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Hematology-Oncology Exam 2 > Opportunistic Infections- Dr. Moscatello > Flashcards

Opportunistic Infections- Dr. Moscatello Flashcards

1
Q

What constitutes a compromised host?

A

More than or equal to one defect in the bodies natural defense against microbial inbaders

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2
Q

What are compromised hosts at risk for?

A

Increased likelihood of suffering from severe and life threatening infections

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3
Q

What is a primary deficiency?

A

Something that’s inherited or congenital

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4
Q

What a secondary deficiency?

A

Something due to underlying disease state or results from treatment from disease

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5
Q

What are 2 examples of innate primary immunodeficiencies?

A

Complement or phagocytic deficiencies

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6
Q

What are 4 examples of secondary innate immunodeficiencies?

A

Burns, trauma, surgery, or obstruction

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7
Q

What are 3 examples of adaptive primary immunodeficiencies?

A

T-cell, B-cell, and combined immunodeficinces

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8
Q

What are 6 examples of adaptive secondary immunodeficiencies?

A

Malnutrition, AIDS, cancer, transplantations, stress, pregnancy

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9
Q

If you have a C3 complement deficiency, what organisms are you likely to get infection from?

A

Enterobacteriaceae, Gram positive cocci, Haemophilus influenzae, Pseudomonas aeruginosa

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10
Q

Who is likely to get neisseria infections?

A

People with MAC complement deficiencies

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11
Q

What type of bacterial infections do people with chronic granulomatous disease get?

A

CATALASE POSITIVE BACTERIA

-Enterobacteriaceae, Staphylococcus, Pseudomonas aeruginosa, Aspergillus, Mucor (Rhizopus)

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12
Q

Who is at risk of infections with these bugs?
Streptococcus pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa, Acinetobacter baumanii

A

Leukocyte Adhesion Deficiency Patients

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13
Q

Why do burns cause secondary innate deficiencies?

A

They damage the cutaneous microbial barrier and vascularized tissue

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14
Q

How do organisms gain access to blood in a trauma or surgery and what can this lead too?

A

Via wound or GI

-Lead to sepsis and shock

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15
Q

What things do obstruction affect that can cause a secondary innate deficiency?

A

Urine flow, ciliary action, and peristalsis

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16
Q

What type of bacterial infections are common in burns?

A
  1. Pseudomonas aeruginosa
  2. S. Aureus
  3. Coagulase negative Staph
  4. Enterobacteriaceae
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17
Q

What type of fungal infections are common in burns?

A
  1. Candida (localized)
  2. Aspergillus
  3. Mucor (disseminated)
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18
Q

What types of viral infections are common in burn patients?

A

Herpes… but these are uncommon

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19
Q

What % of nosocomial infections are catheter related?

A

40%

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20
Q

What kind of bacteria can cause bacteremia due to catheters (obstruction)?

A
  1. E. Coli
  2. K. Pneumoniae
  3. Proteus
  4. Pseudomonas
  5. Yeast
  6. Enterococci
  7. S. Epidermidis
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21
Q

What does X-linked agammaglobulinemia cause?

A

No B cells in the periphery

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22
Q

What bugs are seen in X-linked agammaglobulinemia?

A
  1. S. Pneumoniae

2. H. Influenzae

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23
Q

In Hyper-IgM syndrome and selective IgA deficiency where do you see bacterial infections?

A

At mucosal surfaces

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24
Q

What types of viruses are seen with Hyper-IgM syndrome and selective IgA deficiency?

A

Non-enveloped (B19 and norovirus)

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25
Q

What does DiGeorges syndrome affect?

A

T-cells

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26
Q

What kind of pathogens affect DiGeorges patients?

A

Viruses and fungi

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27
Q

In SCID (combined immunodeficiency) what types of infections would you see?

A

Bacteria, viruses, fungi, parasites

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28
Q

What is required to ensure growth, maintenance, and specific functions?

A

Cellular balance between supply of nutrients and energy and the body’s demand for them

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29
Q

What types of cells are affected by malnutrition?

A

T cell and B cell immunity

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30
Q

What was the progression of HIV?

