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Infectious Diseases > Opportunistic Infections/Immunocompromised hosts > Flashcards

Opportunistic Infections/Immunocompromised hosts Flashcards

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1
Q

Neutropenia associated with

A

Bacterial infections (especially gram negatives/pseudomonas)

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2
Q

Prolonged neutropenia associated with

A

Fungi

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3
Q

T cell associated with

A

Viruses, Fungi, PJP, Mycobacteria

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4
Q

Complement (or eculuzimab) with

A

Meningococcus

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5
Q

Infliximab associated with

A

TB

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6
Q

Asplenia associated with

A

Encapsulated organisms (HiB, Pneumococcal)

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7
Q

CBG associated with

A

Catalase positive organisms (Staph Aureus, Serratia, Nocardia, Burkholderia, Aspergillus)

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8
Q

Cat bite

A

Pasteurella multocida

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9
Q

Cat scratch

A

Bartonella henselae

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10
Q

Cat faeces/litter

A

Toxoplasmosis

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11
Q

Sickle cell disease

A

Salmonella species

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12
Q

Well toddler with BJI/normal CRP

A

Kingella kingae

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13
Q

Varicella PEP in immunocompetent host

A

Vaccine within 3 days could prevent, vaccine within 5 days reduces severity

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14
Q

Varicella PEP in immunocompromised host

A

VZIg- can give up to 10 days after exposure, but give ASAP

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15
Q

COVID treatment in immunocompromised

A

Dexamethasone, IV Remdesivir, PO Paxlovid

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16
Q

Rotavirus treatment in immunocompromised

A

Immunoglobulin

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17
Q

Adenovirus in immunocompromised host features

A

Conjunctivitis, colitis, pneumonitis, hepatitis, haemorrhagic cystitis

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18
Q

Adenovirus treatment in immunocompromised host

A

Cidofovir

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19
Q

RSV treatment in immunocompromised host

A

Nebulised/IV Ribavirin

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20
Q

Influenza and Paraflu treatment in immunocompromised host

A

Oseltamivir

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21
Q

BK and JC virus presentation in immunocompromised host

A

Haematuria/haemorrhagic cystitis

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22
Q

BK and JC virus treatment in immunocompromised

A

Cidofovir

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23
Q

Herpes virus that is not oncogenic

A

HHV-6 (causes febrile seizures)

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24
Q

Virus implicated in PTLD

A

EBV (lymphoblast proliferation)

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25
PTLD spectrum
Glandular fever --> monoclonal proliferation --> Lymphoma
26
PTLD solid organ implicated
Solid organ (lung/liver/heart > renal) more so than HSCT due to amount of lymphoid tissue
27
PTLD immune risks
First two years post transplant, EBV positive organ for EBV negative recipient, heavy immune suppression
28
PTLD treatment
Reduce immune suppression, Rituximab, Chemo
29
Herpes viruses
EBV, CMV, HSV 1, HSV2, VZV, HHV7, HHV 8
30
HSV1 and HSV2 in immunosuppression
Stomatitis, pneumonitis, encephalitis
31
HSV1 and HSV2 treatment
Aciclovir/Valaciclovir
32
CMV in immunosuppression
Pneumonitis, Hepatitis, Colitis, Disseminated, Retinitis
33
CMV treatment in immunosupression
Ganciclovir 1st line, Valganciclovir 2nd line, Foscarnet 2nd like (resistant), Cidofovir 3rd line (resistant)
34
Ganciclovir and Valganciclovir side effects
Neutropenia
35
Foscarnet and Cidofovir side effects
Nephrotoxic
36
Ganciclovir resistance genes
UL97, UL54
37
VZV in immunocompromised
Disseminated chicken pox, pneumonitis, encephalitis, shingles
38
VZV treatment immunocompromised
Aciclovir, Valaciclovir
39
HHV6/HHV7 in immunocompromised
Disseminated rash, encephalitis, pneumonia, bone marrow suppression
40
HHV8 in immunocompromised
Kaposi's sarcoma
41
When post stem cell transplant are children at risk of herpes virus infections?
3 to 12 months (but can happen earlier, even ~6 weeks post)
42
When post stem cell transplant are children at risk of aspergillosis/invasive fungal infections?
4 weeks to 12 months (when prolonged severe neutropenia. Exclusive problem from Day 30 to ~Day 50)
43
PJP in immunocompromised host
Fever and cough with minimal CXR changes
44
PJP treatment
IV Cotrimoxazole
45
PJP prophylaxis
Cotrimoxazole PO or Pentamidine
46
What percentage of leukemia patients without prophylaxis will get PJP
20%
47
Prognosis of PJP without treatment
100% fatal
48
Prognosis of PJP with treatment
5 - 40% fatal
49
Invasive candidiasis in immunocompromised
Unexplained fever/sepsis despite antibiotics, skin lesions, white lesions in eyes, multiple focal liver or spleen lesions
50
Treatment for candidaemia or invasive candidiasis in non-neonate
Caspofungin 1st line, Fluconazole as oral stepdown (but high resistant), Ambisome (Liposomal Amphotericin)
51
Treatment for neonates with candidiasis
Conventional Amphotericin first line, Fluconazole second line if sensitive
52
Downside of Caspofungin
Well tolerated but doesn't reach CSF/Urine
53
Side effect of Amphotericin
Nephrotoxic +++, hypokalemia
54
Prolonged fever and neutropenia antifungal choice
1st line = Ambisome (CSF penetration but nephrotoxic), Second line is Caspofungin. Fluconazole if low risk. Voriconazole alternative
55
Invasive aspergillosis treatment
Voriconazole first line. Second line are Poscanozole, Ambisome, Caspofungin
56
Side effect of Fluconazole/Voriconazole
CYP450 liver toxicity
57
Greatest risk of fungal infection in patients undergoing chemotherapy
Prolonged severe neutropenia. Use of steroids but to a lesser degree
58
Example of polyenes
Amphotericin, Nystatin
59
Mechanism of action of polyenes
Make holes in cell membranes
60
Azoles (Triazoles)
Fluconazole, Voriconazole, Itraconazole, Posaconazole
61
Azoles (Imidazoles)
Clotrimazole, Miconazole, Ketaconazole
62
Echinocandins
Caspofungin
63
MoA Triazoles and Imidazoles
Inhibit cell membrane synthesis (ergosterol)
64
MoA Echinocandins
Inhibit cell membrane synthesis (Beta 1,3 D glucan)
65
Invasive aspergillus sites of infection
Brain, Sinuses, Lungs
66
Diagnosis of Aspergilus
BAL, Galactomann antigen on bronchial wash
67
Aspergillus CT signs
Halo sign (small nodules with hazy edge due to neutropenia), Air crescent sign (cavitate with neutrophil recovery)
68
Antibiotic to treat Stenotrophomonas Maltophillia
Cotrimoxazole
69
Organism risk in first 30 days after HSCT (B cell engrafment)
Bacteria, specifically gram negative e.g. pseudomonas
70
Rash associated with pseudomonas
Ecthyma gangrenosum
71
72
PJP staining
Methenamine silver nitrate or columbine blue of cysts (used for fungi and PJP)

Infectious Diseases (9 decks)

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