Wsu Exam 4 Infections In The Compromised Host

Front 1

Which system consists of:
Skin, mucous membranes
Phagocytes (polymorphs, macrophages)
Complement, Interferons
No memory

Back 1

Innate system

Front 2

3 bugs that invade burns?

Back 2

Streptococci
Staphylococci
Pseudomonas

Front 3

Frequent complications of obstruction of bladder or ureters?

Back 3

Hydronephrosis, pyonephrosis, and chronic pyelonephritis

Front 4

Disease states associated with humoral immune abnormalities?

Back 4

Multiple myeloma
Chronic lymphatic leukemia
Waldenstrom’s macroglobulinemia
Sickle cell

Front 5

Characterized by recurrent bacterial infections secondary to lack of antibodies?

Back 5

Common variable Immuno Deficiency (most common form of antibody deficiency)

Front 6

Requirements for functional cellular immune system (CMI)?

Back 6

Macrophages
T-helper
T-suppressor
Effector lymphocytes

Front 7

What bugs seen in cancer/transplant setting due to ↓↓ T-cells?

Back 7

S. aureus/coagulase (-) staphylococci
Streptococci
Listeria
Nocardia (lecture example of BMT chest x-ray)
Mycobact. Tuberculosis/avium-complex

Front 8

System?
Humoral and cell mediated immunity
Memory

Back 8

Adaptive system

Front 9

Gram + bugs in neutropenic patient?
Respiratory tract/skin:
Sinusitis and Pneumonitis
Local trauma and catheter site

Back 9

Staph aureus
Staph epidermidis
Streptococci

Front 10

What parasite seen in cancer/transplant setting due to ↓↓ T-cells?

Back 10

Strongyloides stercoralis

Front 11

Which defense is most frequently compromised giving rise to life-threatening bacterial infections?

Back 11

Polymorphonuclear neutrophil

Front 12

Main mech to kill bugs?

Back 12

Phagocytes are recruited to site of entry for phagocytosis and intracellular killing
Innate system

Front 13

Which microbe is responsible for most catheter-associated infection?

Back 13

Coagulase-negative staphylococci

-specifically Staph Epidermatis**

Front 14

Function of antibodies

Back 14

Neutralize bacterial toxin, coat (opsonize) extracellular bugs and facilitate phagocytosis.

Front 15

Bug after surgery?
Endocarditis
osteomyelitis

Back 15

Staphylococcus aureus

Front 16

Empiric antimicrobial therapy?

Patient with acute myelogenous leukemia develops fever.

Back 16

Against aerobic Gram negative bacteria

Front 17

Cell types?
Intracellular bugs
Cell mediated immunity

Back 17

T-lymphocytes

Front 18

GI neoplasms→luminal obstruction leads to?

Back 18

Perforation
Peritonitis
Septicemia
Death
Common pathogens involved are enteric Gram-bacilli and anaerobic bacteria

Front 19

Secondary defect of innate system?

Back 19

Clinical problems
Burns, trauma
Surgery
catheters(iv and urinary),
obstructions (lung,prostate,GI),
prosthetics (knees and hips)

Front 20

If your patient has ↓↓ T cells (remember the examples at end of lecture) what can occur?

Back 20

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.

Front 21

Cell types?
Humoral immunity
Neutralize toxin
Opsonization

Back 21

B-lymphocytes

Front 22

Immune dysfunction ?
Caused by primary malignancy(acute leukemia)
Chemotherapy on bone marrow

Back 22

Neutropenia

Front 23

Caused by prostatic, ovarian, cervical or rectal carcinoma?

Back 23

Obstruction→UTI caused by Gram - rods

Front 24

Most important cause of Secondary defect of adaptive immune system?

Back 24

Malnutrition

Front 25

Primary defect of innate system?

Back 25

Congenital
Chronic granulomatous disease

Front 26

Parasites in neutropenic patient?
Respiratory tract/skin:
Sinusitis and Pneumonitis
Local trauma and catheter site

Back 26

Strongyloides stercoralis

Front 27

Bugs?
“hide” in biofilm from antibiotics
Seen in catheter, shunt, pacemaker, graft and prostheses patients

Back 27

Staph epi and Staph aureus

Front 28

How does protein-energy malnutrition present?

