Good afternoon all, here are some points from our last academic activity entitled (The Immunocompromised Patient):
- There are 2 types of immunity: innate which does not need previous exposure and acquired (adaptive) immunity which needs pervious antigen exposure .
- The stem cell of bone marrow contains 3 times the number of WBC found in the circulation .
- Pregnancy causes immunosuppression .
- Cyclosporine is metabolized by cytochrome P-450, so try to avoid prescribing any medication that shares the same enzyme for metabolism, for example, a concomitant macrolide can cause hepatotoxicity or even rejection .
- May cause change in WBC count as early as 6 hours from administration.
- Any abdominal pain in a patient who is on corticosteroid should be taken seriously and needs to be investigated for serious complications such as perforated viscous and intra-abdominal abscess.
- Sutured wounds in patients on corticosteroids need double the time to heal (it affects healing).
- Febrile Neutropenia: ANC = WBC count * ((PMNs/100) + (Bands/100)).
Initiation of monotherapy with an anti-pseudomonal beta-lactam agent, such as cefepime, meropenem, imipenem/cilastatin or piperacillin-tazobactam. Ceftazidime monotherapy has also been shown to be as effective as other regimens .
- HIV-positive patients: if CD4 is below 200 then this patient needs a prophylactic antibiotic for PCP.
- 30% of elderly patients with infection will present without fever. Thus, absence of fever does not rule out infection.
- 89% of elderly patients coming with fever will have an infection. (so deal with fever seriously in this group of patients).