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96 Cards in this Set
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Three immune defects |
1. Humoral 2. Cellular 3. Phagocytic |
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What is the consequence in humoral defect |
1. Ab dependent Cytotoxicity 2. Optimization 3. Phagocytosis |
COPS |
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Pathology of humoral defect |
Recurrent sinopulmonary infections |
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Pathogens in humoral defect |
1. S. pneumoniae 2. H. influenza 3. Neisseria |
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Consequence in cellular defect |
Impaired clearance of pathogens |
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Pathology of cellular defect (2) |
Disseminated infection Pulmonary infection |
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Consequence of phagocytic defect |
Impaired microbial killing or clearance |
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Pathology of phagocytic defects |
Recurrent skin, lung, or liver cold abscess |
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Why do patients get fever and infection |
Due to disruptions in the barriers |
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What is expected if there are skin breaks |
Staphylococci and streptococci infection --> cellulitis |
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What happens in splenectomized patients |
Impaired reticuloendothelial cells --> more prone to infections due to encapsulated organisms |
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Multiple Myeloma Underlying abnormality |
Hypogammaglobulinemia |
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Multiple Myeloma Organisms responsible for infection |
S. pneumoniae H. influenzae N. meningitidis |
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Chronic Lymphocytic Leukemia Underlying immune abnormality |
Hypogammaglobulinemia
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Chronic Lymphocytic Leukemia Organisms responsible for infection |
1. S. pneumoniae 2. H. influenzae 3. N. meningitidis |
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Acute Myeloid/Lymphocytic Leukemia Underlying immune abnormalitiy |
Granulocytopenia Skin lesion Mucus membrane lesions |
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Acute Myeloid/Lymphocytic Leukemia Organisms responsible for infection |
G+ bacteria G- bacteria Fungi |
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Hodgkin's Disease Underlying immune abnormality |
Abnormal t-cell function |
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Hodgkin's Disease Organisms responsible for infection |
M. tuberculosis M. avium Listeria Cryptoccocus Salmonella Herpesviruses |
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Non-Hodgkin's Disease and Acute Lymphocytic Leukemia Underlying immune abnormality |
Glucocorticoid therapy Abnormal T- and B-cell function |
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Non-Hodgkin's Disease and Acute Lymphocytic Leukemia Organisms responsible for infection |
Pneumocystiis |
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Colon and Rectal Tumors Underlying immune abnormality |
Local abnormalities |
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Colon and Rectal Tumors organisms that cause infection |
S. bovis biotype 1 |
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Hairy Cell Leukemia Underlying immune abnormality |
Abnormal T-cell function |
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Hairy Cell Leukemia Organisms that cause infection |
M. tuberculosis M. avium Listeria Cryptococcus Salmonella |
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How do you calculate ANC |
ANC = WBC x (% bands + segs)/100 |
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What is febrile neutropenia |
Fever in a neutropenic patient with uncontrolled neoplasm involving bone marrow or patient undergoing cytotoxic treatement |
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What is a fever |
One temperature >/= 38.5 deg Celcius OR three readings >/= 38 degrees but < 38.5 deg per 24 hours |
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What is neutropenia |
ANC < 500 cells/mm3 OR expected to decrease to < 500 cells/mm3 in the next 48 hours |
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What is neutropenic fever |
Fever during chemothera[y-induced neutropenia |
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What may be the only indication of severe underlying fever |
Neutropenic fever |
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Give the general timeline of neutropenia (Day 0, 1st week, in the next 1-2 weeks) |
Day 0: chemotherapy 1st week: WBC decline, mucositis Next 1-2 weeks: WBC recovery |
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State the pathophysiology of neutropenia (with days) |
Day 0: Chemotherapy 1st week: WBC declines, Mucositis increases Mucositis --> destruction of mucus membranes --> malabsorption --> translocation of bacteria --> increased risk of different infections Next 1-2 weeks: Recovery of WBC |
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In neutropenia, what does peak of fever coincide with |
Nadir of WBC |
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What are the G+ cocci expected in neutropenia |
Staph epdiermidis Staph aureus Strep pneumoniae Viridans streptococcus Enterococcus faecalis |
SSS people have VEry positive cocks |
