Infection in Immunocompromised

Question 1

what type of infection do neutrophils best target?

Answer 1

bacterial and fungal

Question 2

what type of infection do monocytes best target?

Answer 2

• fungal infection

Question 3

what type of infection do eosinophils best target?

Answer 3

parasitic infections

Question 4

what type of infections do T-lymphocytes best target?

Answer 4

fungal and viral infection, PJP

Question 5

what type of infections do B lymphocytes best target?

Answer 5

• bacterial infection

Question 6

what are the most common gram-positive bacteria causing infections in those with haematological malignancy?

Answer 6

• Staphylococci: MSSA, MRSA, coagulase negative
• Streptococci: viridans
• enterococcus faecalis/faecium
• corynebacterium spp
• bacillus spp

Question 7

what are the most common gram-negative bacteria causing infections in those with haematological malignancy?

Answer 7

• E.coli
• Klebsiella spp: ESBL
• Pseudomonas aerugionsa
• enterobacter
• acinetobacter
• citrobacter
• strenotrophomonas maltophilia

Question 8

what is the presentation of neutropenic sepsis?

Answer 8

• fever with no localising signs: single reading of > 38.5 or 38 on two readings one hour apart.
• rigors
• chest infection/pneumonia
• skin sepsis - cellulitis
• UTI
• septic shock

Question 9

Sepsis management (sepsis 6)

Answer 9

• administer high flow oxygen
• take blood cultures, other cultures, consider source control
• give appropriate IV antibiotics within one hour
• measure serum lactate concentration
• start IV fluid resuscitation
• assess/measure urine output

Question 10

management of neutropenic sepsis

Answer 10

• resuscitation ABC
• broad spectrum IV abx: tazocin and gentamicin
• if gram + is identified add vancomycin or teicoplanin
• if no response at 72 hours add IV antifungal e.g. Caspofungin - empiric therapy
• CT CAP to look for source
• modify treatment based on culture results

Question 11

what is the treatment for fungal infections in haematological malignancy?

Answer 11

• empirical - echinocandins e.g. caspofungin, anidulafungin
• aspergillus - voriconazole, isavuconazole
• moulds - liposomal amphotericin (ambisome)

Question 12

management of viral infection in severely lymphopenic patient

Answer 12

• if pneumocystitis jirovecii (PJP) > high-dose co-trimoxazole
• CMV - ganciclovir, foscarnet
• HSV1, VZV - aciclovir