INFECTIONS IN HEMOPOEITIC STEM CELL TRANSPLANT RECIPIENTS DR E.O SHOBOWALE CLINICAL MICROBIOLOGIST PATHCARE NIGERIA
OUTLINE • Introduction • Infectious agents • Diagnosis • Prophylactic agents • PathCare’s role • Conclusion
INTRODUCTION • The transplantation of haematopoietic stem cells from bone marrow results in a transient state of immunologic incompetence. • Shortly after transplantation phagocytes, T and B cells are rapidly depleted and the host is extremely susceptible to various infections.
Infectious Agents • Bacterial • Fungal • Parasitic • Viral
Bacterial • Usually seen in the first 28 days after HSCT. • Marked granulocytopenia is observed • Neutropenia usually lasts for 1 to 3 weeks. • However bacterial infections are more common in the first 7 days • Organisms are usually from the Skin or Intravenous catheters of recipients
Bacterial • Staphylococcus aureus, Coagulase Negative Staphylococci are acquired from the skin and catheters. • Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa are acquired from the bowel. • Nocardiaasteroideswhich is partially acid fast occurs after the first week of transplantation.
Bacterial • Encapsulated bacteria such as Streptococcus pneumoniae cause infections in the late post transplantation period i.e. >6 months. • Chemotherapy and the use of broad spectrum antimicrobial agents place recipients at risk of Clostridium difficileassociated diarrhea.
Fungi • Fungal infections tend to occur after the first week post transplantation. • Seen after chemotherapy, steroid and broad spectrum antibiotic administration. • Granulocytopenia predisposes towards Candida infections. • The increased use of Fluconazole has also helped to select out Molds such as Aspergillus spp, PenicilliummarfenneiandScedosporium spp
Fungi • The following drugs predispose to fungal infections particularly Candida and Aspergillus spp infections in HSCT patients
Fungi • The above mentioned drugs may also cause reactivation of infections due to
Fungi • The prolonged use of intravenous lipid formulations for TPN may predispose to Malassaeziafurfurinfections • HSCT patients are at increased risk of interstitial pneumonia due to Pneumocystisjiroveci.
Parasites • Reactivation of Toxoplasmosis occurs in transplant recipients and may cause CNS lesions.
THE ROLE OF PATHCARE • PathCare can reliably and accurately diagnose infectious syndromes pre and post transplantation. • We have world class diagnostic equipments in all the 4 branches of Pathology – Microbiology, Clinical Chemistry, Hematology and Histopathology. • PathCare has over 13 Pathologists on board who verify and help interpret laboratory reports • Our pathologists are also available for consultation in the patient management
THE ROLE OF PATHCARE • We are located in the following areas • Lagos – Victoria Island, LUTH, FESTAC and Ikeja • Benin • Abuja • Portharcourt • Enugu • Warri • Kaduna • Gwagwalada • Ibadan • Illorin – opening in August
THE ROLE OF PATHCARE • PathCare was established in Nigeria in October 2004 due to demand for accurate and reliable tests • It was started by consortium of health care practitioners including pathologists, haematologists, gynaecologists amongst others who required precision and a wider range of testing to ensure more favourable outcomes for their patients • Sought reputable Partners: PathCare South Africa (foremost pathology service in South Africa). **First to achieve ISO Accreditation in South Africa with an unparalleled reputation for quality and service. • PathCare has since enjoyed a meteoric rise (3 Laboratories and 9 Depots and still growing) in demand for its tests because of the trust clinicians have in the brand
THE ROLE OF PATHCARE • Our Consultant Pathologists • Prof. IbironkeAkinseteConsultant Haematologist and Chairman Board of Directors • Dr. TunjiSoriyanConsultant Chemical Pathologist • Dr. AbiolaOgbennaConsultant Haematologist • Prof. FolasadeOgunsolaConsultant Microbiologist • Dr. JafMomohConsultant Chemical Pathologist • Dr. AdediranConsultant Haematologist • Dr. TamunoWakamaConsultant Haematologist • Dr Olushola Shobowale Consultant Microbiologist • Dr TolulopeAdewole Consultant Chemical Pathologist • Over 70 Specialist Pathologists available in SA for referrals and second opinions
THE ROLE OF PATHCARE • We are currently the first and only ISO 15189 accredited laboratory in West Africa. • This means that our test methodologies and results meet international standards and are acceptable outside Nigeria.
THE ROLE OF PATHCARE • Accurate and reliable results • Highly specialised testing • Timely results (Fast Turn around time) • Excellent service • Nationwide Access
THE ROLE OF PATHCARE • TECHNOLOGY • New Methodology • New Processes … • Wider range of tests • TRAINING • New Skills, Attitudes & Techniques • COMPUTERIZATION • Improved efficiency & accuracy • Reduction of Errors due to human intervention • TOTAL QUALITY MANAGEMENT
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