Infection in immunocompromised

What are the innate defences of the immune system?

1)skin 2)mucous membranes 3)lungs 4)interferons, complement, lysozyme, acute phase proteins 5)normal commensal flora of gut

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Define a qualitative and quantitative defect with relation to neutrophils

Qualitative defects=lose ability to kill or chemotaxis--> Chemotaxis – rare, congenital, e.g. inadequate signalling/Killing power - inherited, e.g. Chronic Granulomatous Disease. At risk of Staph. aureus infections Quantitative defect=less present

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What is the consequence of neutrophil lack?

“Neutropenic” Esp. imp. 50% proceed to infection. High mortality >50% those with Pseudomonal infections will die in 24hrs if not treated

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what bacterial infections are neutropenia patients likely to have?

e.g E. coli, S. aureus - often normal flora. e.g. Coag neg staph

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what fungal infections are neutropenic patients likely to have?

Candida spp. , Aspergillus spp.

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What are the causes of T-cell deficiencies?

Congenital – rare – T helper dysfunction +/- hypogammaglobulinaemia Acquired – drugs e.g. ciclosporin after transplantation (decreases graft versus host disease and rejection), steroids Acquired – viruses e.g. HIV

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What opportunistic pathogens are seen in T-cell deficient patients?

BACTERIAL – Listeria monocytogenes, Mycobacteria VIRAL – transplants - HSV, CMV, VZV. Serological testing, prophylaxis and treatment with e.g. aciclovir and ganciclovir FUNGAL – e.g. Candida spp., Cryptococcus spp. pneumocystis spp.

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What protozoan/ parasitic infections are patients with T-cell deficiencies more likely to have?

Cryptosporidium parvum - oocysts shed by cattle/humans. Faecal oral route. Most patients recover after prolonged illness of up to 3 wks. May take much longer in T-cell deficients. Symptomatic treatment only (in most cases)/ toxoplasma gondii from cat

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What infections are you prone if you have Hypogammaglobulinaemias

Usually encapsulated bacteria e.g. S. pneumoniae Parasitic - e.g. Giardia lamblia Treatment – Immunoglobulin

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What infections are you prone to if you have complement deficiency?

Encapsulated bacteria. Need complement to help kill organisms. e.g. C5-8 then Neisseria meningitidis is important – Frequent, serious S. pneumoniae infections as poor quality opsonisation

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what infections are you prone to if you have a splenectomy?

Streptococcus pneumoniae, Haemophilus influenzae type B, N. meningitidis, malaria

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Infection in immunocompromised

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