Session 10

Question 1

What is a Hickman line? What is it commonly used for? What implications can it have for acquiring infections?

Answer 1

Artificial plastic line inserted through the skin and directly into the vascular system

Administration of chemotherapy drugs

Source of entry for microorganisms and an artificial surface within the body for organisms to attach to

Question 2

What is mucositis? How can it result in increased risk of infection?

Answer 2

Painful inflammation of the mucosal membranes in the body

Provides a break in the mucosal barrier

Question 3

What causes the loose stools seen as a result of treatment with cancer chemotherapy?

Answer 3

Normal mucosal lining is eroded, altering the motility of the bowel leading to loose stools

Question 4

How does chemotherapy affect blood cell levels in the body?

Answer 4

Acts on the dividing cells in the bone marrow resulting in a reduction in all blood cell lines

Question 5

A patient on cancer treatment is an example of an _____________ immune deficiency

Answer 5

Acquired

Question 6

Fungal cell walls are composed largely of…

Answer 6

Chitin

Question 7

Bacterial cell walls are composed largely of…

Answer 7

Peptidoglycan

Question 8

Where do all fungi derive nourishment from? What is this nourishment used for?

Answer 8

From a preformed organic carbon source

Growth

Question 9

Fungi produce enzymes to…

Answer 9

Degrade surrounding material making it soluble and able to cross the cell membrane

Question 10

Aspergillus can be found in ________ in buildings

Answer 10

Dust

Question 11

Does Aspergillus usually affect people with a normal host immune response?

Answer 11

No - people with reduced immunity can be at risk

Question 12

Acute Aspergillus infection commonly infects the…

Answer 12

Lungs

Question 13

What type of organism is Varicella zoster?

Answer 13

Virus - part of the Herpes family

Question 14

Varicella zoster is an example of a _______ virus

Answer 14

Herpes

Question 15

Epstein-Barr virus is an example of a _________ virus

Answer 15

Herpes

Question 16

Varicella zoster has a __________ pattern of infection

Answer 16

Latent

Question 17

What pattern of infection is seen in Varicella zoster?

Answer 17

Latent pattern of infection

Question 18

Varicella zoster causes…

Answer 18

CHICKEN POX

Question 19

Which organism causes chicken pox?

Answer 19

Virus - Varicella zoster

Question 20

Describe the pattern of infection of Varicella zoster

Answer 20

Infection of upper respiratory mucosa with virus containing droplets
Virus spreads to regional lymph nodes and replicates
Virus spreads to the liver and spleen
Infection of the skin leads to the appearance of a vesicular rash
Virus enters cutaneous neurones and migrates to ganglia where it enters a latent state.

Question 21

Name two symptoms of chicken pox

Answer 21

Fever

Rash

Question 22

Varicella zoster initially infects which part of the body?

Answer 22

Upper respiratory mucosa

Question 23

Varicella zoster virus enters _________ where it becomes dormant or enters a latent phase

Answer 23

Ganglia

Question 24

Varicella zoster is kept in check in its latent state by…

Answer 24

T cell surveillance

Question 25

The reactivation of latent Varicella zoster results in which condition?

Answer 25

Shingles

Question 26

What happens in the reactivation of latent Varicella zoster to cause shingles?

Answer 26

Viral particles in the dorsal root ganglion travel along the nerve to sensory terminals in the skin. Virus escapes the sensory terminals and invades the skin ---> Shingles

Question 27

Can shingles occur in healthy individuals?

Answer 27

Yes

Question 28

How can infection with Varicella zoster be diagnosed?

Answer 28

Clinical picture is usually diagnostic. Fluid can be taken from rash vesicles and the virus detected by PCR

Question 29

What does PID stand for?

Answer 29

Primary Immunodeficiencies

Question 30

Why is Immunodeficiency a largely unmet clinical problem?

Answer 30

There is a large spectrum of PIDs There is a failure to recognise and diagnose PIDs

Question 31

What is an immunocompromised host?

Answer 31

State in which the immune system is unable to respond appropriately and effectively to infectious microorganisms

Question 32

Immunodeficiency is due to...

