Immunocompromise

Question 1

what does being immunocompromised mean

Answer 1

state of health where actuarial risk of infection is increased

Question 2

what are 3 person centered aspects that affect the immune system

Answer 2

1. macrobiome
2. microbiome
3. Host

Question 3

5 primary defences that affect the microbiome

Answer 3

1. flow
2. gravity and motility
3. skin and mucosal integrity
4. pH and chemical factors
5. normal flora

Question 4

what happens if alter flow

Answer 4

predisposes to infection - usually from own microbiome

Question 5

3 examples of low flow

Answer 5

1. endobroncial tumor
2. men with BPH get bladder infections
3. women with lymphedema for breast cancer get cellulitis

Question 6

what are diffs. between bacteria in mouth vs. gut

Answer 6

mouth - gram-pos. and araerobes

gut - gram negs

Question 7

2 adv of gravity

Answer 7

1. no butt to mouth transfer

2. shower and clean effectively

Question 8

problems assoc. with bedrest

Answer 8

1. pneumonia is often due to fecal organisms

2. skin wounds infected with fecal organisms

Question 9

2 examples of altered pH

Answer 9

1. intubated patients treated with gastric acid supressants - more pneumonia
2. patients with dry mouth at risk for more cavities and caires

Question 10

3 functions of skin

Answer 10

1. barrier
2. has immune cells within it
3. has mucosae that secrete mucus and works with cilia to move stuff out

Question 11

examples of altered skin/mucosa

Answer 11

1. bed sores
2. surg. site infections
3. burn wounds
4. IV drug use
5. febrile neutropenia

Question 12

what is mech. of bed sores

Answer 12

pressure on “dependent’ areas causes ischemia and get necrosis - flora get in

Question 13

what is burn mortality related to (2)

Answer 13

1. age

2. body surgface burned

Question 14

what happens in IV drug use

Answer 14

• poke bacteria into system from skin (staph)

- local abscess, endocariditis, celulitis

Question 15

2 most common causes of altered normal flora

Answer 15

1. antibiotics

2. poor infection control

Question 16

what is C. diff

Answer 16

anaerobic gram pos. bacteria that resisits all but a few antibiotics

Question 17

ho do people get C. diff

Answer 17

2% already have it or in hospital - shows up once normal flora reduced with antibiotics

Question 18

c.diff Sx

Answer 18

• diarrhea, colitis,

Question 19

what is mucosal candidiasis

Answer 19

normal to have yeast, but held in control normally,

• alteration leads to an overgrowth
• vagina, penis, throat (thrush - usually with HIV)

Question 20

what is candidemia

Answer 20

blood infection of candida

Question 21

2 risk factors for candidemia

Answer 21

1. broad spectrum antibiotics

2. indwelling IV cath.

Question 22

what is problem with prosthetic devices

Answer 22

get infected with staph causing a biofilm on device

Question 23

what is problem with PICC lines

Answer 23

pulls infection in from skin and often goes to heart

Question 24

what is diff. about infection for intra vs. extravascular devices

Answer 24

intra can remain at risk through contact with blood, whereas extra tend to only get infected during insertion

Question 25

2 types of complement deficiency

Answer 25

1. congenital - rare | 2. aquired - acute (serious insult) or chroni (autoimmune)

Question 26

what is most common and important complement deficiney

Answer 26

late complement (c5-9)

Question 27

what is late complement deficency

Answer 27

- increased risk of meningococcal infection (nesseria) - later onset of meningococcus (17 vs. 5) - 50% are recurrent - 1/10 mortality

Question 28

how to help late complement def.

Answer 28

vaccines for meningococcal

Question 29

what are 2 possible problems with neutrophils

Answer 29

1. neutropenia - not enough | 2. defect - don't work right

Question 30

possible ways of neutropenia

Answer 30

1. inherited 2. drug induced 3. chemo 4. autoimmune

Question 31

4 possible neutrophil dysfunctions

Answer 31

1. adhesion defects 2. chemotactic defects 3. opsinic 4. intracellular killing

Question 32

complication diffs. between neutropenia and defects

Answer 32

penia - sepsis | defects - local infections

Question 33

what can complicate neutropenia

Answer 33

lack of primary defence systems

Question 34

primary defences that are down in chemo-induced neutropenia - febrile neutro

Answer 34

1. feel sick and in bed - 2. venous cath - skin organisms 3. mucotitis - GI barriers disrupted 4. previous/prophylaxis antibiotics - fungi later on

