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19 Cards in this Set

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Three preliminary questions to ask when evaluating a Patient with possible infection
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?)
4 major causes of Immunocompromised patients
neutropenia (ANC<500)
decr CMI- cell mediated immunity (CD4 <200)
decr Ab prod (IgG <800)
Disrupted barriers (mucosal, cutaneous)
When encountering an ICH with possible infection, you should
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
Cause of death for cancer patients is mostly
complication from infection
Primary goal of management of ICH is
PREVENTION of infection
Common endogenous pathogens causing infection in ICH
S.aureus, S. epidermidis, gram neg rods, candida, HSV, CMV, parasites
Common exogenous pathogens causing infection in ICH
Aspergilli, zygomyces, CMV, s. aureus, gram neg rods, pneumocystitis
Epidemiology of infection in the ICH (endogenous organisms)
usu resident flora of GI tract.
Account for 50% of infections.
Suppressive measures include frequent hand washing and prophylactic antimicrobials
Epidemiology of infection in the ICH (exogenously Acquired Organisms)
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
the most frequently occurring and reliable sign of infection in the neutropenic host is
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.
Most common cause for fever during neutropenia
majority is infection, but about 1/3 are unexplained.
Noninfectious causes of fever in ICHs
Underlying disease
Hypersensitivity
Metabolic
Cardiac and vascular
Pulmonary
CNS
Fever in ICH defined as
Single temp of >101F
>100.2 for more than an hour
temp of 100.4 on 2 or more occasions within 24 hrs
Approach to the febrile granulocytopenic Patient
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
Common clinical syndromes in ICH
Cutaneous lesions, eye disease, oral lesions, sinusitis, pneumonitis, esophagitis, perianalinfxns, meningitis/encephalitis, septicemia
Fever and respiratory Sx in ICH w. abnormal CXR  usu caused by
infectious causes 75% of the time
Patient with Phagocytic cell  deficiency most commonly are infectied with
Extracellular pathogens:Pyogenic bacteria (s. aureus, GNRs), Filamentous fungi (aspergillis, zygomycetes) candida
Patient with CMI deficiency most commonly infected wtih
Intracellular pathogens: viruses (HSV VZV, CMV), parasites (toxoplasma, pneumocystis), mycobacteria, fungi (candida, cryptococcus), Selected bacteria (legionella, norcardia)
Patient with Antibody deficiency most commonly infected with
Encapsulated bacteria: s. pneumoniae, h. influenzae