Infection in Haematological Malignancy Flashcards
(25 cards)
Neutrophils
Bacterial and fungal infection
Monocytes
Fungal infection
Eosinophils
Parasitic infections
T lymphocytes
Fungal and viral infection, PJP
B lymphocytes
Bacterial infection
Supportive measures aimed at reducing risk of sepsis in haematological malignancy
Prophylaxis Growth factors e.g. G-CSF Stem cell rescue/transplant Protective environment Intravenous immunoglobulin replacement Vaccination
What is the cause of neutropenia in haematological malignancy?
Marrow failure is higher risk than immune destruction
What is significant risk/high risk of neutropenia?
<0.5 x 10^9/l - significant
<0.2 x 10^9/l - high
What duration of neutropenia classes as high risk?
> 7 days
Additional risk factors for infection
Disrupted skin/mucosa
Altered flora/antibiotic resistance
Lymphopenia
Monocytopenia
Causes of disrupted skin/mucosal surfaces
Hickman line, venflons
Mucositis affecting GI tract
GVHD
GVHD
Graft versus host disease
Causes of altered flora/antibiotic resistance
Prophylactic antibiotics
Causes of lymphopenia
Disease process e.g. Lymphoma
Treatment eg Fludarabine, ATG
Stem cell transplantation, GVHD
Causes of monocytopenia
Hairy cell leukaemia
Chemotherapy
Febrile neutropenia bacterial causes
60-70% gram positive bacteria
30-40% gram negative bacteria
Gram positive bacteria
Staphylococci
Streptococci
Gram negative bacteria
Escherichia coli
Klebsiella spp
Pseudomonas aeruginosa
Fungal infection in immunocompromised patients
Candida spp
Monocytopenia and monocyte dysfunction contributes to risk of fungal infection
Presentation of neutropenic sepsis
Fever with no localising signs Rigors Chest infection/ pneumonia Skin sepsis Urinary tract infection Septic shock
Sepsis six
3 out => Blood cultures Urine output Lactate 3 in => IV antibiotics IV fluids Oxygen
Infection in severely lymphopenic patients
Atypical pneumonia -PJP -CMV -RSV Viral -Shingles -Mouth ulcers (Herpes simplex) -Adenovirus -EBV
PJP
Pneumocystis Jirovecii
CMV
Cytomegalovirus
