Infections In The Immunocompromised Host

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  • Created by: Amh
  • Created on: 23-04-16 08:17
Define Infections In The Immunocompromised Host
Infections in the immunocompromised patient occurs when the body’ s defence mechanisms are impaired either by disease or treatment of the underlying disease
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What are the categories of congenital immunodeficiencies
B cell T cell combines
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What are B cell deficiencies
Brutons, Selective IgA
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What are T cell deficiencies
DiGeorges
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What are combined deficiencies
SCID
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What are acquired immunodeficiencies
Malnutrition, Neutropenia, Drugs, HIV, Liver failure
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What pathogens are likely to strike when burns happen
PseA, Staphylococcus aureus
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What pathogens are likely to strike when trauma happens
GAS, staph epidermidis
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What bacteria are most likeley if there is an absolute decrease in phagocytic function
Enteric GN’s, PseA, Aspergillus sp, Candida sp
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What bacteria are most likeley if there is a defect in microbial killing via phagocytes
Staphylococcus aureus, Enteric GN’ s
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What bacteria are most likeley if there is a defect in microbial killing via phagocytes
Staphylococcus aureus, Burkholderia cepacia, GN’s, Aspergillus sp
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What humeral defects leave you vulnerable
Hypogammaglobulinemia, IgA, Asplenic, complement deficiency
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What are you most succeptible to when you have Hypogammaglobulinemia
Strep pneumoniae, Haemophilus influenzae
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What are you most succeptible to when you have an IgA deficiency
Pyogenic bacteria, Giardia
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What are you most succeptible to when you have a complemet deficiency
Pyogenic bacteria, Neisseria
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What are you most succeptible to when you have no spleen
Strep pneumoniae, Haemophilus influenzae
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What are you most succptiblble to if you have a t cell deficiency
Intracellular Bacteria (Listeria), Viruses (Herpes), Fungi, Parasites
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What part of the immune system do neutrophils belong to
innate host defense
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what is neutropenia
reduction in number of neutrophils
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what is neutropenic fever
single T >38.5 o C or two or more T > 38 o C + neutrophil count of < 0.5 x109 /L
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How would you treat neutropenc sepsis
High risk: Meropenam • +/- Gentamicin, Medium Risk: Tazocin, Gentamicin. Low risk: Augmentin, Gentamicin
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outline candida infections
Oral candidal infection common in patients on immunosuppressive treatment & broad spectrum antibiotics. Overgrowth can occur-into the oesophagus, kidneys, liver
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how do you get aspergillus infections
They are inhaled
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are aspergillus spores an isssue in immuno competent people
no they are easily cleared
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what does aspergillus cause
in the immunocomprimeised it stays longer leading to bronchopneumonia, and haemorrhagic infarcts which can disseminate to GI tract brain or kidneys or liver
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how do you investigate fungal infections
nvestigate with bronchoscopy samples to look for fungal elements, serum for galactomannan test, imaging
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which category of the immunosupreesed are most vulnerable to viral infections
mortality highest in transplant population-incompatible grafts, heavy immunosuppression
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What viruses are most common
Herpes (CMV, HSV/VZV, EBV, HHV-6), adenovirus BK/JC virus
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how do you treat viral infetions
Limited anti-viral therapy available, aim to reduce immunosuppression if possibe
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what drugs can cause a t cell deficiency
steroids, monoclonal antibodies
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What are some cell deficiencies
HIV lymphoma, transplant
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At what level are people with HV immuocomprimised
CD4 count under 200
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What infections are people with HIV likely to get when CD4: 100-200
Herpes viruses/ Fungal infection
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What infections are people with HIV likely to get when CD4:
PCP/MAI/Lymphoma
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what can Cryptococcal neoformans cause
Cryptococcal Meningitis
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what is Cryptococcal neoformans
encapsulated yeast
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how you treat Cryptococcal neoformans
Treatment: Amphotericin B + Flucytosine, Regular LP to relieve CSF pressure
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what happens if you get tb when immunosuppressed
you get a rapid progression from a primary infectino to a
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what happens if you get tb when immunosuppressed
you get a rapid progression from a primary infectino to a
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what happens if you get tb when immunosuppressed
you get a rapid progression from a primary infectino to a
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what happens if you get tb when immunosuppressed
you get a rapid progression from a primary infectino to a disseminated disease
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what happens when you get immunosupressed whilst already maintaing tb
caseating granuloms burt and dissemination happens
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what is the mortality of Invasive aspergillosis
High mortality 25-90%
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where does aspergillosis occur
often pulmonary which Disseminate to any other tissue-CNS, sinuses, eyes, heart, kidney q
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whos high risk for Disseminate to any other tissue-CNS, sinuses, eyes, heart, kidney
• SOT, SCT, severe neutropenic patients
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how do you investigate Aspergillosis
Culture tissue samples • Galactomannan test for Aspergillus Ag in blood or other tissue samples • CT
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how do you treat aspergillosis
Treat with voriconazole
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What are the categories of congenital immunodeficiencies

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B cell T cell combines

Card 3

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What are B cell deficiencies

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Card 4

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What are T cell deficiencies

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Card 5

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What are combined deficiencies

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