Question 35

things in timeline in febrile neutropenia

Answer 35

1. mucosistis - 1 week 2. fever - 1 week 3. venous cath infection - 3 weeks 4. lung infections - after venous cath

Question 36

what is main clue to lung infection

Answer 36

fever- rest is subtle

Question 37

2 consequences of neutrophil recovery

Answer 37

1. asymptomatic pulm. infiltrates | 2. hepatosplenic candidiasis

Question 38

why do neutrophil things happen

Answer 38

actually fixing after an infection was already there

Question 39

3 things that make hospitalization a state of immunocompromise

Answer 39

1. antibiotics 2. procedures 3. contact with other sicko and lack of hand washing

Question 40

what does adaptive immune system protect against

Answer 40

exogenous (macrobiome) | - viruses, bacteria, fungi, parasites

Question 41

3 things Ig protect against

Answer 41

1. resp tract from pneumococcal 2. Gi from giardia, campylobacter 3. skin from strep

Question 42

what are types of Ig deficiencies (2)

Answer 42

1. hypogammaimmunoglobunemia - all Ig low - more common | 2. dysgamma.... - some Ig low

Question 43

3 aquired causes of Ig def.

Answer 43

1. nephrotic synd. - loss 2. malabsorbtions - GI 3. CLL

Question 44

what is infection risk for cirrosis

Answer 44

spontaneous bacterial peritonitis - portal hypertension leads to backup as opposed to without, where don't get leak out

Question 45

what happens in CLL

Answer 45

- cell mediated immunocompromise | - sinus, resp, infection - incapulated organisms

Question 46

what is immune function of spleen

Answer 46

clears encapsulated bacteria

Question 47

what is risk for asplenia

Answer 47

overwhelming post-splenectomy infeciton (OPSI)

Question 48

group at risk in OPSI

Answer 48

children

Question 49

infection in OPSI

Answer 49

pneumoniae and meningo - vaccinate to prevent

Question 50

4 main comorbids with HIV

Answer 50

1. virus 2. bact 3. fungi 4. protozoa

Question 51

viruses with HIV

Answer 51

- reactivation with previous virus | - severe or community aquires -hepC, flu

Question 52

bact. with HIV

Answer 52

mycobacteria -TB

Question 53

fungi with HIV

Answer 53

- mucosal condidiasis | 2. other

Question 54

protozoa with HIV

Answer 54

- toxoplasma | - intestinal protozoa

Question 55

3 sources of stem cell transplants (HSCT)

Answer 55

1. autologous -self 2. allogenic - matched donor 3. syngenic - identical twin donor

Question 56

what must be done before HSCT

Answer 56

conditioning - chemo and/or radiation

Question 57

consequences of conditioning (4)

Answer 57

1. transient neutropenia 2. qualitative defects in phago 3. major defects on humoral and cellular immunity 4. mucusitis - causes gut leakage

Question 58

what happens if donor lymphocytes not HLA matched

Answer 58

graft-vs. host disease

Question 59

what happens in GVHD

Answer 59

1. conditioning causes leakage of gut bacteria 2. microbe activate effector cells 3. dendritic cells with Ag go to lymph 4. proliferation of donor Tcekk 5. inflammation and attack other organs

Question 60

what is given to deal with mucusitis in GVHD

Answer 60

1. venous cath. for IV meds 2. TPN 3. supportive blood products

Question 61

what happens d30-100 post graft

Answer 61

herpes viruses very important

Question 62

what happens d100+

Answer 62

- generally out of the woods - if cell mediated def. - viruses - if humoral mediated def. - encapsulated bact

Question 63

what are polyoma viruses

Answer 63

DNA viruses with latency aquired in childhood

Question 64

what is BK virus

Answer 64

normally held in check but with HSCT can get renal graft failure (BK neuropathy)

Question 65

3 HSCT prevention strategies

Answer 65

1. prophylaxis 2. pre-emptive treatment 3. minimize exposure

Question 66

what is CMV

Answer 66

cytoalomegalovirus - 8-90% of adults have -causes serious illness and hard to treat

Question 67

when do HSCT get CMV

Answer 67

if the recipient has no CMV-ABs but the donor has CMV

Question 68

what is frequent complication of lung transplant

Answer 68

pneumonia - hosts own flora

Question 69

what is cause of lymphoproliferative disorder

Answer 69

infection with EB virus (immortalizes B-cells)