Brainscape's Knowledge GenomeTM

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


See full index

Bloc G - Infection > May4 M1-Fever in Immune Compromised Hosts > Flashcards

May4 M1-Fever in Immune Compromised Hosts Flashcards

1
Q

febrile neutropenia def

A
  1. fever >38.3 once or >38 twice with 1 hr interval

2. ANC < 500

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

organisms to consider in febneut

A
  • gram- enteric rods (gut mucositis)
  • gram+ cocci like CoNS and MSSA, MRSA. Also, pseudomonas (central line infection)
  • candida (central line and gut), aspergillus (lungs)
  • Strep pneumo, resp viruses, C.diff (usual org causing fever)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

main cause of febneut in cancer chemo pts

A
  • unexplained fever (39%)
  • clinically defined infection (17%)
  • microbiologically defined infections (44%)
  • # 1 bacteremia with gram+ cocci*
  • # 2 bacteremia with gram - bacilli*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

cause of the unexplained fever in febneut patients

A

LPS and exotoxin shedding from gram- organisms inthe gut (can cross to blood bc barrier problem) but no invasion

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

(imp?) causes of fever in a NEWLY diagnosed cancer patient (no chemo yet)

A
  • tumour or cancer fever

- community stuff (S pneumo, resp viruses)

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

febneut patient with no symptoms: how to approach

A
  1. think of bacteria from denuded gut
  2. think of community things (pneumonia, respiratory viruses)
  3. persistent fever even on broad spectrum Abx, think fungal (candida, aspergillus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

febneut approach in symptomatic patient:

A
  • redness or painful IV = central line sepsis

- diarrhea: think C.diff

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

(imp) most common cause of bacteremia in cancer chemo patient

A

CoNS (staph epidermidis)

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

febneut approach in patient with symptoms of mucositis and shock

A

-gut bacteria
-pneumonia, resp viruses
-fungi
-CoNS
(all the previously said) and
STREP VIRIDANS (add this one if see these symptoms)

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

(imp?) organisms that must always be covered at least (as empiric Abx for the febneut)

A
  • gut bacteria (including anaerobes)
  • pseudomonas
  • staph aureus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

(imp?) organisms that must always be covered if there is presence of mucositis or shock (as empiric Abx for the febneut)

A
  • gut bacteria (including anaerobes)
  • pseudomonas
  • staph aureus
  • strep viridans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

(imp?) organisms that we must worry about when choosing empiric Abx for febneut if we know or are worried about resistance

A
  • MRSA
  • VRE
  • ESBL (extended spectrum beta lactamases, are gram- bacteria)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

(EXAM) broad spectrum Abx required to cover gram- of gut, staph aureus and pseudomonas

A

-broad spectrum beta-lactams (meaning beta-lactam + bli, like Pip/Tazo)
-aminoglycosides IV
-vanco IV
(if oral therapy at home = ciproflaxin + clindamycin)

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

when give empiric antifungal tx in febneut

A
  • NOT in beginning unless clinical evidence for FUNGAL infection
  • only if fever persists >4 days in cancer pt for febneut
  • *never stop Abx**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how to investigate for fungal infection in febneut when suspect it

A
  • check where candida caused disease: 1. liver and spleen imaging 2. retinal exam 3. chest CT
  • invasive pulmonary aspergillosis will be seen on chest CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

(imp?) best anti-fungal against aspergillosis in febneut pts

A

voriconazole

17
Q

when to give empiric anti-viral tx in febneut

A

NOT in the beginning and usually never UNLESS

  • characteristic rash of VZV, shingles or herpes
  • severe resp illness (influenza)
18
Q

3 phases of BMT

A
  • phase 1: pre-engraftment (neutropenia, barrier breakdown, mucositis and CVC access)
  • phase 2: post-engraftment (impaired cellular and humoral immunity. these cells recover in that order: NK, CD8 T. still restricted T cell repertoire
  • phase 3: late phase (impaired cellular and humoral immunity. these cells recovering: B, CD4 T. repertoire diversifies.
19
Q

(important) infections in phase 1 of BMT (bacteria, viruses, fungi)

