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Infections In The Infections In The Immunocompromised HostImmunocompromised Host
• Objectives of this lecture:
To review the components of the host defense mechanisms
To recognize the importance of immunodeficiency and infections
To know the common infectious complications in major immunodeficiency categories(other than HIV&AIDS)
Infections In The Infections In The Immunocompromised HostImmunocompromised 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 20th edition chapter 4 pages 64-75
Infections In The Infections In The Immunocompromized HostImmunocompromized Host
The importance of infections in IC host:
Increasing numbers of Immunocompromised patients.
Seriousness of infections in those patients.
Infections with unusual, nonpathogenic microorganisms.
Atypical presentation of infections by common pathogens
Infections In The Infections In The Immunocompromized HostImmunocompromized 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 20th edition chapter 4 pages 64-75
Infections In The Infections In The Immunocompromized HostImmunocompromized Host
HostHost Defects and Associated Prevalent PathogensDefects and Associated Prevalent Pathogens
DefectPathogenGranulocytopeniaStaph. 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 CMIHSV, VZ, EBV, CMV, RSV, M. tuberculosis, Aspergillus spp and other fungi, Toxoplasma gondi.
Impaired humoral immunity
Streptococcus pneumoniae, Haemophilus influenzae
Spleen dysfunctionStreptococcus pneumoniae, Haemophilus influenzae
Neisseria meningitides.
Complement deficiency
Neisseria meningitides, Neisseria gonorrhea
Fever In Neutropenic PatientFever In Neutropenic Patient
Definition: Fever: Oral temperature of 38c for more than two hours or
single temperature of 38.3c or more.
Neutropenia: A Neutrophil count of <500 cells/mm³ or a count of <1000 cells/mm³ with a predicted decline to 500/mm
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.
IDSA guidelines CID;2002:34:730-751
Fever In Neutropenic PatientFever In Neutropenic PatientSEQUENTIAL INFECTIVE EVENTSSEQUENTIAL INFECTIVE EVENTS
Fever In Neutropenic PatientFever In Neutropenic Patient
Causes of fever in neutropenic patients;
Fever In Neutropenic PatientFever In Neutropenic PatientIDSA 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 PatientFever 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 Infections in Solid-Organ Transplant RecipientsTransplant 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):S5-S8
Infections inInfections in Organ Transplant Organ Transplant RecipientsRecipients
Common infection in Specific Organ transplant: o Bone marrow transplant Bloodstream infections, pneumonia,
viral infections o Kidney transplant Urinary tract infections.
o Liver transplant Intra abdominal infections.
o Heart and Heart-Lung Chest, Mediastinitis
transplant
CMR;1997:277-297
Infections inInfections in Organ Transplant Organ Transplant RecipientsRecipients
1 2 3 4 5 6 7 8 9 10
Months post transplantation
Common bacteria
EBV,CMV,HBV
VZV,CMV retinitis
Candida,Aspergillosis
Histoplasma,Nocardia,Toxoplazma,Pneomocystis
TB,Legionella
CID;2001 (supp 1):S5-S8
INFECTIONS IN INFECTIONS IN IMMUNOCOMPROMISED HOSTIMMUNOCOMPROMISED HOST
• Suggested readings:
Davidson's principles and practice of medicine 20th edition
Harrison's Principles of Internal Medicine 16th or 17th edition