1. Infections In The Immunocompromized 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

2. Infections In The Immunocompromized Host The importance of infections in IC host: Increasing numbers of immunocompromized patients. Seriousness of infections in those patients. Infections with unusual, nonpathogenic microorganisms. Atypical presentation of infections by common pathogens

3. 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.

4. Infections In The Immunocompromized Host Host Defects and Associated Prevalent Pathogens Pathogen Defect Staph. Aureus,CNSS, V strep, Enterococci, E. coli, Pseudomonas aeruginosa, K.pneumoniae, other gram –ve bacilli, Aspergillus spp Granulocytopenia CNSS, Staph. Aureus, pseudomonas aeruginosa and other gram-ve bacilli, candida spp, V. strep, enterococci, HSV. Damaged skin and mucous membrane HSV, VZ, EBV, CMV, RSV, M. tuberculosis, Aspergillus spp and other fungi, Toxoplasma gondi. Impaired CMI Streptococcus pneumoniae, Haemophilus influenzae Impaired humoral immunity Streptococcus pneumoniae, Haemophilus influenzae Neisseria meningitides. Spleen dysfunction Neisseria meningitides, Neisseria gonorrhea Complement deficiency

5. 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

6. Fever In Neutropenic Patient SEQUENTIAL INFECTIVE EVENTS

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

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

14. 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

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

16. CMR;1997:277-297

17. 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

18. Infections in Organ Transplant Recipients 1234 567 89 10 Months post transplantation Common bacteria EBV,CMV,HBV VZV,CMV retinitis Candida,Aspergillosis Histoplasma,Nocardia,Toxoplazma,Pneomocystis TB,Legionella CID;2001 (supp 1):S5-S8