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Immunology > Immunodeficiency > Flashcards

Immunodeficiency Flashcards

1
Q

what are the major risk factors for candidemia

A

broad spectrum abx

indwelling central venous catheters

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2
Q

Prosthetic devices most often get colonized with

A

Coag negative staph!

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3
Q

3 bacteria commonly associated with peripherally inserted catheters

A

coag neg staph
staph aureus
candida

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4
Q

common bacteria for permanent intravascular devices

A

staph - but pacemakers and valves are covered by endothelium within weeks

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5
Q

common bacteria for permanent EXTRAvascular devices

A

staph aureus and

coag negative staph

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6
Q

how common is complement deficiency?

A

rare - 1/3000

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7
Q

Late complement deficiency increases the risk for what type of infection

A

meningocococal - 5,000 to 10,000 fold increase

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8
Q

what is the age of onset of meningococal infection in late complement deficiency?

A

median age is 17 vs 5 in general population

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9
Q

compare the mortality from meningococoal disease in LCCD

A

1/10 that of the generla population

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10
Q

Neutropenia results in an increased risk of

A

Infection due to microflora
and
Aspergillus

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11
Q

within 1 week after chemo what happens?

A

Develop neutropenia and mucositis

as well as a fever - concurrent with bacteremia

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12
Q

after the 3rd week of chemo

A

central venous catheter infections

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13
Q

lung infections tend to occur 4 weeks after

A

fever for 5-6 days

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14
Q

what happens if febrile neutropenia extends beyond 1 week?

A

the risk of aspergillosis increases

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15
Q

Early in the disease invasive pulmonary aspergillosis will show

A

halo effects

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16
Q

LATE in the disease invasive pulmonary aspergillosis will show

A

SHOW An air crescent

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17
Q

2 major immune reconstitution syndromes after neutrophil count returns to normal

A

Asymptomatic pulmonary infiltrates

Hepatosplenic candidiasis

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18
Q

when patients present with hepatosplenic candidasis how

A 
fever
abdominal pain 
increased liver enzymes
SEE GRANULOMAS
tissue cultures are often negtive
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19
Q

why do patients with meningococcal disease in LCCD have a lower mortality?

A

Poor immune response

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20
Q

what does vaccination do for meningococal infections in LCCD?

A

reduces recurrence

reduces frequency of infection

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21
Q

Neutrophils primarily protect us from

A

Our own microbiome

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22
Q

If you have neutropenia you are more likely to get …

A

sepsis whereas neutrophil dysfunction you have a localized infection

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23
Q

Because of disrupted mucosal barriers in chemo induced neutropenia you end up with

A

infections from GI tract- gram negative bacilli

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24
Q

As the gut develops mucositis/bacteremia it coincides with

A

Developing a fever

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25
Q

neutrophils that are normal

A

0.5 x 109 -

26
Q

patients with immunoglobulin deficiency are prone to what type of infections

A

Pneumococcal infections

27
Q

Patients with asplenia are most prone to

A

S. pneumo

28
Q

Patients with cell-mediated immunocompromise are at risk for

A

viruses,
mycobacteria
fungi
protozoa

29
Q

Think of things that Immunoglobulins protect us from

A

1- pneumococcal infections
2- GI tract from Giardia, campylobacter, enteroviruses
3- Skin from group A strep, Staph

30
Q

Which globulinemias are more common

A

Hypo (all) more common than some (Dysgammaglob)

31
Q

3 causes of acquired immunoglob deficiency

A

1 - nephrotic syndrome - renal loss
2 - malabsorption or protein losing enteropathy
3- CLL - no B cells

32
Q

You are more likely to bacterial peritonitis with

A

Ascites from cirrhotic liver

33
Q

Ascitic fluid in cirrhosis

A

Lacks IgG

and lacks flow -

34
Q

patients with UNTREATED CLL are at risk for

A

sinus and resp infections

bacteremia

35
Q

patients with TREATED CLL have

A

cell-mediated immunocompromise

36
Q

major role of the spleen is to clear

A

encapsulated bacteria

37
Q

functional asplenia is recognize by 2 things

A

1) howell jolly

2) Heinz bodies

38
Q

Patients with asplenia are at greatest risk for

A

Overwhelming Post-Splenectomy Infection - OPSI

39
Q

OPSI is due to

A 
S. Pneumo
N. Meningitidis
Babesia
Malaria
capnocytophaga canimorsus (GN bacillis)
40
Q

how can you prevent OPSI

A

vaccinate with pneumococ and meningococ vaccines

41
Q

3 fungi associated with HIV infection

A 
mucosal candidiasis
Pneumocy Jorivecci
Dimorphic fungi
Toxoplasma
intestinal protozoa
42
Q

most common complications associated with HIV immunosuppression

A

reactivation of latent viruses -

43
Q

Prior to HSCT engraftment what is the most common problem

A

1) oral Mucositis

2) gut mucositis - diarrhea, cramping

44
Q

The first 30 days following HSCT are similar to

A 
Febrile neutropenia (diseases from skin and GI tract colonizers)
- reactivation of HSV
45
Q

d30 -d 100 after HSCT characterized by

A

reduced cell-mediated immunity

46
Q

Most important viruses between d30-d100 after HSCT

A

Herpesviruses

  • pulmonary or GI CMV
  • EBV - PTLD - post trans lymphoprolif disorder
47
Q

near the end of d30-d100 after HSCT most imp

A

fungi

Aspergillis and Pneumocystis

48
Q

d100 (late phase of HSCT) there is a reduction in 2 things

A

cell mediated AND humoral immunity
cell-mediated deficiency –> virus latent ones and Comm acquired resp viruses
Humoral deficiency –> encapsulated bacteria

49
Q

With severe immunosuppression which viruses can reactivate

A
  • Polyoma - BK and JC viruses

and Papillomaviruses

50
Q

In HSCT reactivation of BK virus leads to

A

haemorrhagic cystisis

51
Q

In renal graft recipients reactivation of BK virus leads to

A

renal graft failure - BK neuropathy

52
Q

JC virus causes

A

latent CNS infection

PML

53
Q

Which Abx do you give for prophylactic HSCT and when

A

TMP-SMX POST-ENGRAFTMENT

54
Q

What does TMP SMX do

A

prevents Pneumocystis and Toxo

55
Q

how do you treat all CMV mismatched patients

A

treat with valganciclovir few days after transplant

56
Q

Lung transplantation often complicated by

A

post transplant pneumonia -
from host
from transplanted organ
from anatomical dysfunction/intubation

57
Q

Liver transplantation often complicated by

A

infections at the surgical site

58
Q

Renal transplant often complicated by

A

pyelonephritis

59
Q

Post transplant lymphoprolif disorder often associated with

A

EBV infection -
T cell depletion
B cell immortilization previously infected with EBV - proliferate

60
Q

more important than HLA mismatching is

A

whether or not the recipient has anti-HLA antibodies against the donor

Immunology (9 decks)

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