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INFECTIONS IN HEMOPOEITIC STEM CELL TRANSPLANT RECIPIENTS

INFECTIONS IN HEMOPOEITIC STEM CELL TRANSPLANT RECIPIENTS. DR E.O SHOBOWALE CLINICAL MICROBIOLOGIST PATHCARE NIGERIA. OUTLINE. Introduction Infectious agents Diagnosis Prophylactic agents PathCare’s role Conclusion. INTRODUCTION.

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INFECTIONS IN HEMOPOEITIC STEM CELL TRANSPLANT RECIPIENTS

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  1. INFECTIONS IN HEMOPOEITIC STEM CELL TRANSPLANT RECIPIENTS DR E.O SHOBOWALE CLINICAL MICROBIOLOGIST PATHCARE NIGERIA

  2. OUTLINE • Introduction • Infectious agents • Diagnosis • Prophylactic agents • PathCare’s role • Conclusion

  3. INTRODUCTION • The transplantation of haematopoietic stem cells from bone marrow results in a transient state of immunologic incompetence. • Shortly after transplantation phagocytes, T and B cells are rapidly depleted and the host is extremely susceptible to various infections.

  4. Infectious Agents • Bacterial • Fungal • Parasitic • Viral

  5. Infectious agents

  6. Bacterial • Usually seen in the first 28 days after HSCT. • Marked granulocytopenia is observed • Neutropenia usually lasts for 1 to 3 weeks. • However bacterial infections are more common in the first 7 days • Organisms are usually from the Skin or Intravenous catheters of recipients

  7. Bacterial • Staphylococcus aureus, Coagulase Negative Staphylococci are acquired from the skin and catheters. • Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa are acquired from the bowel. • Nocardiaasteroideswhich is partially acid fast occurs after the first week of transplantation.

  8. Bacterial • Encapsulated bacteria such as Streptococcus pneumoniae cause infections in the late post transplantation period i.e. >6 months. • Chemotherapy and the use of broad spectrum antimicrobial agents place recipients at risk of Clostridium difficileassociated diarrhea.

  9. Fungi • Fungal infections tend to occur after the first week post transplantation. • Seen after chemotherapy, steroid and broad spectrum antibiotic administration. • Granulocytopenia predisposes towards Candida infections. • The increased use of Fluconazole has also helped to select out Molds such as Aspergillus spp, PenicilliummarfenneiandScedosporium spp

  10. Fungi • The following drugs predispose to fungal infections particularly Candida and Aspergillus spp infections in HSCT patients

  11. Fungi • The above mentioned drugs may also cause reactivation of infections due to

  12. Fungi • The prolonged use of intravenous lipid formulations for TPN may predispose to Malassaeziafurfurinfections • HSCT patients are at increased risk of interstitial pneumonia due to Pneumocystisjiroveci.

  13. Parasites • Reactivation of Toxoplasmosis occurs in transplant recipients and may cause CNS lesions.

  14. Viruses

  15. Viruses

  16. Clinical Syndromes

  17. Clinical Syndromes

  18. THE ROLE OF PATHCARE • PathCare can reliably and accurately diagnose infectious syndromes pre and post transplantation. • We have world class diagnostic equipments in all the 4 branches of Pathology – Microbiology, Clinical Chemistry, Hematology and Histopathology. • PathCare has over 13 Pathologists on board who verify and help interpret laboratory reports • Our pathologists are also available for consultation in the patient management

  19. THE ROLE OF PATHCARE • We are located in the following areas • Lagos – Victoria Island, LUTH, FESTAC and Ikeja • Benin • Abuja • Portharcourt • Enugu • Warri • Kaduna • Gwagwalada • Ibadan • Illorin – opening in August

  20. THE ROLE OF PATHCARE • PathCare was established in Nigeria in October 2004 due to demand for accurate and reliable tests • It was started by consortium of health care practitioners including pathologists, haematologists, gynaecologists amongst others who required precision and a wider range of testing to ensure more favourable outcomes for their patients • Sought reputable Partners: PathCare South Africa (foremost pathology service in South Africa). **First to achieve ISO Accreditation in South Africa with an unparalleled reputation for quality and service. • PathCare has since enjoyed a meteoric rise (3 Laboratories and 9 Depots and still growing) in demand for its tests because of the trust clinicians have in the brand

  21. THE ROLE OF PATHCARE • Our Consultant Pathologists • Prof. IbironkeAkinseteConsultant Haematologist and Chairman Board of Directors • Dr. TunjiSoriyanConsultant Chemical Pathologist • Dr. AbiolaOgbennaConsultant Haematologist • Prof. FolasadeOgunsolaConsultant Microbiologist • Dr. JafMomohConsultant Chemical Pathologist • Dr. AdediranConsultant Haematologist • Dr. TamunoWakamaConsultant Haematologist • Dr Olushola Shobowale Consultant Microbiologist • Dr TolulopeAdewole Consultant Chemical Pathologist • Over 70 Specialist Pathologists available in SA for referrals and second opinions

  22. THE ROLE OF PATHCARE • We are currently the first and only ISO 15189 accredited laboratory in West Africa. • This means that our test methodologies and results meet international standards and are acceptable outside Nigeria.

  23. THE ROLE OF PATHCARE • Accurate and reliable results • Highly specialised testing • Timely results (Fast Turn around time) • Excellent service • Nationwide Access

  24. THE ROLE OF PATHCARE • TECHNOLOGY • New Methodology • New Processes … • Wider range of tests • TRAINING • New Skills, Attitudes & Techniques • COMPUTERIZATION • Improved efficiency & accuracy • Reduction of Errors due to human intervention • TOTAL QUALITY MANAGEMENT

  25. THE END • PLEASE USE PATHCARE • THANKS FOR LISTENING

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