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51 Cards in this Set

  • Front
  • Back
Which system consists of:
Skin, mucous membranes
Phagocytes (polymorphs, macrophages)
Complement, Interferons
No memory
Innate system
3 bugs that invade burns?
Streptococci
Staphylococci
Pseudomonas
Frequent complications of obstruction of bladder or ureters?
Hydronephrosis, pyonephrosis, and chronic pyelonephritis
Disease states associated with humoral immune abnormalities?
Multiple myeloma
Chronic lymphatic leukemia
Waldenstrom’s macroglobulinemia
Sickle cell
Characterized by recurrent bacterial infections secondary to lack of antibodies?
Common variable Immuno Deficiency (most common form of antibody deficiency)
Requirements for functional cellular immune system (CMI)?
Macrophages
T-helper
T-suppressor
Effector lymphocytes
What bugs seen in cancer/transplant setting due to ↓↓ T-cells?
S. aureus/coagulase (-) staphylococci
Streptococci
Listeria
Nocardia (lecture example of BMT chest x-ray)
Mycobact. Tuberculosis/avium-complex
System?
Humoral and cell mediated immunity
Memory
Adaptive system
Gram + bugs in neutropenic patient?
Respiratory tract/skin:
Sinusitis and Pneumonitis
Local trauma and catheter site
Staph aureus
Staph epidermidis
Streptococci
What parasite seen in cancer/transplant setting due to ↓↓ T-cells?
Strongyloides stercoralis
Which defense is most frequently compromised giving rise to life-threatening bacterial infections?
Polymorphonuclear neutrophil
Main mech to kill bugs?
Phagocytes are recruited to site of entry for phagocytosis and intracellular killing
Innate system
Which microbe is responsible for most catheter-associated infection?
Coagulase-negative staphylococci

-specifically Staph Epidermatis**
Function of antibodies
Neutralize bacterial toxin, coat (opsonize) extracellular bugs and facilitate phagocytosis.
Bug after surgery?
Endocarditis
osteomyelitis
Staphylococcus aureus
Empiric antimicrobial therapy?

Patient with acute myelogenous leukemia develops fever.
Against aerobic Gram negative bacteria
Cell types?
Intracellular bugs
Cell mediated immunity
T-lymphocytes
GI neoplasms→luminal obstruction leads to?
Perforation
Peritonitis
Septicemia
Death
Common pathogens involved are enteric Gram-bacilli and anaerobic bacteria
Secondary defect of innate system?
Clinical problems
Burns, trauma
Surgery
catheters(iv and urinary),
obstructions (lung,prostate,GI),
prosthetics (knees and hips)
If your patient has ↓↓ T cells (remember the examples at end of lecture) what can occur?
A broad range of microorganisms including intracellular bacteria, viruses, fungi and protozoa can infect and reactivate latent process, in contrast to normal host, are more likely to disseminate and become life threatening to the immunodeficient patient.
Cell types?
Humoral immunity
Neutralize toxin
Opsonization
B-lymphocytes
Immune dysfunction ?
Caused by primary malignancy(acute leukemia)
Chemotherapy on bone marrow
Neutropenia
Caused by prostatic, ovarian, cervical or rectal carcinoma?
Obstruction→UTI caused by Gram - rods
Most important cause of Secondary defect of adaptive immune system?
Malnutrition
Primary defect of innate system?
Congenital
Chronic granulomatous disease
Parasites in neutropenic patient?
Respiratory tract/skin:
Sinusitis and Pneumonitis
Local trauma and catheter site
Strongyloides stercoralis
Bugs?
“hide” in biofilm from antibiotics
Seen in catheter, shunt, pacemaker, graft and prostheses patients
Staph epi and Staph aureus
How does protein-energy malnutrition present?
Wide range of disorders, with kwashiorkor and marasmus as the two poles.

kwashiorkor:
type of malnutrition with controversial causes, but it is commonly believed to be caused by insufficient protein intake

marasmus:
a form of severe protein-energy malnutrition characterized by energy deficiency
Bug in neutropenic patient?
GI:
Periolontitis, pharyngitis, esophagitis, colitis, perianal lesions
Gram(-) bacilli
E. coli
Klebsiella pneumonia
Pseudomonas aeruginosa-lethal**most concern
Primary defect of adaptive immune system?
Congenital:
Bruton’s agammaglobulinemia (B cell defect)
DiGeorge (T cell defect)
SCID
Common Variable Immuno Deficiency
Complement Deficiency (late component→Neisseria)
Viral infections causing immunosuppression?
HIV
HSV
CMV and EMV (reactivated after organ/bone marrow transplant)
Bugs in humoral immune impairment?
S. pneumonia
H. influenza
N. meningitidis
What bugS?
Chronic lymphatic leukemia
Fever
pneumonia
S. pneumonia
H. influenza
N. meningitidis
Treatment ONLY with documented Gram + catheter infections
Vancomycin
Cause of persistant fever despite broad-spectrum antibiotics in profoundly neutopenic hosts?
Fungi
Candida (common)
Aspergillus
Target of humoral immunity?
Extracellular organisms
Multiple myeloma
Most common cause of catheter-associated infection?
Staph epidermidis
Virus in neutropenic patient?
HSV
Target of cellular immunity?
Intracellular organisms-viruses
AIDS
*Pseudomonas aeruginosa treatment?
Penicillin or cephalosporin PLUS aminoglycoside or cabapenems
Example: Cefipime and Cephtazidine NOT Vanco
Gram + bugs in neutropenic patients?
(low virulence/treat for Gram- first)
Staphylococci
Streptococci
Corynebacteria
Enterococci
Bacillus sp. of cutaneous origin
What viruses seen in cancer/transplant setting due to ↓↓ T-cells?
Herpes group-HSV, VZV, CMV, EBV, HHV6, HHV7, HHV8
Hep B and C
Polyoma-BK, JC
HIV
What fungi seen in cancer/transplant setting due to ↓↓ T-cells?
Candida spp.
Aspergillus/mucor
Cryptococcus neoformans
Histoplasma capsulatum
Pneumocystis carinii
Diseases seen in CMI? (Cellular immune impairment)
Hodgkin’s and non-Hodgkin’s lymphoma
Hairy cell leukemia
Chronic lymphatic leukemia
Yeast in neutropenic patient?
Respiratory tract/skin:
Sinusitis and Pneumonitis
Local trauma and catheter site
Less common
Candida
Torulopsis glabrata
Aspergillus fumigates/flavus
Target of rapid empiric antimicrobial therapy in neutropenic patient and why?
*Pseudomonas aeruginosa – bc rapidly lethal organism
In what pt pop is a fever considered an medical emergency and why?
Cancer pt on chemotherapy bc they are neutropenic and lack the ability to respond to life threatening bacterial infections
In a neuropenic pt with persistent fever and NEGATIVE bacterial culture and response to empiric therapy what organism should then be consider as the source of infection?
Candida or asperigillus
Diseases tx by TNF- alpha inhibitors and what is the concerns are associated with tx?
Diseases which have an over production of TNF- alpha including:
Rheum Arthritis (RA)
crohn’s disease
Psoriatic arthritis
Concern: inc risk of infection from TB, histoplasma and listeria
What is the fxn of TNF-alpha?
Essential in immune defense
-recruit inflammatory cells to sit of infection
-form and maintain granuloma which contain (wall off) infective organism
Procedures/treatments that profoundly impair cell-mediated immunity?
Cytotoxic chemotherapy
Corticosteoids
Radiation treatment
Transplantation