Infections In The Immunocompromised 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

Infections In The Immunocompromised Host The importance of infections in IC host: Increasing numbers of immunocompromised patients. Seriousness of infections in these patients. Infections with unusual microorganisms. Atypical presentation of infections by common pathogens

Infections In The Immunocompromised Host Causes of immune deficiency: Primary (congenital); Rare; more common in children: chronic granulomatous disease, combined immunodeficiency syndrome, specific Ig deficiency, others. Secondary (acquired); Common; 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.

Infections In The Immunocompromised Host: Host Defects and Associated Prevalent Pathogens 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 Neisseria meningitides. Spleen dysfunction Neisseria meningitides, Neisseria gonorrhea Complement deficiency

Fever In Neutropenic Patient Definition: Fever: Oral temperature of 38 C for more than two hours or single temperature of 38.3 C or greater. 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

Fever in the Neutropenic Patient SEQUENTIAL INFECTIVE EVENTS

Fever In Neutropenic Patient: Etiology

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

IDSA guidelines CID;2002:34:730-751

IDSA guidelines CID;2002:34:730-751

IDSA guidelines CID;2002:34:730-751

IDSA guidelines CID;2002:34:730-751

IDSA guidelines CID;2002:34:730-751

Treatment of Fever in the Neutropenic Patient Antibacterials: Piperacilline-tazobactam + aminoglycoside or Cefepime + aminoglycoside or Imipenem Vancomycin, if indicated. Antifungals: Amphotericin, Fluconazole Antiviral: Acyclovir Patient must receive Granulocyte stimulating factors concomitantly.

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: Intra-abdominal infections. Heart and Heart-Lung: Chest, Mediastinitis

CMR;1997:277-297

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 anti-rejection therapy. The occurrence of surgical complications. Presence of latent infection in the donor or recipient. CID;2001 (supp 1):S5-S8

Infections in Organ Transplant Recipients TB, Legionella Histoplasma, Nocardia, Toxoplasma, Pneumocystis Candida, Aspergillosis EBV, CMV, HBV VZV, CMV Common bacteria 1 2 3 4 5 6 7 8 9 10 Months post transplantation CID;2001 (supp 1):S5-S8