A

Asymptomatic Infection –>
Persistent, generalized lymphadenopathy –>
Symptomatic –>
AIDS defining conditions

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31
Q

Did you review the charts of pulmonary, GI, and Cutaneous infections in patients with HIV?

A

GO DO IT

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32
Q

What CD4 levels do you see pneumocystis jiroveci with?

A

50-200

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33
Q

What CD4 levels will you see cryptococcus neoformans in an HIV patient?

A

Under 100

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34
Q

What CD4 levels will you see toxoplasma gondii in an HIV patient?

A

Under 200

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35
Q

What are some other CNS infections seen in HIV patients?

A

TB, syphillis, listeria, HIV, systemic fungi

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36
Q

Did you review the infections associated with malignancy chart?

A

GO DO IT

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37
Q

What are infections in the first month post-transplant generally related to?

A

Surgery

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38
Q

What exacerbates infections post-transplant in the first month?

A

Immunosuppression

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39
Q

What types of infections are seen in the first month post-transplant?

A

Wound infections, nosocomial pneumonia, UTI, bacteremia, colitis, and VRE

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40
Q

What is the most common viral infection seen in first weeks post-transplantation?

A

HSV

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41
Q

What causes infection post-transplantation from 2-6 months?

A

Immunosuppression

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42
Q

After 6 months post transplantation, where do infections come from?

A

Community acquired infections

43
Q

What types of infections are seen 6 months post transplantation?

A

Influenza, UTI, pneumococcal pneumonia, VZV reactivation, HBV, HCV, CMV, HHV-6, HHV-8, EBV

44
Q

When are bacterial infections in transplant patients generally seen?

A

First month after transplant

45
Q

List some bacterial infections seen commonly in the first month after transplant?

A

P. qeruginosa, S. marcescens, E. cloacae, MRSA, VRE, Legionella, Nocardiosis

46
Q

What type of virus reactivates in many transplant recipients?

A

HERPES

47
Q

What is the most common and most important infection in solid organ transplants?

A

CMV

48
Q

What % of all transplant develop symptomatic CMV infections?

A

20-60%

49
Q

When is the risk greatest for CMV infection post-transplant?

A

With a CMV seropositive donor to a seronegative recipient

50
Q

When is CMV post-transplant commonly seen?

A

A few months after transplants

51
Q

What are some symptoms of CMV infection post transplant?

A

Fever, pneumonia, GI ulcers, hepatitis, intersitial pneumonitis*

52
Q

What type of transplant is VZV seen in 5-10%?

A

Renal

53
Q

True or False, HSV is a viral infection seen post-transplant?

A

TRUE

54
Q

What 2 things can EBV cause post-transplant?

A

Mononucleosis and PTLD

55
Q

What 2 things can BK virus cause post-transplant?

A

Polyomavirus

Renal disease

56
Q

What viruses are community acquired rather than reactivation of latent viruses in viral infections post-transplant?

A

Influenza A and B, RSV, Parainfluenza 1, 2, 3, and adenovirus

57
Q

What are the 5 fungal infections seen post-transplant?

A
  1. Candida: Oral, esophageal, vaginal, disseminated
  2. Aspergillus
  3. Cryptococcus
  4. Coccidiodes
  5. Histoplasmosis
58
Q

What is seen in toxoplasmosis infections?

A

Ring enhancing lesions

59
Q

What is seen in cryptococcus neoformans infections?

A

Encapsulated yeasts

60
Q

What is a major opsonin to remove bacteria from the blood?

A

C3b

“B binds Bacteria”

61
Q

What is made from C5-C9?

A

MAC

62
Q

What part of neisseria makes it susceptible to complement mediated lysis?

A

The lipooligosaccharide

-Complement can’t lyse gram + or gram - bacteria because they have lipopolysaccharide

63
Q

What enzyme is deficient in chronic granulomatous disease?

A

NADPH oxidase

64
Q

What are some catalse positive bacteria?

A 
SPANS KEC
S. Aureus
Pseudomonas
Aspergillous
Nocardia
Serratia

Klebsiella
E. Coli
Candida

65
Q

Do you see pus in LAD?

A

NO… the neutrophils can’t adhere to vascular endothelium so there is no pus or abscess

66
Q

What can bacterial infections post burn lead to?

A

Sepsis

67
Q

What are the 2 most common bacterial infections after a burn?

