Infections In The Immunocompromised Host

1. Infections In The Immunocompromised 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)

2. 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 20th edition chapter 4 pages 64-75

3. Infections In The Immunocompromized 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

4. 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 20th edition chapter 4 pages 64-75

5. Infections In The Immunocompromized HostHostDefects and Associated Prevalent Pathogens

6. Fever 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

7. Fever In Neutropenic PatientSEQUENTIAL INFECTIVE EVENTS

8. Fever In Neutropenic Patient Causes of fever in neutropenic patients;

9. Fever In Neutropenic Patient IDSA guidelines CID;2002:34:730-751

10. IDSA guidelines CID;2002:34:730-751

11. IDSA guidelines CID;2002:34:730-751

12. IDSA guidelines CID;2002:34:730-751

13. IDSA guidelines CID;2002:34:730-751

14. IDSA guidelines CID;2002:34:730-751

15. 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

16. 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):S5-S8

17. Infections inOrgan Transplant Recipients Common infection in Specific Organ transplant: • Bone marrow transplant Bloodstream infections, pneumonia, viral infections • Kidney transplant Urinary tract infections. • Liver transplant Intra abdominal infections. • Heart and Heart-Lung Chest, Mediastinitis transplant

18. CMR;1997:277-297

19. Infections inOrgan Transplant Recipients TB,Legionella Histoplasma,Nocardia,Toxoplazma,Pneomocystis Candida,Aspergillosis EBV,CMV,HBV VZV,CMV retinitis Common bacteria 1 2 3 4 8 9 5 6 7 10 Months post transplantation CID;2001 (supp 1):S5-S8

20. INFECTIONS IN IMMUNOCOMPROMISED HOST • Suggested readings: Davidson's principles and practice of medicine 20th edition Harrison's Principles of Internal Medicine 16th or 17th edition