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Dr A.J.France. Ninewells Hospital © A.J.France 2010
Infection in immunocompromised patients. Recognising the immunocompromised patient is an undergraduate skill Treatment is a postgraduate subject © A.J.France 2010
Who is immunocompromised ? Extremes of age Patients on immunosuppressant drugs Transplant. High dose steroid etc Cytotoxic chemotherapy Infection: HIV Marrow replacement by leukaemia Splenectomy Rare hereditary disorders © A.J.France 2010
The very young and the very old © A.J.France 2010
Splenectomy © A.J.France 2010
Chemotherapy © A.J.France 2010
Opportunistic infections Symptoms may be mild Wider range of pathogens Reactivation of dormant organisms Exposure to new pathogens © A.J.France 2010
Opportunistic lung infections PneumocystisHIV CytomegalovirusTransplant AspergillusChemotherapy PneumococcusSplenectomy BronchiectasisCystic fibrosis Hypogamma - -globulinaemia © A.J.France 2010
Pneumocystis in HIV infection History Dry cough for several weeks Breathless Poor response to first line antibiotics Examination Very little to find, but…….. Cyanosis Breathless on exertion Other features of HIV © A.J.France 2010
Pneumocystis in HIV infection Investigations Chest X-ray Arterial blood gases Making the diagnosis Induced sputum Bronchoscopy Lung biopsy © A.J.France 2010
Pneumocystis pneumonia © A.J.France 2010
Pneumocystis close up © A.J.France 2010
Pneumocystis in HIV infection Treatment High dose cotrimoxazole (septrin) High dose corticosteroids Complications Pneumothorax Respiratory failure Death © A.J.France 2010
Broncho-alveolar lavage © A.J.France 2010
Pneumocystis pneumonia. Lung biopsy, silver stain. © A.J.France 2010
After treatment © A.J.France 2010
After treatment close ups © A.J.France 2010
Symptom free Disease Treatment Symptom free Normal pathway © A.J.France 2010
Symptom free Disease Treatment Symptom free Relapse Without prophylaxis © A.J.France 2010
Symptom free Disease Treatment Symptom free Relapse With prophylaxis Septrin 480mg daily © A.J.France 2010
Aspergillus Lives all over the place Ask about building/demolition work Ask about gardening hobbies © A.J.France 2010
Bronchial biopsy. Leukaemia and…. © A.J.France 2010
Bronchial biopsy - aspergillus © A.J.France 2010
Summary First, recognise the immunocompromised patient Second, have a high index of suspicion for infection – even when there are few abnormal physical signs Third, have a low threshold for admission to hospital © A.J.France 2010
Pneumonia SAHD Senior Academic Half Day Matt Rogers & James Clayton
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