ICinfhandout

What groups are at a greater risk for opportunistic infections?

Age extremes, HIV/AIDS, cancer, transplants, corticosteroid treatment, immunotherapy usage, asplenic, prior antibiotic therapy

What is a risk factor for increased susceptibility to infection?

Neutropenia (<500/mm³)

What are some common sites of infection?

Lung, oropharynx, blood, urinary tract, skin and soft tissue

What are some gram positive bacteria that cause neutropenia-associated infections?

Streptococci, staphylococci, enterococci

What are some gram negative bacteria that can cause opportunistic infections?

E. coli, pseudomonas, enterobacter, proteus, acinetobacter, stenotrophomonas

What are some fungi that can lead to opportunistic infections?

Candida, aspergillus, fusarium, trichosporon

What are examples of cellular immune dysfunction?

Bone marrow transplant, HIV, solid organ transplant, drugs

What are common causes of cellular immunity dysfunction-associated infections?

Mycobacterium, cryptococus

What is humoral immune dysfunction?

Decreases in B cellsW

What are some causes of humoral immune dysfunction?

Malignancy, wasting, splenectomy, bone marrow transplant, HIV-related antibody deficiency

In which immunosuppressed population would we expect to see more viral infections?

HIV, bone marrow transplant

What should we do to prevent viral infections?

Vaccinate if possible, try to do so before period of immunosuppression

What are the most common protozoal infections?

Pneumocystis jirovecii, toxoplasma gondii

What do we treat P. jirovecii with?

Bactrim or pentamidine

What do we treat T. gondii with?

Pyrimethamine, sulfadiazine

What are some dermatological complications we may see in immunocompromised patients?

Kaposi sarcoma, viral, bacillary angiomatosis, molluscum contagiosum, eosinophillic folliculitis, scabies, psoriasis, seborrhea, dermatophytic fungi

If a patient is neutropenic and febrile, what do we do?

Immediately start empiric broad spectrum antibiotics at maximal doses after obtaining necessary cultures

What should our empiric regimen for febrile neutropenic patients cover?

Gram negative including pseudomonas, gram positive

What are some strategies for providing broad spectrum coverage for febrile neutropenic patients?

Aminoglycoside + antipseudomonal beta-lactam, broad spectrum drug as monotherapy, all ± vanco

How often should we repeat cultures?

Daily while the patient is febrile

In addition to cultures, what else should we collect from the patient?

Radiographs, CBCs

What are some possibilities for empiric monotherapy?

Zosyn, carbapenem, ceftazidime, cefepime

If a patient is low risk, what therapies do we recommend empirically?

Oral cipro+augmentin or moxifloxacin or levofloxacin

How long do we treat an infection?

Based on site of infection, causative pathogen, and free of signs and symptoms of infection

What is Neupogen?

Granulocyte colony-stimulating factor which reduces the severity and duration of neutropeniaWhe

When should we consider Neupogen?

Documented infections who fail to respond to standard therapy after 1-2 days

What is the number one cause of mortality in HIV patients and how do we prevent it?

Opportunistic infections, prophylaxis

When do we consider pneumocystis pneumonia chemoprophylaxis?

If a patient has AIDS or is close and cannot be monitored

What do we use for pneumocystis pneumonia chemoprophylaxis?

Bactrim 1 tab qD

How do we avoid toxoplasmic encephalitits infection?

Do not eat undercooked meat, wash hands after contact with raw meat or soil, wash fruits/vegetables prior to eating them raw, change cat litter daily

When do we provide chemoprophylaxis for toxoplasmic encephalitis?

CD4 <100 and toxoplasma IgG +

What do we use for chemoprophylaxis of toxoplasmic encephalitis?

Bactrim 1 tab qD

What is the secondary prophylaxis which is used for life for toxoplasmic encephalitis?

Pyrimethamine + sulfadiazine + leucovorin

How do we avoid cryptosporidosis infection?

Avoid direct contact with infectious adults, animals, diaper aged children, contaminated drinking water/food, wash hands after any contact with feces or soil

What is the treatment for cryptosporidosis?

Immune restoration and symptomatic rehydration for diarrhea

When should we use prophylaxis for TB?

Positive skin test but no clinical evidence of disease

What is the prophylaxis for TB?

Isioniazid qD or BIW x 9 months

When a patient has HIV, what should we include with their isoniazid?

Pyridoxine (B-6) due to increased risk of neuropathy

When should we give chemoprophylaxis for disseminated MAC infection?

CD4 <50

What should we give as chemoprophylaxis for disseminated MAC infection?

Clarithromycin and azithromycin

What vaccines should we recommend to prevent respiratory infections?

Pneumococcal q5y, not Hib

What is the prophylaxis for histoplasmosis?

Itraconazole 200 mg PO qD

What is the treatment for coccidioidomycosis?

Fluconazole 400 mg qD or itraconazole 200 mg BID

How do you prevent herpes infection?

Use latex condoms during every sexual act, avoid contact with visible herpetic lesions

What is the primary version of prophylaxis for varicella-zoster?

VZV vaccination

What is the method of prophylaxis for Kaposi sarcoma (HHV-8)?

ART to suppress HIV replication

What is the primary prophylaxis for HepC?

Screen HIV infected patients, avoid alcohol use, get Hep A and Hep B vaccines if chronic Hep C or other liver disease

What is secondary prophylaxis for HepC?

None really, just hope that they don’t need it after getting their HCV treatment