Infections in the Immunocompromised Host

Infections in the Immunocompromised Host

Nicolas C. Issa, M.D Division of Infectious Diseases Brigham & Women's Hospital Dana-Farber Cancer Institute

Boston, MA

Disclosures

? Research Grant Support:

? Astellas Pharma Inc. ? GlaxoSmithKline ? Merck

? Consultant

? Akros Pharma Inc.

Question 1

? 67 y.o female with breast cancer presenting with watery diarrhea, abdominal cramping and leukocytosis. Stool studies were positive for C. difficile toxin. What is the best first line therapy for her condition:

? A) Metronidazole 500 mg po Q 8h x 10 days. ? B) Vancomycin 125 mg po q6h x 10 days. ? C) Fidaxomicin 200 mg po q12h x 10 days. ? D) Both B and C are correct. ? E) Fecal microbiota transplant

Question 2

? Which one of the following vaccines is contraindicated in household contacts of a patient who underwent allogeneic hematopoietic cell transplant 6 months ago?

A) Measles Mumps and Rubella (MMR) vaccine. B) Varicella vaccine. C) Oral typhoid vaccine. D) Both A and B are contraindicated. E) None of the above.

General Approach to Infections in ICH

? Infectious etiologies are diverse ranging from common bacterial and viral pathogens to opportunistic pathogens.

? Can be pauci-symptomatic due to impaired inflammatory responses .

? Concomitant infections. ? Reactivation of latent infections. ? Opportunistic infections with

unusual organisms

Courtesy of Lindsey Baden, M.D

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