Infection Flashcards
(29 cards)
What type of infections do neutrophils play a role in?
- Bacterial
- Fungal
What type of infections do monocytes play a role in?
Fungal
What type of infections do eosinophils play a role in?
Parasitic
What type of infections do T lymphocytes play a role in?
- Fugal
- Viral
- PJP
What type of infections do B lymphocytes play a role in?
Bacterial
What supportive factors are aimed at reducing sepsis in haematological malignancy?
- Prophylaxis
- Growth factors e.g. G-CSF
- Stem cell rescue/transplant
- Protective environment e.g. laminar flow rooms
- Intravenous immunoglobulin replacement
- Vaccination
What prophylaxis can help reduce sepsis in haematological malignancy?
- Antibiotics (ciprofloxacin)
- Anti-fungal (fluconazole or itraconazole)
- Anti-viral (aciclovir)
- PJP (co-trimoxazole)
What is the cause of neutropenia?
Marrow failure proves a higher risk than immune destruction
How is the degree of neutropenic risk classified?
Neutrophils
- <0.5x10^9= significant risk
- <0.2x10^9= high risk
What duration of neutropenia carries a high risk?
- Neutropenic >7 days
- In AML therapy and stem cell transplantation there is profound neutropenia ~14-21 days
What are additional risk factors for infection?
Disrupted skin / mucosal surfaces
- Hickman line, venflons
- Mucositis affecting GI tract
- Graft Versus Host Disease
Altered flora/ antibiotic resistance
-Prophylactic antibiotics
Lymphopenia
- Disease process e.g. Lymphoma
- Treatment eg Fludarabine, ATG
- Stem cell transplantation, GVHD
Monocytopenia
- Hairy cell leukaemia
- Chemotherapy
What is the pattern of bacterial causes of febrile neutropenia?
- Gram-positive bacteria (60-70%)
- Gram-negative bacilli (30-40%)
-These patterns may now relate to antibiotic prophylaxis, emerging infections, use of lines etc
What gram positive bacteria are implicated in febrile neutropenia?
- Staphylococci: MSSA,MRSA, coagulase negative
- Streptococci : viridans
- Enterococcus faecalis/faecium
- Corynebacterium spp
- Bacillus spp
What gram negative bacteria are implicated in febrile neutropenia?
- Escherichia coli
- Klebsiella spp : ESBL
- Pseudomonas aeruginosa
- Enterobacter spp
- Acinetobacter spp
- Citrobacter spp
- Stenotrophomonas maltophilia
What are possible sites of infection in haematological patients?
- Respiratory tract
- Gastrointestinal (Typhlitis)
- Dental sepsis
- Mouth ulcers
- Skin sores
- Exit site of central venous catheters
- Perianal (avoid PRs!)
What type of infection are immunocompromised patients particularly at risk of?
Fungal
Give examples of fungal infections.
- Candida
- Aspergillus
What can fungal infections in immunocompromised patients lead to?
Life threatening deep seated infection
What contributes to the risk of fungal infection?
Monocytopenia and monocyte dysfunction
Where are fungal infections likely to affect?
- Lung
- Liver
- Sinuses
- Brain
How does neutropenic sepsis present?
- Fever with no localised signs ( single reading of 38.5 or 2 readings of 38, 1 hour apart)
- Rigors
- Chest infection/ pneumonia
- Skin sepsis - cellulitis
- Urinary tract infection
- Septic shock
What is the timeline of sepsis?
- Signs of systemic inflammation
- Presumed infection and organ dysfunction
- Severe sepsis/ septic shock
What action should be taken for sepsis?
Sepsis 6
What are the sepsis 6?
- High flow oxygen
- Blood cultures
- IV antibiotics within 1 hour
- Serum lactate
- IV fluids
- Measure urine output