A

Pseudomonas (blue/green pus with a grape smell)

S. Aureus

68
Q

What is the most common community acquired cause of UTI?

A

E. Coli

69
Q

What is the most common cause of nosocomial UTI?

A

Still E. Coli, but Klebsiella, Pseudomonas, Proteus can also be more common causes

70
Q

What is mutated in X-linked agammaglobulinemia?

A

BTK… the cells can’t mature in the BM so you have no B cells in the peripery

71
Q

Why are people with X-linked agmmaglobulinemia more susceptible to encapsulated bacteria?

A

Because they need antibodies to remove these and you can’t make antibodies because you don’t have B cells

72
Q

What causes Hyper-IgM sndrome?

A

Mutation in CD-40L so there is no class switching

73
Q

What is the most common B cell disorder?

A

Selective IgA deficiency (no IgA)

74
Q

What causes DiGeorge’s?

A

Failure of development of the 3/4 branchial pouch and aplasia of the thymus and parathyroid

75
Q

Who gets opportunistic infections?

A

HIV, CA, and Transplant

76
Q

What are T-cell levels in AIDS defining conditions?

A

Under 200

77
Q

What kind of antibodies are seen in HIV patients?

A

Ones to p24 and enveloped antigens

78
Q

True or False: Early on in HIV, the immune system is “winning”

A

TRUE

The virus hides out in macrophages, ect. while T-cells are eventually destroyed and start falling

79
Q

In the symptomatic stage of HIV, what kind of diseases are seen?

A

Indicator disease like thrush, esophagitis, and recurrent yeast

80
Q

With full blown AIDS, what are the T-Cell counts?

A

Under 200

81
Q

Why do antibodies to p24 decrease over time?

A

As T-cells are destroyed, there is less class switching and IgG,which is required for the p24 antibody

82
Q

Why do antibodies to Env Ag stay steady with the progression of HIV?

A

This is susceptible to antigenic drift,so it changes over time
-The immune system uses IgM to deal with this which doesn’t require T-cells, so it can keep up

83
Q

What does cryptococcus neoformans cause?

A

Meningitis

84
Q

What does toxoplasma gondii cause?

A

Encephalitis

85
Q

If you have had your spleen removed, what kind of bacteria are you susceptible too?

A

Encapsulated ones

86
Q

What do AIDS patients with reactivated CMV get?

A

Retinitis and interstitial pneumonia

87
Q

Where can VZV go if you are immunosuppressed that can cause issues?

A

CNS- Encephalitis

88
Q

What does JC cause

A

Progressive multifocal leukoencephalopathy

89
Q

What 2 types of candida can patients get post transplant?

A

Albicans or Grabata

90
Q

Why is aspergillous so bad in an IC patient?

A

Because it’s so hard to treat… is the treatment or the aspergillous going to kill the patient

91
Q

Owl’s Eye Inclusion?

A

CMV

92
Q

Dented Helmets (or a condom)?

A

P. Jiroveci- PCP

93
Q

What is persistent diarrhea from?

A

PARASITE

94
Q

What do cryptosporidium, isospora, and microsporida all have in common?

A

Acid fast oocysts in stool

95
Q

What is the watery HIV diarrhea dx most likely going to be 90% of the time?

A

Crypto

96
Q

What is seen in the stool of isospora?

A

Huge, elliptical oocysts (similar to giarhdia, causes malabsorption)

97
Q

Acid-Fast Bacillia with a CD4 count over 200?

A

TB

98
Q

Acid-Fast Bacilla with a CD4 cound 75+?

A

Thinking Mycobacterium avum

99
Q

If something is India Ink + (it had a capsule)?

A

Crypto

100
Q

Antibodies against B. Henselae with lesions?

A

Bacillary angiomatosis

101
Q

What else is on the ddx for with an HIV patients with lesions?

A

Kaposi sarcoma or bacillary agiomatosis (Bacillary is raised)

102
Q

45 degree branching hypae that are septate?

A

Aspergillosis

103
Q

90 degree angles with non-septate hyphae that is RIBBON like?

A

MUCOR

Think ketoacidotic patient with sinusitis

Hematology-Oncology Exam 2 (15 decks)

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