W04 - HAEM: Infection in Immunocompromised

Question 1

Know which infections occur in different forms of immunosuppression

Answer 1

FEBRILE NEUTROPENIA

Fungal: candida: aspergillus dt monocytopenia

Severely lymphopenic patients: SC transplants recipients, total body irradiation, graft vs host disease, lymphoid malignancy
-pneumonitis: jirovecci, CMV, RSV
-viral: shingles, herpes simplex, adenovirus, EBV, COVID
- fungal: candida, aspergillus, mucomycosis, atypical mycobacteria

Question 2

Know the principles of treatment of each of these infections

Answer 2

SEPSIS SIX
> o2, iv abx, iv fluids rehydr.
> blood cultures, serum lactate concentration, urine output

FUNGAL INFECTIONS
> caspofungin, anidulafungin
> VORICONAZOLE (aspergillus = azole endings)
> AMBISOME (moulds)

Question 3

Prophylaxis in haematological malignancy

Answer 3

> ciprofloxacin

> fluconazole (anti-fung.)

> aciclovir

> co-trimox.

> Grwoth factors

> SC rescue/ transplant

> laminar flow rooms => protective environment

> IV Ig replacement

> vaccination

Question 4

RF for infection in imm compr.

Answer 4

• consider disruopted skin, and mucosal surfaces
• altered flora / abx resistance
• lymphopenia
• monocytopenia

Question 5

FEBRILE NEUTROPENIA bacterial causes and presentation

Answer 5

bacterial causes:
gram+ often,
- MSSA, MRSA, coagulase neg.
- strep viridans
- enterococcus faecalis
- corynebacterium spp
- bacillus spp

*resp tract, typhlitis, dental sepsis, mouth ulcers, skin sores, exit site of ventral venous catheters, perianal

Question 6

Presentation of neutropenic sepsis

Answer 6

*fever with no localising signs

+rigors
+ chest infection/pneumonia
+ skin sepsis
+ UTI
+ septic shock

Question 7

FEBRILE NEUTROPENIA: dx

Answer 7

• clinical dx: blood cultures, cxr, hx and exam., throat swap sputum, fbc, renal, liver function coag screen

Question 8

FEBRILE NEUTROPENIA: mgmt

Answer 8

RF: recent chemo; fever

> broad abx IV
TAZOCIN & GENTAMICIN

> VANCOMYCIN (with gram+_

> IV ANTIFUNGAL: caspofungin if no response

> CT scan look for source

> alter mgmt based off of blood culture results

Question 9

therapy for viral & fungal infections

Answer 9

jirovecci (fungal)
> COTRIMOX.

CMV
>GANCICLOVIR, FOSCARNET

HSV1
> aciclovir

influenza A/B
> oseltamivir, zanamivir

Adenovirus
> cidofovir

RSV
> ribavirin

> Ig replacement