Answer 32

A defect in one or more components of the immune system

Question 33

Name the main two types of Immunodeficiency

Answer 33

Primary Immunodeficiency (congenital) Secondary Immunodeficiency (acquired)

Question 34

Is a primary Immunodeficiency, congenital or acquired?

Answer 34

Congenital

Question 35

Is a secondary Immunodeficiency, congenital or acquired?

Answer 35

Acquired

Question 36

Primary immunodeficiencies are due to...

Answer 36

Intrinsic gene defects

Question 37

What can result from the intrinsic gene defects that cause primary Immunodeficiencies?

Answer 37

``` Missing protein Missing cell (of immune system) Non-functioning components produced ```

Question 38

Secondary Immunodeficiencies are due to...

Answer 38

An underlying disease/treatment

Question 39

How can underlying diseases/treatments cause secondary Immunodeficiency? (3)

Answer 39

Reduced production of immune components Reduced function of immune components Increased loss of immune components

Question 40

Infections suggesting an underlying immune deficiency are defined as...

Answer 40

SPUR infections

Question 41

What does the mnemonic SPUR stand for?

Answer 41

Severe Persistent Unusual Recurrent

Question 42

SPUR describes infections that...

Answer 42

Suggest underlying immune deficiency

Question 43

Give four warning signs of PID in children

Answer 43

4 or more new ear infections within 1 year 2 or more serious sinus infections within 1 year Two or months of antibiotics with little effect Two or more pneumonias within 1 year Family history of PID

Question 44

Give 4 warning signs of PID in adults

Answer 44

2 or more new ear infections within 1 year 2 or more serious sinus infections in 1 year without an allergy 1 pneumonia per year for more than 1 year Family history of PID

Question 45

Name three limitations of the 10 warning signs for PID

Answer 45

Lack of population based evidence PID patients with different defects/presentations PID patients with non-infectious manifestations

Question 46

Name the three most common PIDs with regards to their diagnosis

Answer 46

CVID - common variable Immunodeficiency IgA Deficiency IgG Deficiency

Question 47

What is the most common PID disease by diagnosis?

Answer 47

CVID

Question 48

What does CVID stand for?

Answer 48

Common Variable Immunodeficiency

Question 49

Onset of PID disease symptoms before 6 months highly suggests which sort of defect is present?

Answer 49

T cell | Phagocyte

Question 50

Onset of PID disease symptoms between 6 months and 5 years often suggests which sort of defect is present?

Answer 50

B Cell Antibody Phagocyte

Question 51

Onset of PID disease symptoms above 5 years of age usually suggests which sort of defect is present?

Answer 51

B Cell Antibody Complement (Secondary Immunodeficiency)

Question 52

Give an example of an infection that is commonly associated with complement deficiency

Answer 52

Meningitis

Question 53

Give an example of an infection that is commonly associated with phagocytic defects

Answer 53

Skin/mucous infections

Question 54

Give an example of a disease that is commonly associated with antibody deficiency

Answer 54

Malignancies

Question 55

Give an example of an infection that is commonly associated with T cell defects

Answer 55

Opportunistic infections

Question 56

What type of disease is chronic granulomatous disease?

Answer 56

Primary Immunodeficiency Disease

Question 57

What results from chronic granulomatous disease?

Answer 57

Increased susceptibility to bacterial and fungal infections

Question 58

Name two clinical signs you may see in someone with chronic granulomatous disease

Answer 58

Pulmonary aspergillosis | Skin infections

Question 59

Describe some supportive treatments for the management of PIDs (5)

Answer 59

Infection prevention Treat infections promptly and aggressively Nutritional supplement - e.g. Vitamins A & D Use UV-irradiated CMVneg blood products only Avoid live attenuated vaccines in patients with severe PIDs

Question 60

What does SCID stand for? What is it?

Answer 60

Severe Combined Immunodeficiency Combined deficiency of the immune system - both antibodies and T cells missing

