14 Infection in the immunocompromised host Flashcards

1
Q

Explain how neutrophils may have qualitative defects.

A

Chemotaxis - rare, inadequate signalling/receptors/movement

Killing - CGD - no NADPH oxidase, no hydrogen peroxide. Staph aureus risk.

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2
Q

What might cause a quantitative lack of neutrophils?

A

Cancer rx.
Bone marrow malignancy.
Aplastic anaemia caused by drugs.

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3
Q

Which infections are neutropenic patients especially at risk of? (5).

A
E. coli (G-ve bacilli).
S. aureus (G+ve cocci).
Coagulase -ve staph.
Candida spp.
Aspergillus spp.
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4
Q

What is the treatment for an infection in a neutropenic patient? (2,2,1)

A

Aminoglycoside and an antipseudomonal penicillin.
2nd line - carbapenem, antifungals.
GCSF.

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5
Q

Which drugs may cause T cell deficiencies? (2).

A

Ciclosporin (transplantation).

Steroids.

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6
Q

Which bacterial, viral (3) and fungal (2) infections are T cell deficient patients most susceptible to?

A

Listeria monocytogenes.
Mycobacteria.
HSV, CMV, VZV.
Candida spp, ctyptococcus spp.

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7
Q

Which protozoan and parasitic infections are T cell deficient patients most at risk of? (3)

A
Cryptosporidium pavum (faecal-oral, symptomatic rx only).
Toxoplasma gondii (cat, or heart with bradyzoites - asymptomatic).
Strongyloides stercoralis.
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8
Q

Three causes of acquired hypogammaglobulinaemias and three commonly resulting infections.

A

Multiple myeloma, CLL, burns.
Usually encapsulated bacteria:
S. pneumoniae, Giardia lambia, Cryptosporidium.

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9
Q

Which infections occur with a complement deficiency? (3)

A

Encapsulated bacteria
S. pneumoniae - poor opsonisation.
If C5-8 Neisseria meningitides.

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10
Q

What does the spleen do? (2)

A

Source of complement and B cells, removes opsonised bacteria.

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11
Q

Which infections are people who take biological therapies at risk of? (4).

A

Tuberculosis.
Herpes zoster.
Legionella pneumophila.
Listeria monocytogenes.

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12
Q

What are the five stages of different infections that can follow organ transplantation?
Which infections occur? (1,2,2,2,2)

A
Initial disease: Hep B.
Surgery related: ventilator acquired pneumonia, S. aureus.
Organ: Toxoplasmosis, CMV.
Initial opportunistic: CMV, Aspergillus.
Later opportunistic: VZV, Listeria.
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13
Q

Which prophylactic antimicrobials are used in immunocompromised patients? (4).

A

Penicillin.
Cotrimoxazole.
Acyclovir.
Passive immunoglobulin.

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14
Q

When should Strongyloides stercoralis be suspected? (3).

A

Eosinophilia.
G-ve septicaemia.
Tropical/ old POW.

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15
Q

Which infections commonly occur after a splenectomy? (4).

A

Streptococcus penumoniae.
Haemophilis influenza type B.
N meningitides.
Malaria.

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