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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 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 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. Infections In The Immunocompromized Host Host Defects and Associated Prevalent Pathogens Defect Pathogen Granulocytopenia Staph. Aureus,CNSS, V strep, Enterococci, E. coli, Pseudomonas aeruginosa, K.pneumoniae, other gram –ve bacilli, Aspergillus spp Damaged skin and mucous membrane CNSS, Staph. Aureus, pseudomonas aeruginosa and other gram-ve bacilli, candida spp, V. strep, enterococci, HSV. Impaired CMI HSV, VZ, EBV, CMV, RSV, M. tuberculosis, Aspergillus spp and other fungi, Toxoplasma gondi. Impaired humoral immunity Streptococcus pneumoniae, Haemophilus influenzae Spleen dysfunction Streptococcus pneumoniae, Haemophilus influenzae Neisseria meningitides. Complement deficiency Neisseria meningitides, Neisseria gonorrhea 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 IDSA guidelines CID;2002:34:730-751 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. Fever In Neutropenic Patient SEQUENTIAL INFECTIVE EVENTS Fever In Neutropenic Patient Causes of fever in neutropenic patients; 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 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 Infections in Organ Transplant Recipients Common infection in Specific Organ transplant: Bone marrow transplant Kidney transplant Bloodstream infections, pneumonia, viral infections Urinary tract infections. Liver transplant Intraabdominal infections. Heart and Heart-Lung transplant 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 antirejection 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,Toxoplazma,Pneomocystis Candida,Aspergillosis EBV,CMV,HBV VZV,CMV retinitis Common bacteria 1 2 3 4 5 6 7 8 9 10 Months post transplantation CID;2001 (supp 1):S5-S8