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What are the G- cocci expected in neutropenia |
Serratia Acitenobacter Citrobacter Klebsiella Enterobacter Stenotrophomonas Pseudomonas aeruginosa E coli Non-aeruginosa pseudomonas |
SACK ESPEN for their negative cocks |
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What are the G+ bacilli expected in neutropenia |
Diptheroids JK bacillus |
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What are the fungi expected in neutropenia |
Candida Aspergillus Mucor |
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Therapy for neutropenia What is the initial therapy |
Antibiotics that cover G+ and G- aerobes |
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Therapy for neutropenia If on follow up there are obvious infectious sites found, what do you do |
Treat with best available antibiotics Continue with both G+ and G- aerobe coverage |
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Therapy for neutropenia If on follow there are no obvious infectious sites and patient is afebrile what do you do |
Continue with regiment |
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Therapy for neutropenia If on follow there are no obvious infectious sites and patient is febrile what do you do |
Add a broad-spectrum antifungal agent |
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Therapy for neutropenia When do you stop treatment |
When neutropenia resolves at granulocyte count > 500 |
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Therapy for neutropenia What treatment is recommended for high-risk patients |
IV empirical antibiotic therapy |
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Therapy for neutropenia What is a recommended agent and type (monotherapy? multiple therapy? |
Monotherapy with an anti-pseudomonal beta lactam agent |
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Therapy for neutropenia What are some drugs that can be used for monotherpay for high risk patients (3) |
Cefepime Carbapenem Pip-Tazo |
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Therapy for neutropenia When should you add other antimicrobilas to the regimen |
1. Management of complications 2. Suspicion or proof of antimicrobial resistance |
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Therapy for neutropenia What drug is not recommended to be part of the inital antibiotic regiment for fever and neutropenia |
Vancomycin |
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Catheter infections If there is exit site erythema but there's negative blood culture, what will you do with the catheter |
NO necessary removal needed and it depends if infection responds to treatment |
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Catheter infections If there is exit site erythema but there's negative blood culture, how will you proceed in terms of antibiotics |
Begin treatment for G+ cocci |
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Catheter infections If there is tunnel site erythema but there's negative blood culture, what will you do with the catheter |
REMOVE THE CATHETER |
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Catheter infections If there is tunnel site erythema but there's negative blood culture, how will you proceed in terms of antibiotics |
Treat for G+ cocci pending culture results |
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Catheter Infections If blood culture is positive for coagulase-negative staphylococci, what will you do to the catheter |
It is optimal to remove Unnecessary if patient is stable and responds to antibiotics |
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Catheter Infections If blood culture is positive for G+ cocci and G+ rods, what will you do to the catheter |
Recommended to remove |
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Catheter Infections If blood culture is positive for G- bacteria, what will you do to the catheter |
Recommended to remove |
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Catheter Infections If blood culture is positive for fungi, what will you do to the catheter |
Recommended to remove |
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Catheter infections If blood culture is positive for coagulase-negative staphylococci, how will you proceed in terms of antibiotics |
Start with vancomycin Alternative drugs 1. Linezolid 2. Quinupristin/dalfopristin 3. Daptomycin |
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Catheter infections If blood culture is positive for G+ cocci and rods, how will you proceed in terms of antibiotics |
Antibiotics to which organism is sensitive |
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Catheter infections If blood culture is positive for G- bacteria, how will you proceed in terms of antibiotics |
Antibiotiic to which organism is sensitive |
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Cancer chemotherapy affects which arm of the immune system |
innate imune response |
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Solid Organ Transplant When do infections usually occur |
First few months after transplant |
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Solid Organ Transplant How can infections be acquired (4) |
1. Donor-derived 2. Recipient-derived 3. Community acquired 4. Hospital acquired |
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Solid Organ Transplant What are the 8 herpesvirus syndromes in transplant patients |
1. HSV 1 2. HSV 2 3, VZV 4. Cytomegalovirus 5. EBV 6. HHV 6 7. HHV 7 8. HPV 8 (Kaposi's Sarcoma) |
