0071643192.pdf

HEMATOLOGY, ONCOLOGY, ALLERGY,

AND IMMUNOLOGY

■ Listeria

■ Pneumocystic

■ Aspergillosis

Infections After 6 Months

■ Chronic viral infections

■ CMV, EBV, hepatitis B or C,HSV

■ Varicella-zoster virus:Primacy varicella infection can result in dissemi-

nated diseases. Seronegative patients should receive varicella-zoster

immune globulin after exposure to chickenpox or zoster. Hospitaliza-

tion with IV acyclovir should be considered in transplant patients with

cutaneous herpes zoster.

■ Increased risk of community-acquired infections (pneumonia, UTIs)

■ Also consider Strongyloideshyperinfection syndrome, Tuberculosis, Toxo-

plasmosis,fungal infections.

IMMUNODEFICIENCY/IMMUNOSUPPRESSION

Immunodeficiency results in increased susceptibility to infection. Patients

with defects in antibody-mediatedimmunity (also known as humoral or

B-cell–mediated immunity) are at particularly increased risk of infection by

encapsulated bacteria. By contrast, cellularimmunity (also known as T-cell–

mediated immunity) is more important in protecting patients against viral,

intracellular, bacterial, and fungal infections as well as malignancies.

Evaluation for suspected immunodeficiency:

■ CBC with differential, quantitative immunoglobulin levels, complement

levels, HIV test

Antibody-Mediated Immune Dysfunction

■ IgA deficiency (a selective immunoglobulin deficiency)

■ Recurrent sinus and pulmonary infections

■ At risk for developing severe transfusion reactions

■ Common variable immunodeficiency (CVID)

■ Low or dysfunctional IgG, IgA, IgM antibodies

■ Recurrent sinus and pulmonary infections

■ Hyper-IgE syndrome (Job syndrome)

■ Recurrent pyogenic infections of the skin and lower respiratory tract

■ Multiple myeloma

■ Defect in production of opsonizing antibodies

■ Splenectomy patients

■ Increased susceptibility to encapsulated bacteria

■ Administer pneumococcal, meningococcal, H. influenzae type B vaccines.

Cellular Immune Dysfunction

■ Congenital causes:

■ Bruton agammaglobulinemia

■ Recurrent bacterial infections

■ DiGeorge syndrome

■ Recurrent viral, fungal, and protozoan infections