Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
1/9/2016
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OUTLINE
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What/who is immunocompromised?
Risk of infections
Types of infection & examples
Clinical features
Laboratory investigations
Principles of management
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What / who is immunocompromised?
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threatening
Risk of opportunistic infections
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Risk of infection
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1) Infections of the host with deficient
innate immunity due to physical factors
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2) Infections associated with secondary
adaptive immunodeficiency
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a) Haematologic malignancy and bone marrow
transplant infections
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Examples of opportunistic
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pathogens
Bacteria Viruses
GPB Herpesviruses
Staph aureus Hepatitis B, C
Coagulase-negative staphylococci Polyomaviruses e.g. BKV, JCV
Streptococci Adenoviruses
Listeria spp. HIV
Nocardia asteroides Fungi
M. tuberculosis,
Mycobacterium avium-intracellulare Candida spp.
Aspergillus spp.
GNB Cryptococcus neoformans
Enterobacteriaceae Histoplasma capsulatum
Pseudomonas aeruginosa Pneumocystis jirovecii
Legionella spp. Parasites
Bacteroides spp. Toxoplasma gondii
Strongyloides stercoralis 13
Important opportunistic pathogens & clinical
features
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FUNGI Gastrointestinal
1. Candida spp. candidiasis major
Mucocutaneous candidiasis gastric / abdo
rare, persistent, non- surgery, neoplastic
invasive disease. Blood
Oropharyngeal /
oesophageal candidiasis culture +ve if
HIV pts, DM, on antibx / dissemination
steroids Disseminated
candidiasis via
GIT, or IV cath-
related infections.
Leukaemia and
lymphoma patients
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are at risk 14
2) Cryptococcus neoformans
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Impaired cell-mediated
immunity
Onset maybe slow
Lung infections or
meningoencephalitis
Also skin, bone, joints
infections
Diagnosis: Treatment: ampho B +
CSF
india ink encapsulated flucytosine (prophylaxis
yeast cells fluconazole)
Latex agglutination test
(antigen detection) Prognosis: depends on
culture
the underlying disease
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3) Histoplasma capsulatum
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Highly infectious
Endemic in tropical
countries
Natural habitat : soil
Transmit by air-borne
Fungal spores deposited Dx: cultures of blood,
in alveoli spreads via bone marrow, sputum,
lymphatics regional CSF, skin lesions; biopsy
nodes & HPE (BM, liver, lymph
Causes skin lesions, nodes)
pulmonary infection, Thermally dimorphic
disseminated dzs fungi budding yeasts
Disseminated disease @37C and hyphae
after many years after @25C
initial exposure
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Tx: amphothericin 16
4) Aspergillus spp.
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Invasive disease
High fatality rate
Usually in profoundly
neutropenic patients Dx: microscopy,
or those receiving culture, Ag detection,
high-dose PCR (specimen BAL,
corticosteroids lung biopsy)
Transmission: Tx: IV liposomal
airborne ampho B (prophylaxis
Site of infxn: lungs, caspofungin,
may disseminate to posaconazole,
other sites (eg CNS, voriconazole & early
heart 25% of patients) dx)
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5) Pneumocystis jirovecii (P.carinii)
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Bacteria
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= slow-growers, but
resistant to conventional
anti-TB drugs.
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Culture & AFB (tissue)
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Protozoa & helminths
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2) Strongyloides stercoralis
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Parasitic roundworm
Dormant after initial
infection reactivated =
autoinfection
Most common sites: lungs,
liver, brain
Dx: identification of the
adult worms, larvae or
eggs
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Viruses
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1. CMV
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4. EBV Risk factors: post-tx
primary CMV infections,
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mismatched D-R CMV
a/w development of Hodgkins,
status, CMV disease,
non-Hodgkins lymphoma (HIV
intensity/type of
pts), PTLD & smooth muscle
immunosuppression tx.
tumours (in
Primary EBV infection in
immunosuppressed children)
children & adolescents
EBV-associated PTLD = broad
incidence of PTLD higher
spectrum of clinical syndromes
in paeds pts
(infectious mono to
Tx: reducing
malignancies)
immunosuppression (for
Abnormal proliferation of EBV-
better host response to
infected B-cells (lack of T-cells
fight infection BUT risk of
(immunosuppression) to
graft rejection), rituximab,
contain B-cell replication)
chemotherapy
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5. Respiratory viruses 6. Polyomaviruses
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Can be difficult
Aetiology can be ANYTHING
CT scan
BAL
biopsy
Presumptive treatment
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Principle of management
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Prophylaxis vs Pre-emptive
therapy
Organism-targeted therapy
transplant)
High index of suspicion
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