Infections In The Immunocompromised Host Objectives of this
Infections In The Immunocompromised Host • Objectives of this lecture: Ø To review the components of the host defense mechanisms Ø To recognize the importance of immunodeficiency and infections Ø To know the common infectious complications in major immunodeficiency categories(other than HIV&AIDS)
Infections In The Immunocompromised Host Components of Host Defenses: Mechanical barriers Skin, mucous membranes, epiglottis, cilia. Granulocytes Cell mediated Immunity Macrophages, T-lymphocytes, NKC, cytokines Humoral Immunity B-lymphocytes, immunoglobulins, complements Spleen Davidson's Principles and Practice of Medicine 20 th edition chapter 4 pages 64 -75
Infections In The Immunocompromized Host The importance of infections in IC host: Ø Increasing numbers of Immunocompromised patients. Ø Seriousness of infections in those patients. Ø Infections with unusual, nonpathogenic microorganisms. Ø Atypical presentation of infections by common pathogens
Infections In The Immunocompromized Host Causes of immune deficiency: Primary (congenital); Rare, more common in children e. g chronic granulomatus disease, combined immunedifiency syndrome, specific Ig deficiency, others. Secondary (acquired); The commonest, there are many causes like; Extremes of age, pregnancy, infections, malignancy, chemotherapy, steroids, burns, trauma, procedures, connective tissue diseases, chronic diseases like DM, CRF etc. Davidson's Principles and Practice of Medicine 20 th edition chapter 4 pages 64 -75
Infections In The Immunocompromized Host Defects and Associated Prevalent Pathogens Defect Pathogen Granulocytopenia Staph. Aureus, CNSS, V strep, Enterococci, E. coli, Pseudomonas aeruginosa, K. pneumoniae, other gram –ve bacilli, Aspergillus spp Damaged skin and mucous membrane CNSS, Staph. Aureus, pseudomonas aeruginosa and other gram-ve bacilli, candida spp, V. strep, enterococci, HSV. Impaired CMI HSV, VZ, EBV, CMV, RSV, M. tuberculosis, Aspergillus spp and other fungi, Toxoplasma gondi. Impaired humoral immunity Streptococcus pneumoniae, Haemophilus influenzae Spleen dysfunction Streptococcus pneumoniae, Haemophilus influenzae Neisseria meningitides. Complement deficiency Neisseria meningitides, Neisseria gonorrhea
Fever In Neutropenic Patient Definition: Fever: Oral temperature of 38 c for more than two hours or single temperature of 38. 3 c or more. Neutropenia: A Neutrophil count of <500 cells/mm³ or a count of <1000 cells/mm³ with a predicted decline to 500/mm IDSA guidelines CID; 2002: 34: 730 -751 Approach to patient: Careful history and examination, investigations (like blood cultures, urine culture, CXR, others), then start antibiotic therapy to cover the most likely organisms.
Fever In Neutropenic Patient SEQUENTIAL INFECTIVE EVENTS
Fever In Neutropenic Patient Causes of fever in neutropenic patients;
Fever In Neutropenic Patient IDSA guidelines CID; 2002: 34: 730 -751
IDSA guidelines CID; 2002: 34: 730 -751
IDSA guidelines CID; 2002: 34: 730 -751
IDSA guidelines CID; 2002: 34: 730 -751
IDSA guidelines CID; 2002: 34: 730 -751
IDSA guidelines CID; 2002: 34: 730 -751
Fever In Neutropenic Patient Treatment: Antibacterial like; pipracilline+ aminoglycoside or ceftazidime+ aminoglycoside or Imipenem, vancomycine. Antifungal like; Amphotericine B, Fluconazole Antiviral like; Acyclovir Granulocyte stimulating factors
Infections in Solid-Organ Transplant Recipients • Factors affecting the incidence of infections: The type of organ transplanted. The degree of immunosupression. The need for additional antirejection therapy. The occurrence of surgical complications. Presence of latent infection in the donor or recipient. CID; 2001 (supp 1): S 5 -S 8
Infections in Organ Transplant Recipients Common infection in Specific Organ transplant: o Bone marrow transplant o Kidney transplant Bloodstream infections, pneumonia, viral infections Urinary tract infections. o Liver transplant Intra abdominal infections. o Heart and Heart-Lung transplant Chest, Mediastinitis
CMR; 1997: 277 -297
Infections in Organ Transplant Recipients TB, Legionella Histoplasma, Nocardia, Toxoplazma, Pneomocystis Candida, Aspergillosis EBV, CMV, HBV VZV, CMV retinitis Common bacteria 1 2 3 4 5 6 7 8 Months post transplantation 9 10 CID; 2001 (supp 1): S 5 -S 8
INFECTIONS IN IMMUNOCOMPROMISED HOST • Suggested readings: Davidson's principles and practice of medicine 20 th edition Harrison's Principles of Internal Medicine 16 th or 17 th edition
- Slides: 20