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