Question 61

What is the specific treatment for most PIDs?

Answer 61

Immunoglobulin therapy

Question 62

Give two examples of immunoglobulin therapies that can be used in the treatment of PIDs

Answer 62

IVIG - intravenous immunoglobulin | SCIG - subcutaneous immunoglobulin

Question 63

What is the usual treatment for SCID?

Answer 63

Haematopoietic stem cell therapy

Question 64

Is immunoglobulin replacement therapy a lifelong treatment?

Answer 64

Yes

Question 65

What is the goal of using immunoglobulin replacement therapy, with regards to the serum IgG levels?

Answer 65

To increase IgG to > 8g/l

Question 66

Secondary immunodeficiencies are due to an underlying disease/treatment. What three things can cause them?

Answer 66

Reduced production of immune components Reduced function of immune components Increased loss of immune components

Question 67

State 4 conditions that can result in decreased production of immune components and as a result secondary immune deficiencies

Answer 67

Malnutrition Liver diseases Lymphoproliferative diseases Splenectomy

Question 68

What is splenectomy?

Answer 68

A surgical procedure where the spleen is removed

Question 69

Name three conditions that can result in the need for a splenectomy

Answer 69

Infarction Trauma Coeliac disease Autoimmune haemolytic disease

Question 70

What can cause infarction of the spleen resulting in the need for a splenectomy?

Answer 70

Sickle cell anaemia

Question 71

Describe the immune functions of the spleen?

Answer 71

Important in the clearance of ENCAPSULATED bacteria Antibody production (IgM - acute, IgG - long term) Contains splenic macrophages for removal of microbes

Question 72

An asplenic patient will have particularly susceptibilities to which type of bacteria?

Answer 72

Encapsulated bacteria

Question 73

Give thee examples of encapsulated bacteria

Answer 73

Haemophilus influenzae Neisseria meningitidis Streptococcus pneumoniae

Question 74

What does OPSI stand for? What can it lead to? (2)

Answer 74

Overwhelming post-splenectomy infection Meningitis Sepsis

Question 75

What can be done in the management of asplenic patients? (3)

Answer 75

Medic alert bracelet Penicillin prophylaxis (life-long) Immunisation against encapsulated bacteria

Question 76

Patients with haematological malignancies have an _____________ susceptibility to infection

Answer 76

Increased

Question 77

How can chemotherapy affect neutrophil levels?

Answer 77

Reduces them ---> chemotherapy induced neutropenia

Question 78

What action would you take in case of suspected neutropenic sepsis?

Answer 78

Treat as an acute medical emergency and offer antibiotic therapy immediately

Question 79

Give an example of two conditions that can cause an increased loss/catabolism of immune components and as a result secondary immunodeficiencies

Answer 79

Protein-losing conditions | Burns

Question 80

Give two examples of protein-losing conditions

Answer 80

Nephropathy | Enteropathy

Question 81

The pattern and type of infections always reflect the nature of immunological defect. State some factors that can help you recognised and diagnose IDs

Answer 81

``` Age at presentation Sex Site and frequency of infection Type of organism Family history ```

Question 82

VIRUSES and fungi commonly indicate which sorts of IDs?

Answer 82

Related to T cell deficiencies

Question 83

BACTERIA and fungi commonly indicate which sorts of IDs?

Answer 83

Related to B cell/granulocyte deficiency

Question 84

How would you test for Immunodeficiency? (3)

Answer 84

Look for secondary Immunodeficiency FBC Tests of humoral immunity (antibody levels) Tests of cell mediated immunity (lymphocyte count) Test for phagocytic cells (neutrophil count) Complement tests

Question 85

How can neutrophil function be tested to see if a patient has chronic granulomatous diseases?

Answer 85

Checking for oxidative burst in neutrophils

Question 86

Aciclovir is used for the treatment of...

Answer 86

Herpes simplex virus infections

Question 87

Which bacteria commonly causes tonsillitis?

Answer 87

Strep pyogenes

Question 88

What is the specific treatment for tonsillitis?

Answer 88

Antibiotics - Penicillin V