A
  • gram- rods (bacilli)
  • gram+ organisms
  • HSV
  • resp and enteric viruses
  • aspergillus
  • candida
20
Q

(important) infections in phase 2 of BMT (bacteria, viruses, fungi)

A

-reactivation of latent viruses and organisms (CMV, EBV, HSV, VZV, TB)
-aspergillosis
(chronic viruses back. gut healing so less gram-)

21
Q

(important) infections in phase 3 of BMT (bacteria, viruses, fungi)

A
  • encapsulated bacteria (prob now bc immune system never back 100%)
  • VZV
  • aspergillus
  • pneumocystis
  • opportunistic pathogens
22
Q

(important) what organisms to cover in febneut

A

-gut organisms (including anaerobes)
-pseudomonas aeruginosa
-staph aureus
-respiratory
organisms
(beta-lactam+bli comination AND aminoglycoside)

23
Q

(important) when to use big things like vanco in febneut

A

ONLY if:

  • shock
  • mucositis
  • line sepsis
  • known MRSA
  • known bacteremia with g+ cocci
24
Q

infections in people with humoral immunity dysfunction

A
  • Strep pneumo
  • H. influenza
  • mycoplasma spp
  • moraxella
  • recurrent sinopulmonary infections with community organisms*
25
Q

function of humoral immunity against infections

A
  • secretory Abs in mouth and resp tract

- not functioning = sinusitis, recurrent ear infection, pneumonias

26
Q

cellular immunity dysfunction: infections you get

A
  • IC organisms: salmonella, listeria, mycobacterium spp

- fungi (inc. pneumocystis), viruses, parasites (inc. toxoplasma)

27
Q

cellular immunity dysfunction can happen how

A
  • SCID (no lymphoid tissue, no tonsils)
  • HIV
  • large amount systemic CSs
28
Q

complement immunity dysfunction = get what recurrent infection

A

Neisseria meningitidis

prob in MAC

29
Q

infections in neutropenic pts (not due to chemo)

A

community organisms

  • S. pneumo
  • S. aureus
  • Mycoplasma spp
  • resp viruses
  • N meningitidis
  • UTIs
30
Q

infection in Jobe’s syndrome

A

staph aureus (skin disease boils and all that)

31
Q

infections in CGD (chronic granulomatous disease, macrophages can’t do oxidative burst after phagocytosis)

A

catalase + organisms

  • S aureus
  • Aspergillus
32
Q

infections in asplenic or splenic dysfct people

A

encapsulated organisms (S pneumo, H influenza, N meningitidis) and also salmonella spp if have sickle cell

33
Q

management of fever in babies <3 months

A

medical emergency (especially if under 6 months of age)

34
Q

organisms babies can get infected with because of maternal stool and vaginal organisms and maternal organisms

A
  • enteric gram- rods
  • GBS
  • listeria
  • S aureus (MSSA, MRSA)
  • GAS
  • HSV (sepsis, encephalitis)
35
Q

organisms premature babies can be infected

A

candida albicans and all the previous (-enteric gram- rods

  • GBS
  • listeria
  • S aureus (MSSA, MRSA)
  • GAS
  • HSV (sepsis, encephalitis))
36
Q

approach to febrile neonates <1 months

A
  • presume serious bacterial infection
  • full septic workup (blood, urine cultures), LP culture
  • empiric Abx covering gram-, listeria, GBS
  • CXR, nasopharyngeal viral studies, stool culture
  • meningitis doses of ampicillin and cefotaxime if suspected
37
Q

acyclovir to febrile neonates: yes or no

A
  • not in current practice

- but delaying it increases mortality…

38
Q

tx of febrile neonates <1 month

A
  • ampicillin IV
  • gentamicin IV
  • cefotaxime IV for meningitis (3rd gen cephalosporin)
39
Q

tx of febrile neonates between 1-3 months of age

A

-option 1: ampicillin IV
+ gentamicin IV
-option 2: -ampicillin IV + cefotaxime IV for meningitis (3rd gen cephalosporin)

Bloc G - Infection (39 decks)

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