infections in the immunocompromised Flashcards Preview

Infectious Disease > infections in the immunocompromised > Flashcards

Flashcards in infections in the immunocompromised Deck (30)
1

What immunity is lacking in HSCT?

Initally both innate and adaptive
Innate recovers after 1 month
Adaptive is abnormal for years

2

What immunity is lacking solid organ transplants?

Predominantly adaptive immunity
Dont have inital period of innate immune loss unlike HSCT
Adaptive immune defects persist as continue on long term immunosuppression

3

Immune defect seen with chemo?

Innate immunity affected, neutrophils are commonly decreased
- infections with gram positives and gram negatives
*prolonged neutropenia can cause fungal infections

4

Immune defect seen with TNF-alpha inhibitors?

TNF alpha is important for development of innate immune system - particulary involves organisms that are sequestered in granulomas (Tb, MAC, aspergillous)

5

Immune defect in HIV?

Adaptive immunity
- loss of CD4 cells

6

Features of norcardia infection?

Gram positive
High risk in those with impairment of adaptive immunity
Sites of infection: lung (multiple or single nodules), CNS (abscesses), cutaneous (mycetoma - painless nodule)
Treatment: Cotrimoxazole, carbapenums

7

Features of disseminated of MAC?

Fever, night sweats, bone marrow suppression
organomegaly, diarrhoea, raised LFTs
Treat with macrolides + rifampicin

8

What infections are seen in splenectomy patients and why?

Encapsulated organism
- strep pneumoniae
- haemophilis influenzae
- neisseria meningitidis
- klebsiella pneumonaie, salmonella
Absence of splenic macrophages which usually destroy opsonised bugs

9

Features of CMV infection?

Highest risk period 1-4 months after transplant
Features:
- hepatitis
- GI ulceration
- meningoencephalitis/retinitis (only in HIV patients)
- pneumonitis (lower lobe infiltrates spreading upwards)
- prolonged fevers and flu like symptoms
- bone marrow suppression

10

Treatment of CMV?

Gancylcovir (myelosuppression)
Foscarnet
Cidovofir

11

How do you detect CMV in transplant patients?

Monitor CMV PCR weekly and treat when positive for 2 consecutive measurements

12

What is EBV lymphoproliferative disease?

abnormal outgrowth of EBV infected cells
presents with fever and lymphadenopathy
pathology: B-cell hyperplasia
Treatment: Rituximab
Highest risk intestinal or multiorgan transplant

13

What is oral hairy leukoplakia associated with?

Occurs in HIV patients with EBV
Treat with acyclovir

14

What are the risks of VSV in immunocompromised?

VSV hepatitis - fatal
Shingles - lengthly risk, up to a year post transplant
- lesions last for longer and can get pneumonitis, meningioencephalitis from shingles

15

Prophylaxis for vSV?

VSV if exposed
Aciclovir

16

Complications of HSV in immunocompromised patients?

reactivate latent virus to cause encephalitis, heaptitis, pneumonitis, oesophagitis
Can prophylax with acyclovir

17

Manifestations of HHV-6?

Limbic encehpalitis, pneumonitis and disseminated disease

18

What are the manifestations of HHV-8 (KSHV)

Kaposis sarcoma
Primary effusion lymphoma
Multicentric castlemans disease

19

Manifestations of candida?

Mucocutaneous candida - oral, vaginal, paronychia
Invasive disease with oesophageal infection, haematogenous seeding to brain, heart, kidneys, retina

20

Clinical manifestations of aspergillous infection?

invasive pulmonary aspergillosis
disseminated aspergillous with haemorrhagic infarction, cerebral abscesses, cutaneous necrotic eschars and endocarditis

21

Features of cryptococcal infection?

Subacute, headache, fever, lethargy
Focal neurology
Chronic meningitis with hydrocephalus
Diagnosed with crytpcoccal antigen test and indian ink stain

22

Treatment of cryptococcus?

Amphotericin B + flucytosine, ongoing oral fluconazole after

23

Features of PJP?

fever, non productive cough, SOB
HYPOXIA
Bilateral ground glass infiltrates more apparent on CT than CXR

24

Treatment of PJP?

Cotrimoxazole

25

What is strongyloides hyperinfection syndrome?

Helminth
Massive dissemination of larvae into lungs, heart, liver, CNS
Present with fever, haemoptysis, diarrhoea, vomitting
Treat with ivermectin

26

Features of toxoplasmosis?

cerebral
- altered mental state
- fever
- headache
- focal neurology

27

Findings on CT head?

Ring enhancing lesion/lesions

28

Treatment of toxoplasmosis?

Treatment is sulphadiazine/pyrimethamine + folinic acid

29

Features of cryptosporidium?

weight loss, diarrhoea, abdo pain
biliary involvement

30

Treatment of cryptosporium?

Usual treatment for cryptosporidum - nitazoxamide - not effective in HIV patients
Need to treat with ART