Management + Prevention Bacterial Immunocompromised

Question 1

Factors affecting Innate system- Primary (2)

Answer 1

Complement deficiencies

Phagocyte cell deficiencies

Question 2

Factors affecting Innate system- Secondary (6)

Answer 2

Burns 
Trauma
Major surgery 
Catheterization 
Foreign bodies (shunts, prosthesis)
Obstruction

Question 3

Factors affecting Adaptive systems- Primary (3)

Answer 3

T cell defects
B cell deficiencies
Severe combined immunodeficiency

Question 4

Factors affecting Adaptive systems- Secondary (6)

Answer 4

Malnutrition 
Infectious diseases 
Neoplasm 
Irradiation 
Chemotherapy 
Splenectomy

Question 5

What do Burns damage? (3)

Answer 5

Body’s mechanical barriers, Neutrophil function, and immune response

Question 6

What are the major pathogens in Burn wound infections?

Answer 6

Aerobe, Facultative anaerobe, Fungi

Pseudoneumonas aeruginosa and staphylococcus aureus

—-> Ecthyma gangrenosum

Question 7

How to treat Burn wound infection? (2)

Answer 7

Aminoglycoside + Beta-lactam (ceftazidime)

Carbapenem (Imipenem)

Question 8

What causes traumatic injury and surgical wound infections?

Answer 8

S.aureus

Question 9

What causes Catheter-associated infection of urinary tract?

Answer 9

GNB- Endogenous bacteria or cross-infection

Question 10

What causes intravenous and peritoneal dialysis catheter infections?

Answer 10

Staphylococci (most common)

GNB

Candida

Question 11

What causes infection of plastic devices in situ? E.g. Prosthetic Heart Valve

Answer 11

S.epidermidis

Question 12

What causes infection in Leukemia?

Answer 12

Due to lack of circulating neutrophils that follows bone marrow failure

Question 13

When is septicemia more common?

Answer 13

After exposure to chemotherapy

Question 14

What is the Neutrophil count for Neutropenia?

Answer 14

< 0.5 x 10^9 neutrophils/L

Question 15

When do prolonged periods of Neutropenia occur?

Answer 15

After bone marrow transplantation

Question 16

What is length of Neutropenia for a fungal infection?

Answer 16

> 21 days

Question 17

Which infective organisms are more common is the early periods of Neutropenia?

Answer 17

E.coli, P.auerginosa, Staphylococci, Sreptococci, Enterococci

Question 18

How long do solid organ transplant infections take to occur?

Answer 18

3-4 months

Question 19

Solid Organ Transplant infection- Drugs (2)

Answer 19

Cytotoxic Drugs —> Suppress CMI and Humoral Immunity

High doses Corticosteroids —> Suppress inflammatory response

Question 20

Causes of Infection in Neutropenic patients - Gram-positive (7)

Answer 20

S. aureus 
Coagulase-negative staphylococci
Streptococci
Listeria 
Nocardia asteroids
Mycobacterium tuberculosis 
Mycobacterium avium-intracellulare

Question 21

Causes of infection in Neutropenic patients - Gram-negative (6)

Answer 21

E.coli
Klebsiella pneumoniae
Other Enterobacteriacae 
Pseudoneumonas aeruginosa
Bacteroids fragilis
Other anaerobes

Question 22

Causes of Infection in Neutropenic patients - Fungi (5)

Answer 22

Candida 
Aspergillus
Cryptococcus neoformans
Histoplasmosis capsulatum
Pneumocystis jiroveci

Question 23

Causes of infection in Neutropenic patients - Parasites (2)

Answer 23

Toxoplasma gondii

Strongyloides stercoralis

Question 24

Causes of infection in Neutropenic patients - Viruses (6)

Answer 24

Herpesviruses (MOST COMMON)
Hepatitis B 
Hepatitis C
Polyomaviruses- BKV, JCV
Adenoviruses
HIV

Question 25

AIDS infections

Answer 25

Lack of CMI —> Intracellular microbes

Question 26

Cellular Immune Dysfunction- Bacteria and Fungi (9)

Answer 26

Listeria monocytogenes
Salmonella
Nocardia asteroids
Legionella
Mycobacterium tuberculosis, non-mycobacterium tuberculosis 
Cryptococcus neoformans
Histoplasma capsulatum 
Coccidiodes immitis
Pneumocystis jiroveci

Question 27

Cellular Immune Dysfunction- Viruses and Protozoa (3)

Answer 27

HSV, CMV, VZV
Cryptosporidium
Toxoplasma gondii

Question 28

Principles of empiric antibiotic therapy (3)

Answer 28

1- Intravenous administration
2- Cover both Gram -ve and Gram +ve
3- Give Bactericidal agents (e.g. Aminoglycoside —> Vancomycin)

Question 29

How does Empiric therapy work? (3)

Answer 29

After culture collection DONT WAIT for Lab reports

1- Gram Negative —> Anti-pseudomonal activity
2- Gram Positive suspected —> Vancomycin
3- Fungi suspected —> Amphotericin B

Question 30

Vaccines for what?

Answer 30

Pneumococcal, VZV

Question 31

Chemoprophylaxis for what?

Answer 31

PJP