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Y4: Infectious Disease > Infections in the Immunocompromised Host COPY > Flashcards

Infections in the Immunocompromised Host COPY Flashcards

1
Q

What is the Adaptive Immune Response split up in to?

A
  • Humoral (B cells)
  • Cellular (T cells)
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2
Q

What results if there is a compromised immune defence system?

A

Increased susceptibility to infection

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3
Q

What conventional pathogens may take advantage of a compromised defence system?

A
  • Endogenous flora
  • Hospital acquired bacteria
  • Environmental organisms
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4
Q

Name some opportunistic pathogens which may take advantage of a compromised immune system?

A
  • CoNS
  • Aspergillus
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5
Q

What are the different types of immunodeficiency?

A
  • Primary
  • Secondary
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6
Q

Describe primary immunodeficiency?

A
  • Inherited
  • Exposure to i**n utero environmental factors
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7
Q

Describe secondary immunodeficiency?

A
  • Underlying disease state
  • Treatment for disease
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8
Q

What is the principal cause of morbidity and mortality in the immunocompromised host?

A

Infection

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9
Q

What is the most important risk factor for infection?

A

Neutropaenia

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10
Q

How is neutropenia defined?

A

Less than 0.5 x109/L

OR

Less than 1x109 and still falling

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11
Q

Draw a flowchart to show how neutropaenia can arise?

A
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12
Q

What happens to the incidence of infection neutropaenia duration?

A

The higher the duration of neutropaenia, the greater incidence of infection

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13
Q

What else is also important regarding neutrophils?

A

Neutrophil function

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14
Q

What can occur after a patient has received any of the following: cytotoxic drugs, irradiation and steroids?

A
  • Reduced:
    • Chemotaxis
    • Phagocytic activity
    • Intracellular killing
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15
Q

Describe Chronic Granulomatous Disease

A
  • Inherited
  • X-linked inheritance is most common
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16
Q

What is the cause of Chronic Granulomatous Disease?

A
  • Defect in NADPH oxidase gene
  • Oxygen radicals deficiency
    • Normally give neutrophils their damaging effect
  • Defective intracellular killing
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17
Q

How does Chronic Granulomatous Disease manifest?

A
  • Abscesses
  • Recurrent infections
  • Granuloma formation
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18
Q

What is the pulmonary infection in Chronic Granulomatous Disease often caused by?

A
  • S. aureus
  • Aspergillus
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19
Q

What does this child suffer from?

A

Chronic granulomatous disease

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20
Q

What is cellular immunity suppressed by?

A
  • DiGeorge syndrome
  • Malignant lymphoma
  • Cytotoxic chemotherapy
  • Extensive irradiation
  • Immunosuppressive drugs
  • Infections
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21
Q

Name some infections which can suppress immunity?

A
  • HIV
  • EBV
  • CMV
  • Mycobacterial
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22
Q

What do radiotherapy and chemotherapy ultimately cause?

A

Hypogammaglobulinaemia

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23
Q

What role does the spleen play in immunity?

A
  • Splenic macrophages eliminate encapsulated bacteria
  • Site of the primary immunoglobulin response
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24
Q

What is the site of the primary immunoglobulin response?

A

The spleen

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25
Q

What infections are you at risk of if you suffer from any of the following:

  • Humoral deficiency
  • Splenectomy
  • Hyposplenism
A
  • S. Pneumoniae
  • H. Influenzae b
  • N. Meningitidis
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26
Q

Name some are the principal physical barriers against infection?

A
  • Skin
  • Conjunctivae
  • Mucous membranes
    • GIT
    • RT
    • GU tract
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27
Q

What does desquamate mean?

A

The process where the top layer of skin dies and falls off to give place to newer skin

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28
Q

Describe the normal physiological environment of the skin?

What can impair the integrity of the skin?

A
  • Dry
  • pH 5-6
  • 5o cooler than the rest of the body
  • Secretory IgA present in sweat

Chemotherapy

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29
Q

Draw the flow chart for what happens with GI mucosal barrier injury and colonization resistance?

A
30
Q

What is important to note about mucosal barriers?

A
  • They have a high mitotic index
    • ie mitosis occurs rapidly -> fast healing
31
Q

How is a severe nutritional deficiency defined?

A
  • Less than 75% ideal body weight
    • OR
  • Rapid weight loss
    • +
  • Hypoalbuminaemia
32
Q

What can a severe nutritional deficiency result in?

A

Compromised integrity of host defences

33
Q

What can iron deficiency specifically result in?

A

Reduces killing capacity of neutrophils and T cells

34
Q

How can tumours cause local organ dysfunction?

Which organ is particularly susceptible?

A
  • Due to the obstruction of the tumour
  • Can lead to infection

Lung

35
Q

What can a CNS tumour cause?

