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Infectious Diseases > Opportunistic Infections/Immunocompromised hosts > Flashcards

Opportunistic Infections/Immunocompromised hosts Flashcards

1
Q

Neutropenia associated with

A

Bacterial infections (especially gram negatives/pseudomonas)

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2
Q

Prolonged neutropenia associated with

A

Fungi

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3
Q

T cell associated with

A

Viruses, Fungi, PJP, Mycobacteria

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4
Q

Complement (or eculuzimab) with

A

Meningococcus

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5
Q

Infliximab associated with

A

TB

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6
Q

Asplenia associated with

A

Encapsulated organisms (HiB, Pneumococcal)

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7
Q

CBG associated with

A

Catalase positive organisms (Staph Aureus, Serratia, Nocardia, Burkholderia, Aspergillus)

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8
Q

Cat bite

A

Pasteurella multocida

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9
Q

Cat scratch

A

Bartonella henselae

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10
Q

Cat faeces/litter

A

Toxoplasmosis

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11
Q

Sickle cell disease

A

Salmonella species

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12
Q

Well toddler with BJI/normal CRP

A

Kingella kingae

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13
Q

Varicella PEP in immunocompetent host

A

Vaccine within 3 days could prevent, vaccine within 5 days reduces severity

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14
Q

Varicella PEP in immunocompromised host

A

VZIg- can give up to 10 days after exposure, but give ASAP

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15
Q

COVID treatment in immunocompromised

A

Dexamethasone, IV Remdesivir, PO Paxlovid

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16
Q

Rotavirus treatment in immunocompromised

A

Immunoglobulin

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17
Q

Adenovirus in immunocompromised host features

A

Conjunctivitis, colitis, pneumonitis, hepatitis, haemorrhagic cystitis

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18
Q

Adenovirus treatment in immunocompromised host

A

Cidofovir

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19
Q

RSV treatment in immunocompromised host

A

Nebulised/IV Ribavirin

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20
Q

Influenza and Paraflu treatment in immunocompromised host

A

Oseltamivir

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21
Q

BK and JC virus presentation in immunocompromised host

A

Haematuria/haemorrhagic cystitis

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22
Q

BK and JC virus treatment in immunocompromised

A

Cidofovir

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23
Q

Herpes virus that is not oncogenic

A

HHV-6 (causes febrile seizures)

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24
Q

Virus implicated in PTLD

A

EBV (lymphoblast proliferation)

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25
Q

PTLD spectrum

A

Glandular fever –> monoclonal proliferation –> Lymphoma

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26
Q

PTLD solid organ implicated

A

Solid organ (lung/liver/heart > renal)–> amount of lymphoid tissue

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27
Q

PTLD immune risks

A

First two years post transplant, EBV positive organ for EBV negative recipient, heavy immune suppression

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28
Q

PTLD treatment

A

Reduce immune suppression, Rituximab, Chemo

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29
Q

Herpes viruses

A

EBV, CMV, HSV 1, HSV2, VZV, HHV7, HHV 8

30
Q

HSV1 and HSV2 in immunosuppression

A

Stomatitis, pneumonitis, encephalitis

31
Q

HSV1 and HSV2 treatment

A

Aciclovir/Valaciclovir

32
Q

CMV in immunosuppression

A

Pneumonitis, Hepatitis, Colitis, Disseminated, Retinitis

33
Q

CMV treatment in immunosupression

A

Ganciclovir 1st line, Valganciclovir 2nd line, Foscarnet 2nd like (resistant), Cidofovir 3rd line (resistant)

34
Q

Ganciclovir and Valganciclovir side effects

A

Neutropenia

35
Q

Foscarnet and Cidofovir side effects

A

Nephrotoxic

36
Q

Ganciclovir resistance genes

A

UL97, UL54

37
Q

VZV in immunocompromised

A

Disseminated chicken pox, pneumonitis, encephalitis, shingles

38
Q

VZV treatment immunocompromised

A

Aciclovir, Valaciclovir

39
Q

HHV6/HHV7 in immunocompromised

A

Disseminated rash, encephalitis, pneumonia, bone marrow suppression

40
Q

HHV8 in immunocompromised

A

Kaposi’s sarcoma

41
Q

When post stem cell transplant are children at risk of herpes virus infections?