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SOT: Donor-Derived Infection What is the biggest clue of this kind of inection |
Other recipients unrelated to the donor having similar infection symptoms |
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SOT: Donor-Derived Infection When do these usually occur |
1 month of transplant |
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SOT: Donor-Derived Infection What is the main differential |
Hospital acquired infection |
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SOT: Donor-Derived Infection What symptoms/stuffs will make you suspect this |
1. Fever 2. Allograft involvement |
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Solid Organ Transplant If an infection occurs within 0-30 days, what's the likely cause |
Donor derived or Nosocomial |
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Solid Organ Transplant If an infection occurs within 31 days - 4 mos, what is the likely cause |
1. Reactivation of infection 2. Opportunistic infection |
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Solid Organ Transplant If an infection occurs occurs more than 6 months after the transplant, what is the likely cause |
Community acquired |
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Solid Organ Transplant What is the relation between surgery length and risk of infection |
Longer the surgery, higher the risk |
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Solid Organ Transplant What are responsible for majority of febrile episodes 31 days - 4 mos after the transplant |
1. Viral pathogens 2. Allograft rejection |
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Solid Organ Transplant What is done to prevent UTI and opportunistic infections |
Trimethoprim-sulfamethoxazole prophylaxis |
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Solid Organ Transplant Risk of infection ________ 6 mos after the transplant Why? |
Diminishes Because immunosuppresive therapy is tapered |
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Solid Organ Transplant What is the most notorious virus in SOT |
Cytomegalovirus |
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Hematologic Transplant What does syngeneic transplant mean |
Transplant from a twin |
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Hematologic Transplant What does allogeneic transplant mean |
Transplant from a sibling or unrealted donor |
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Hematologic Transplant What does autologous transplant mean |
Transplant from the self |
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Hematologic Transplant What is engraftment |
Acceptance of the donor transplant by the recipient |
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Hematologic Transplant What is graft versus host disease |
Immunologic reaction by the donor lymphocytes against the recipient which leads to inflammation of target tissues |
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Hematologic Transplant What days are covered by the pre-engraftment period |
0-30 days |
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Hematologic Transplant What days are covered by the engraftment period |
30-100 days |
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Hematologic Transplant What days are covered by the post-engraftment period |
> 100 days |
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Hematologic Transplant What infections are predominant in the pre-engraftment phase |
bacterial infections |
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Hematologic Transplant What specific virus may appear due to reactivation in the pre-engraftment phase |
HSV infection |
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Hematologic Transplant What kind of infections start toappear in the engraftment phase |
Viral infections |
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Hematologic Transplant There is a __________ risk of fungal infections in HSCT compared to SOT |
higher |
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Hematologic Transplant What should you expect after the first month of HSC transplant |
Complications similar to those in granulocytopenic patients --> febrile neutropenia |
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Hematologic Transplant How long can you expect neutropenia to last |
1-4 weeks |
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Hematologic Transplant What can you do given that there may be a duration of neutropenia |
Give prophylactic antibiotics |
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Hematologic Transplant When do you give prophylactic antibioitcs |
Initiation of myeloablative therapy |
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Hematologic Transplant When can human herpes virus become common Why |
During the second phase, after transplantation because of reactivation |
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Hematologic Transplant What is the notorious virus |
Cytomegalovirus |
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If a patient will undergo HSCT when should vaccination be done |
AFTER the transplant |
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If a patient will undergo SOT when should vaccination be done |
BEFORE the transplant |
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How long should you defer live vaccines in patient who underwent HSCT |
6 months |
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