Safe living strategies for the immunocompromised child Flashcards

1
Q

What medical conditions and treatments are associated with significant immunocompromised states?

A

Conditions

  • HSCT (within 2 years or still taking immunosuppressive drugs)
  • solid-organ transplant
  • current or recently treated malignancy
  • aplastic anemia
  • asplenia (risk of S pneumoniae, N meningitidis, Hib)
  • HIV (CD4+ count < 200/mm3 in >/= 5 yrs or CD4+ count < 15% in <5 years)
  • SCID

Treatments

  • high dose steroids (>2mg/kg or >/=20 mg/day pred in >10 kg) for >/= 2 weeks
  • Cancer chemotherapeutics (cyclophosphamide)
  • antimetabolite (azathioprine)
  • transplant-related immunosuppressive drugs (cyclosporine, tacro, siro, MMF)
  • Biologics (etanercept, adalimumab, infliximab, rituximab, alemtuzumab)
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2
Q

How to build a protective environment for immunocompromised kids?

A
  • immunization
    • immunocompromised individuals - receive all routine immunizations
    • HCP - immunizations should be complete
    • Most important: VZV, MMR, annual flu vaccine
  • hygiene (hand hygiene)
    • before eating/preparing food
    • after urinating/defecating
    • after touching body fluids/excretions/items in contact with feces (clothing, bedding, toilets)
    • after touching plants/soils
    • after collecting/depositing garbage
    • after being in public place or outside home
    • after touching animals
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3
Q

What viral resp infections are associated with greatest risk of illness in immunocompromised kids?

A

RSV, influenza, adenovirus

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4
Q

In immunocompromised kids:

How do you reduce risk of resp infections?

A
  • avoid contact with individuals with respiratory illness
  • notify physician at first sign of resp illness during influenza season (testing/prophylaxis with neuraminidase inhibitors)
  • inform medical team when influenza is in household
  • inimize exposure to crowded environments during influenza season
  • avoid primary/secondary exposure to tobacco smoke
  • avoid risk of fungal pathogens:
    • minimize exposure to construction, excavation, renovation sites (Aspergillus)
    • minimize inhalation of fungal spores from plants/animals (farms, barns, pigeon coops, mulching, turning compost piles, cave exploration)
    • don’t smoke marijuana
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5
Q

In immunocompromised kids:

How do you reduce risk of waterborne illnesses?

A
  • don’t drink tap water when “boil water” advisories in effect
  • drink bottled or boiled water when travelling in areas with suboptimal sanitation
  • don’t drink well water (unless screened and monitored)
  • don’t drink water from rivers/streams/lakes/ponds
  • No hot tubs (pseudomonas, legionella pneumophilia, mycobacterial infections)
  • clean abrasions with water and avoid swimming in contaminated water
    • waterborne pathogens can enter skin abrasions or resp tract if aspirated
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6
Q

In immunocompromised kids:

How do you reduce risk of foodborne illnesses?

A
  • pasteurize milk, fruit, vegetable juices
  • avoid cheese from raw or unpasteurized milk (esp soft and semi-soft like Brie, Camembert, blue-veined)
  • avoid raw meat, seafood, eggs
  • wash raw vegetables (even if labelled prewashed)
  • avoid cross contamination
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7
Q

In immunocompromised kids:

How do you reduce risk of animal/pet exposures?

A
  • Precautions:
    • wait to have pet when pt is less immune suppressed
    • evaluate pets by veterinarian (before being placed with pt)
    • avoid contact with ill animals (esp lip lesions)
    • avoid cleaning birdcages, bird feeders or litter boxes - if not possible, wear disposable gloves and standard surgical mask
    • avoid contact with cleaning aquariums
  • Universal principles
    • wash hands after contact
    • avoid stray animals
    • Inspect places with raccoons for stool & regularly clean
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8
Q

What animal borne pathogens are asplenic kids at risk of?

A

Capnocytophaga and Salmonella

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9
Q

Can immunocompromised kids go to school?

A

majority can attend school and child care (except SCID)

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10
Q

Specific infection with:

reptile & frogs

A

salmonella

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11
Q

Specific infection with:

chick/duckling

A

salmonella

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12
Q

Specific infection with:

rodent

A

lymphocycit choriomeningitis virus

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13
Q

Specific infection with:

kitten

A

bartonella

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14
Q

Specific infection with:

cats

A

toxoplasma gondii

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15
Q

Specific infection with:

puppies, kittens, chicks

A

campylobacter

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16
Q

Specific infection with:

fish tank

A

mycobacterium marinum

17
Q

Specific infection with:

raccoons

A

roundworm

Bayliascaris procyonis

18
Q

How to minimize risk of infections in kids with immunocompromise?

A
  • vaccines
  • hand washing
  • resp, waterborne, foodborne, animal exposure precautions
  • travel with health passport
  • prevent insect bites
  • safer sex practices

most can go back to school (except SCID)

19
Q

What are the most important vaccines for an immunocompromised pt?

A

VZV, MMR, annual flu