The Immunocompromised Patient Flashcards
What is humoral immunity?
It’s antibody mediated immunity. (Not cell mediated). It involves substances found in the ‘humours’ (body fluids). Antibodies are immunoglobulins and there are five types.
What does B cell or humoral deficiency mean?
Affects antibody production
What is cell mediated immunity?
Doesn’t involve antibodies but the activation of phagocytes, antigen specific cytotoxic t lymph yes and various cytokines in response to an antigen. Activated lymphocytes produce lymphokines. Important in defences against mycobacterium fungi and viruses.
What types of immune deficiency are there?
Congenital: (rare) -cyclic neutropenia -wiskott-Aldrich syndrome Aquired: -corticosteroid therapy -malignancy leukaemia/myeloma -chemotherapy/bone marrow, organ transplantation -viral:HIV
What are corticosteroids (steroids) used for?
To relieve inflammation. In autoimmune conditions such as rheumatoid arthritis or lupus (inflammation in both the joints and skin) the immune system triggers inflammation even though no infection is present. Can also be used to treat severs flare ups of asthma or COPD.
What are the side effects of steroids?
Predisposition to diabetes mellitus. Cushingoid appearance (moon face). Increased risk of fungal infections. Hypertension (high blood pressure). Osteoporosis. Adrenal suppression. Gastric ulceration.
What are dental problems associated with steroids?
Hypotension crisis. Underlying disease process. Candidal infection. Osteoporosis. Aspirin and NSAIDs should be avoided.
What is a steroid/adrenal crisis?
Potentially fatal and due to an acute deficiency of cortisol and to a lesser extent aldosterone. Occurs when demand for these hormones exceeds the ability of adrenal glands to produce them ie immunodeficiency patient on time of stress or infection or pregnancy therefore before surgery steroid patients (taking more than 10mgs of prednisolone daily) should get their dose upped as their body will not be able to compensate by itself. If immediate treatment in bdh give 100mg hydrocortisone hemisuccinate iv prior to procedure.
Cytotoxic agents from chemo can affect bone marrow and result in:
Leukopenia and neutropenia
Thrombocytopenia
Anaemia
What else can chemo cause (adverse effects)
Mucositis Oral ulceration with superimposed opportunistic infections Pseudomonas Candida albicans Herpes simplex
Prophylactic cover in chemo:
Patients usually covered prophylactically for viral and fungal infections. If pyrexic and neutropenic the first line is AB’s (fluconazole/itraconazole, acyclovir and other related antivirals. Resistance to them could be fatal.
When is a patient immunocompromised?
Full blood count:
Neutrophils less than 1.5x10^9/litre
Platelets less than 50x10^9/litre
Prophylactic AB cover is recommended if any work is going to be carried out.
What antibiotic prophylaxis could be given?
Amoxycillin 3gms
Orally one hour prior to procedure it if patient is allergic to penicillin give: clindamycin 600mg.
If in hospital could give iv infusion 1gm amoxil or 300mg clindamycin prior to procedure.
List some anti-rejection drugs
Cyclosporin (but causes gingival hyperplasia)
Azathioprin
Prednisolone
HIV
An immunocompromised patient. Caused by a blood borne virus.
