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Haematology > Infection > Flashcards

Infection Flashcards

1
Q

Which immune cells do you need? and if they are not there then what type of infections may you get?

A
  • Neutrophils – bacterial & fungal infection
  • Monocytes – fungal infection
  • Eosinophils – parasitic infections
  • T lymphocytes – fungal & viral infection, PJP
  • B lymphocytes – bacterial infection
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2
Q

CAUSES OF DEATH AFTER
TRANSPLANTS DONE IN 1996-2000

how do the number of deaths due to infection comapre beteen ALLO and AUTO transplants?

A

ALLO – allogeneic transplant

Significant number of infections

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3
Q

what are some Supportive measures aimed at reducing risk of sepsis in Haematological malignancy?

A

•Prophylaxis:

  • Antibiotics (ciprofloxacin)
  • Anti-fungal (fluconazole or itraconazole)
  • Anti-viral (aciclovir)
  • PJP (co-trimoxazole)
  • Growth factors e.g. G-CSF (important way of speeding neutrophil recovery and reducing duration of neutropenia)
  • Stem cell rescue/transplant (If patient has gotten a high dose of chemo we don’t wait for their body to recover, we use stem cells to speed up recovery)
  • Protective environment e.g. laminar flow rooms
  • Intravenous immunoglobulin replacement
  • Vaccination
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4
Q

in this picture showing, what can this lead to?

A

Neutropenia

Bone marrow - Before you have plenty of cells and fat spaces

Neutropenia is predictable after standard cytotoxic chemotherapy

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5
Q

Neutropenic Risk:

what is the cause of neutropenia?

A

marrow failure higher risk than immune destruction

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6
Q

Neutropenic Risk:

what is the different degress of neutropenia?

A

< 0.5 x 109/l - significant risk

< 0.2 x 109/l - high risk

Neutrophil count has to fall significantly before there is a risk of infection

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7
Q

Neutropenic Risk:

what is the duration of neutropenia?

A

> 7 days - high risk

(AML therapy & stem cell transplantation produces profound neutropenia ~ 14-21 days)

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8
Q

what are some Additional Risk Factors for Infection?

A

•Disrupted skin / mucosal surfaces

  • Hickman line, venflons
  • Mucositis affecting GI tract
  • GVHD

•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
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9
Q

Febrile Neutropenia Bacterial causes:

how common is gram positive or gram negative infections?

A
  • Gram-positive bacteria (60-70%) (Positive often get in through lines)
  • Gram-negative bacilli (30-40%)
  • These patterns may now relate to antibiotic prophylaxis, emerging infections, use of lines etc
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10
Q

Febrile Neutropenia Bacterial causes:

what are some gram-positive bacteria that may be repsonsible?

A

•Staphylococci: MSSA,MRSA, coagulase negative

•Streptococci : viridans

  • Enterococcus faecalis/faecium
  • Corynebacterium spp
  • Bacillus spp
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11
Q

Febrile Neutropenia Bacterial causes:

what are some gram-negative bacteria that may be repsonsible?

A

•Escherichia coli

•Klebsiella spp : ESBL

•Pseudomonas aeruginosa

  • Enterobacter spp
  • Acinetobacter spp
  • Citrobacter spp
  • Stenotrophomonas maltophilia
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12
Q

what are some possible sites of infection?

A
  • Respiratory tract (often have signs of pneumonia and hypoxia)
  • Gastrointestinal (Typhlitis)
  • Dental sepsis
  • Mouth ulcers
  • Skin sores
  • Exit site of central venous catheters
  • Perianal (avoid PRs! - When you have patients with low blood counts then don’t do PRs)
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13
Q

Area of cellulitis around hickman line insertion site

A

Periorbital cellulitis

Disseminated herpes infection associated with secondary cellulitis so combination of a viral and bacterial infection

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14
Q

how does neutropenic sepsis present?

A
  • Fever with no localising signs - Single reading of >38.50C or 380C on two readings one hour apart
  • Rigors
  • Chest infection/pneumonia
  • Skin sepsis - cellulitis
  • Urinary tract infection
  • Septic shock
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15
Q

Early recognition and treatment of Sepsis is ________________

A

Life saving

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16
Q

what is the definition of Severe Sepsis/Septic Shock?

A
17
Q

Action

Deliver the sepsis six - what is it?

Every hour’s delay in administering antibiotics increases chance of mortality by 8%

A
  • Administer high flow oxygen
  • Take blood cultures, other cultures, consider source control
  • Give appropriate IV antibiotics within ONE hour (of presentation)
  • Measure serum lactate concentration ( can give you an idea of prognosis)
  • Start IV fluid resuscitation (maintains blood pressure)
  • Assess/measure urine output
18
Q

what are some Investigations of neutropenic fever

A
  • History and examination
  • Blood cultures - Hickman line & peripheral
  • CXR
  • Throat swab & other clinical sites of infection
  • Sputum if productive (if they have productive cough)
  • FBC, renal and liver function, coagulation screen
19
Q

what is the management of neutropenic sepsis?

A
  • Resuscitation – ABC (Resuscitation is the initial goal and getting in the sepsis 6 as soon as possible)
  • Broad spectrum I.V. antibiotics - Tazocin and Gentamicin
  • If a gram positive organism is identified add vancomycin or teicoplanin
  • If no response at 72 hours add I.V. antifungal treatment e.g. Caspofungin - empiric therapy
  • CT chest/abdo/pelvis to look for source
  • Modify treatment based on culture results
20
Q

Infection in immunocompromised patients - what may cause a fungal infection and what is it like?

A

e.g. Candida species, Aspergillus

Life threatening deep seated infection

Lung, liver, sinuses, brain

•Monocytopenia and monocyte dysfunction contributes to risk of fungal infection

Pulmonary aspergillosus

Also can make a microbiological diagnosis

21
Q

what is the therapy for fungal infections?

A
  • Empirical – echinocandins eg Caspofungin, Anidulafungin
  • Aspergillus – Voriconazole, Isavuconazole
  • Moulds – Liposomal amphotericin (Ambisome)

(Mould is tough to treat but don’t come across it that often)

22
Q

Infection in severely lymphopenic patients - what different ways can it occur?

A
  • Stem cell transplant recipients, especially allogeneic
  • Recipients of Total Body Irradiation (TBI)
  • Graft vs Host Disease
  • Nucleoside analogues (fludarabine) or ATG (both very suppressive to T cell making you prone of infection for long periods of time)
  • Lymphoid malignancy e.g Lymphoma, CLL, ALL
  • Pneumonitis - Pneumocystis Jirovecii (PJP), CMV, RSV
  • Viral - Shingles (Varicella Zoster), Mouth ulcers (Herpes simplex), Adenovirus, EBV (PTLD), SARS-CoV2
  • Fungal - candida, aspergillus, mucormycosis
  • Atypical mycobacteria - Skin lesions, pulmonary and hepatic involvement
23
Q

what therapies are used for different viral infections?

A
  • PJP – high dose co-trimoxazole
  • CMV – ganciclovir, foscarnet
  • HSV1, VZV – aciclovir
  • Influenza A/B – oseltamivir, zanamivir
  • Adenovirus – cidofovir
  • RSV – ribavirin
  • Immunoglobulin replacement (eg post alloSCT)
24
Q

Summary:

  • Recognise & treat possible infection _____ in post-___________ patients
  • Immunity (particularly T cell) can be __________ for a long time due to disease or treatment
  • Much lower threshold for ________ and hospitalisation in the immunocompromised
A

early

chemotherapy

suppressed

antibiotics

Haematology (15 decks)

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