A
  • Spinal cord compression
  • Loss of cough/swallowing reflex
  • Incomplete bladder emptying

All increase risk of infection

36
Q

Describe the effect of stress and diabetes on the immune system?

A
  • Stress
    • reduced T cell function
  • Diabetes Mellitus
    • reduced opsonization
37
Q

What are the general principles of infection in solid organ transplant?

A
  • Optimal tissue typing
  • Donor evaluation
  • Organ procurement
  • Surgical technique
  • Tailored immunosuppressive regimen
  • Prevention of infection
38
Q

What transplants have the highest infection rate and mortality related to infection?

A

Heart and lung transplants

39
Q

What should be used for the diagnosis of an infection following an SOT (solid organ transplant)?

A
  • Radiology
  • Histology
  • Serology
  • Molecular medicine
40
Q

What is an important consideration regarding infection relating to solid organ transplant?

A
  • The inflammatory response is impaired
    • Less clinical signs
    • Less radiological signs
41
Q

What ensures good clinical outcomes with infection in SOT?

A
  • Early diagnosis
  • Fast, aggressive radiotherapy
42
Q

What infections can occur following Solid Organ Transplant?

A
  • Donor-derived infections
    • latent
    • active blood stream infection at procurement
  • Reactivation of infections
  • Opportunistic pathogens
43
Q

What are the latent donor-derived infectious agents to worry about?

A
  • TB
  • HIV
  • Syphilis
44
Q

What infections can be active bloodstream infection at procurement from a donor following SOT?

A
  • E. Coli
  • Salmonella
  • Pneumococci
  • Staphylococci
45
Q

What infections can be reactivated following SOT?

A
  • HSV
  • CMV
  • M. tuberculosis
46
Q

What opportunistic pathogens can cause infection following SOT?

A
  • Aspergillus
  • Pneumocystis
47
Q

What is pictured here?

What would cause it?

A

Severe lung infection in a transplant recipient

Pneumocystis jerovecii

48
Q

What is pictured here?

A

Herpetic stomatitis caused by HSV

49
Q

What is pictured here?

A

Shingles caused by Varicella zoster virus

50
Q

What would cause the following?

A

CMV

51
Q

What is neutropaenic fever until proven otherwise?

A

Infection

52
Q

What percentage of haematology malignancies and solid tumour cases does neutropaenic fever develop in?

A
  • Haematological malignancies
    • 100%
  • Solid tumours
    • 50%
53
Q

What are 2/3 of neutropaenic fever cases due to?

A
  • Infection
    • endogenous or exogenous
54
Q

What are the most common infection sites in febrile neutropaenic patients with a haematological malignancy?

What is the single most common site?

A

The single most common site is the blood stream

55
Q

Name some anaerobic bacteria?

A
  • Bacteroides spp.
  • Clostridium spp.
56
Q

What is rigors?

A

Sudden feeling of cold with shivering accompanied by a rise in temperature

57
Q

What is Sepsis?

A

SIRS and evidence of infection

58
Q

What is septic shock?

A

Sepsis-induced hypotension requiring inotropic support

59
Q

What is Neutropenic Sepsis / Febrile Neutropenia?

A
  • Neutrophil count less than 0.5
  • +
  • Fever/Hypothermia OR SIRS OR Sepsis
60
Q

What is used to assess the severity of sepsis?

A

NEWS score

61
Q

What is the sepsis 6?

A
  • Administer high flow oxygen
  • Take blood cultures
  • Give IV fluid
  • Give broad spectrum antibiotics
  • Measure serum lactate and FBC
  • Measure hourly urine output
62
Q

What makes a sepsis patient a standard risk patient?

A

NEWS <= 5

63
Q

What is the treatment pathway for a standard risk patient with Neutropaenic Sepsis?

A
64
Q

What makes a Neutropenic shock patient high risk?

A

NEWS >= 5

65
Q

How do you treat a high-risk patient with Neutropenic sepsis?

A
66
Q

What do you add to Neutropaenic Sepsis treatment if a skin or soft tissue infection is suspected?

A

Vancomycin

67
Q

What do you add to Neutropaenic Sepsis treatment if there is a suspected atypical pneumonia?

A

Clarithromycin

68
Q

What do you add to Neutropaenic Sepsis treatment if there is a previous/known ESBL infection/carrier?

A

Meropenem

69
Q

CMV?

A
  • Causes problems in babies
  • Once infected, you have it for life
  • Cold sores, chicken pox
  • Newborn hepatosplenomegaly
70
Q

Pneumocystis jiroveci?

A
  • Fungus
  • Pneumonia in immunocompromised host
  • Green
71
Q
A

Y4: Infectious Disease (18 decks)

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