Back 28

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

Front 29

Bug in neutropenic patient?
GI:
Periolontitis, pharyngitis, esophagitis, colitis, perianal lesions

Back 29

Gram(-) bacilli
E. coli
Klebsiella pneumonia
Pseudomonas aeruginosa-lethal**most concern

Front 30

Primary defect of adaptive immune system?

Back 30

Congenital:
Bruton’s agammaglobulinemia (B cell defect)
DiGeorge (T cell defect)
SCID
Common Variable Immuno Deficiency
Complement Deficiency (late component→Neisseria)

Front 31

Viral infections causing immunosuppression?

Back 31

HIV
HSV
CMV and EMV (reactivated after organ/bone marrow transplant)

Front 32

Bugs in humoral immune impairment?

Back 32

S. pneumonia
H. influenza
N. meningitidis

Front 33

What bugS?
Chronic lymphatic leukemia
Fever
pneumonia

Back 33

S. pneumonia
H. influenza
N. meningitidis

Front 34

Treatment ONLY with documented Gram + catheter infections

Back 34

Vancomycin

Front 35

Cause of persistant fever despite broad-spectrum antibiotics in profoundly neutopenic hosts?

Back 35

Fungi
Candida (common)
Aspergillus

Front 36

Target of humoral immunity?

Back 36

Extracellular organisms
Multiple myeloma

Front 37

Most common cause of catheter-associated infection?

Back 37

Staph epidermidis

Front 38

Virus in neutropenic patient?

Back 38

HSV

Front 39

Target of cellular immunity?

Back 39

Intracellular organisms-viruses
AIDS

Front 40

*Pseudomonas aeruginosa treatment?

Back 40

Penicillin or cephalosporin PLUS aminoglycoside or cabapenems
Example: Cefipime and Cephtazidine NOT Vanco

Front 41

Gram + bugs in neutropenic patients?
(low virulence/treat for Gram- first)

Back 41

Staphylococci
Streptococci
Corynebacteria
Enterococci
Bacillus sp. of cutaneous origin

Front 42

What viruses seen in cancer/transplant setting due to ↓↓ T-cells?

Back 42

Herpes group-HSV, VZV, CMV, EBV, HHV6, HHV7, HHV8
Hep B and C
Polyoma-BK, JC
HIV

Front 43

What fungi seen in cancer/transplant setting due to ↓↓ T-cells?

Back 43

Candida spp.
Aspergillus/mucor
Cryptococcus neoformans
Histoplasma capsulatum
Pneumocystis carinii

Front 44

Diseases seen in CMI? (Cellular immune impairment)

Back 44

Hodgkin’s and non-Hodgkin’s lymphoma
Hairy cell leukemia
Chronic lymphatic leukemia

Front 45

Yeast in neutropenic patient?
Respiratory tract/skin:
Sinusitis and Pneumonitis
Local trauma and catheter site

Back 45

Less common
Candida
Torulopsis glabrata
Aspergillus fumigates/flavus

Front 46

Target of rapid empiric antimicrobial therapy in neutropenic patient and why?

Back 46

*Pseudomonas aeruginosa – bc rapidly lethal organism

Front 47

In what pt pop is a fever considered an medical emergency and why?

Back 47

Cancer pt on chemotherapy bc they are neutropenic and lack the ability to respond to life threatening bacterial infections

Front 48

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?

Back 48

Candida or asperigillus

Front 49

Diseases tx by TNF- alpha inhibitors and what is the concerns are associated with tx?

Back 49

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

Front 50

What is the fxn of TNF-alpha?

Back 50

Essential in immune defense
-recruit inflammatory cells to sit of infection
-form and maintain granuloma which contain (wall off) infective organism

Front 51

Procedures/treatments that profoundly impair cell-mediated immunity?

Back 51

Cytotoxic chemotherapy
Corticosteoids
Radiation treatment
Transplantation