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19 Cards in this Set
- Front
- Back
Three preliminary questions to ask when evaluating a Patient with possible infection
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1- what type of host is being evaulated (immunocompromised/immunocompetent/immunoincompetent)2-If immunocompromised, what is the nature of the major defect in host defenses? Can the major defect be identified or predicted? If more than one defect is likely present, is one dominant?3-how long has the defect been present (is a disecrete onset identifiable?)
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4 major causes of Immunocompromised patients
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neutropenia (ANC<500)
decr CMI- cell mediated immunity (CD4 <200) decr Ab prod (IgG <800) Disrupted barriers (mucosal, cutaneous) |
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When encountering an ICH with possible infection, you should
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pause and reflect upon the underlying disease and its treatment and try to characterize the primary host defense defect that is present as well as its severity
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Cause of death for cancer patients is mostly
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complication from infection
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Primary goal of management of ICH is
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PREVENTION of infection
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Common endogenous pathogens causing infection in ICH
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S.aureus, S. epidermidis, gram neg rods, candida, HSV, CMV, parasites
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Common exogenous pathogens causing infection in ICH
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Aspergilli, zygomyces, CMV, s. aureus, gram neg rods, pneumocystitis
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Epidemiology of infection in the ICH (endogenous organisms)
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usu resident flora of GI tract.
Account for 50% of infections. Suppressive measures include frequent hand washing and prophylactic antimicrobials |
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Epidemiology of infection in the ICH (exogenously Acquired Organisms)
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not part of hosts resident flora (aspergillis)
Account for other 50% of infxns Sources of acquisition would include hands of personnel, air, foor, fomites etc Measures to reduce acquisition include strict handwashing, protective isolation, HEPA filtration, special diets- fewer veggies |
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the most frequently occurring and reliable sign of infection in the neutropenic host is
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FEVER
**remember though that infxn may be benign and progress in the absence of fever. 30 to 45% of febril episodes may be noninfectious in etiology. |
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Most common cause for fever during neutropenia
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majority is infection, but about 1/3 are unexplained.
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Noninfectious causes of fever in ICHs
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Underlying disease
Hypersensitivity Metabolic Cardiac and vascular Pulmonary CNS |
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Fever in ICH defined as
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Single temp of >101F
>100.2 for more than an hour temp of 100.4 on 2 or more occasions within 24 hrs |
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Approach to the febrile granulocytopenic Patient
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Initial eval incl: Hx, PE, CXR urinalysis, Blood cultures, biopsy and culture of suspicious lesions
Initial management incl:empiric broad spectrum antibiotics Subsequent therapy: documented infxn, fever of unknown origin |
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Common clinical syndromes in ICH
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Cutaneous lesions, eye disease, oral lesions, sinusitis, pneumonitis, esophagitis, perianalinfxns, meningitis/encephalitis, septicemia
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Fever and respiratory Sx in ICH w. abnormal CXR usu caused by
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infectious causes 75% of the time
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Patient with Phagocytic cell deficiency most commonly are infectied with
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Extracellular pathogens:Pyogenic bacteria (s. aureus, GNRs), Filamentous fungi (aspergillis, zygomycetes) candida
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Patient with CMI deficiency most commonly infected wtih
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Intracellular pathogens: viruses (HSV VZV, CMV), parasites (toxoplasma, pneumocystis), mycobacteria, fungi (candida, cryptococcus), Selected bacteria (legionella, norcardia)
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Patient with Antibody deficiency most commonly infected with
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Encapsulated bacteria: s. pneumoniae, h. influenzae
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