tumours
Organ obstruction
Spinal cord compression

20
Q

How does spinal cord compression cause increased risk of infection? (2)

A
  1. Loss of cough/swallow reflex
    a. Pathogens cannot be properly removed from lungs
  2. Incomplete bladder emptying
    a. Pathogens aren’t removed from bladder properly
21
Q

How would you define neutropenic fever? (5)

A

Neutrophil count: <0.5 (OR <1.0 if recent chemotherapy)
Fever/hypothermia: <36 or 38+

SIRS
Sepsis
Septic shock

22
Q

How would you define sepsis?

A

Evidence of infection, including SIRS

1 of the following, indicating organ dysfunction:

  • Hypotension (<100, <60)
  • Confusion
  • Resp rate 22+
23
Q

How would you define SIRS? (6)

A 
Sweats/chills
Rigors
Malaise
Resp rate 20+
HR 90+
Hypotension
24
Q

How would you define septic shock? (3)

A

Sepsis induced hypotension requiring inotropic support

OR

Sepsis induced hypotension which does NOT respond to fluid replacement

PLUS

Lactic acidosis

7. Microbiology II (12 decks)

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