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Approach to Opportunistic Infection

Approach to Opportunistic Infection - bacterium seen in...

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Approach to Opportunistic Infection 2.3. Disorders of Humoral Immunity Immunoglobulin deficiency may be congenital (Burton’s X linked agammaglobulinemia) or acquired (common variable). Acquired can also arise from protein losing states (nephrotic syndrome), cancer within cell lines that make immunoglobulins or burns. Generally infections occur in respiratory tract from organisms that are encapsulated (Pneumococcus, H influenzae). Spleen is source of complement and antibody producing G cells. Asplenia results in infections, which may be quite fulminant, ie. Overwhelming sepsis with encapsulated bacteria. Complement deficiencies also predispose to infection with encapsulated bacteria. Neisseria are a special problem for patients with late component deficiencies. 2.4. Disorders of cell mediated immunity Defects of macrophages and T lymphocytes lead to an increased risk of infection with bacteria viruses and fungi that survive intracellularly. Listeria monocytogenes is classic intracellular
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Unformatted text preview: bacterium seen in patients with this defect. Parasite example is Toxoplasma gondii, viruses in Herpes family, fungi like cryptococcus. Primary cell mediated immune deficiency is usually congenital – Dx in childhood and lethal. Acquired defects usually arise in transplantation (solid organ and bone marrow) through use of immunosuppressive drugs, or viral infection (HIV). 2.5. Temporal sequence There is a general temporal sequence following transplantation. 1. Early post transplant – o postoperative complications. ICU type organisms 2. Months 1-4 – o CMV, Candida, Aspergillus. 3. Months 4-12 – o Cryptococcus, Listeria. 3. Principles of Management • Diagnose aggressively • Treat early • More than one pathogen may be present ie. CMV and Aspergillus, CMV and PCP, Nocardia and Aspergillus. • Physical signs may be masked due to absence of neutrophils. • Prevention generally better than waiting to treat....
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