A

3 to 12 months (but can happen earlier, even ~6 weeks post)

42
Q

When post stem cell transplant are children at risk of aspergillosis/invasive fungal infections?

A

4 weeks to 12 months (when prolonged severe neutropenia. Exclusive problem from Day 30 to ~Day 50)

43
Q

PJP in immunocompromised host

A

Fever and cough with minimal CXR changes

44
Q

PJP treatment

A

IV Cotrimoxazole

45
Q

PJP prophylaxis

A

Cotrimoxazole PO or Pentamidine

46
Q

What percentage of leukemia patients without prophylaxis will get PJP

A

20%

47
Q

Prognosis of PJP without treatment

A

100% fatal

48
Q

Prognosis of PJP with treatment

A

5 - 40% fatal

49
Q

Invasive candidiasis in immunocompromised

A

Unexplained fever/sepsis despite antibiotics, skin lesions, white lesions in eyes, multiple focal liver or spleen lesions

50
Q

Treatment for candidaemia or invasive candidiasis in non-neonate

A

Caspofungin 1st line, Fluconazole as oral stepdown (but high resistant), Ambisome (Liposomal Amphotericin)

51
Q

Treatment for neonates with candidiasis

A

Conventional Amphotericin first line, Fluconazole second line if sensitive

52
Q

Downside of Caspofungin

A

Well tolerated but doesn’t reach CSF/Urine

53
Q

Side effect of Amphotericin

A

Nephrotoxic +++, hypokalemia

54
Q

Prolonged fever and neutropenia antifungal choice

A

1st line = Ambisome (CSF penetration but nephrotoxic), Second line is Caspofungin. Fluconazole if low risk. Voriconazole alternative

55
Q

Invasive aspergillosis treatment

A

Voriconazole first line. Second line are Poscanozole, Ambisome, Caspofungin

56
Q

Side effect of Fluconazole/Voriconazole

A

CYP450 liver toxicity

57
Q

Greatest risk of fungal infection in patients undergoing chemotherapy

A

Prolonged severe neutropenia. Use of steroids but to a lesser degree

58
Q

Example of polyenes

A

Amphotericin, Nystatin

59
Q

Mechanism of action of polyenes

A

Make holes in cell membranes

60
Q

Azoles (Triazoles)

A

Fluconazole, Voriconazole, Itraconazole, Posaconazole

61
Q

Azoles (Imidazoles)

A

Clotrimazole, Miconazole, Ketaconazole

62
Q

Echinocandins

A

Caspofungin

63
Q

MoA Triazoles and Imidazoles

A

Inhibit cell membrane synthesis (ergosterol)

64
Q

MoA Echinocandins

A

Inhibit cell membrane synthesis (Beta 1,3 D glucan)

65
Q

Invasive aspergillus sites of infection

A

Brain, Sinuses, Lungs

66
Q

Diagnosis of Aspergilus

A

BAL, Galactomann antigen on bronchial wash

67
Q

Aspergillus CT signs

A

Halo sign (small nodules with hazy edge due to neutropenia), Air crescent sign (cavitate with neutrophil recovery)

68
Q

Antibiotic to treat Stenotrophomonas Maltophillia

A

Cotrimoxazole

69
Q

Organism risk in first 30 days after HSCT (B cell engrafment)

A

Bacteria, specifically gram negative e.g. pseudomonas

70
Q

Rash associated with pseudomonas

A

Ecthyma gangrenosum

71
Q
A
72
Q

PJP staining

A

Methenamine silver nitrate or columbine blue of cysts (used for fungi and PJP)

Infectious Diseases (9 decks)

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