Infectie na stamceltransplantatie.pptx

Infec&e na stamceltransplanta&e Wanneer welke infec-e? 26 mei 2015 Loes Hoogveld, C1a Casus Man, 29 Jaar Recidief non-­‐hodgkin lymfoom Autologe stamceltransplanta-e Dag 4: beginnende mucosi-s Dag 5: neutropene koorts: forse mucosi-s Dag 7: Respiratoire verslechtering wv IC opname •  consolida-es bilateraal, verdenking pneumonie •  Welke verwekker? • 
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Beloop infec&erisico •  PreengraPment: van transplanta-e tot ongeveer dag 30 •  Early postengraPment: van engraPment tot dag 100 •  Late postengraPment: na dag 100 • 
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Leukopenie Ook daarna: tot herstel B-­‐ en T-­‐cel immuniteit Autoloog: 6 tot 12 maanden Allogeen: 12 tot 24 maanden Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preven/ng infec/ous complica/ons among hematopoie/c cell transplanta/on recipients: a global perspec/ve. Biol Blood Marrow Transplant 2009; 15:1143. Preengra6ment •  Schade natuurlijke barrière (huid, mucosa) •  Neutropenie •  Verlies func-e fagocyten • 
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Niet-­‐opportunis-sche infec-es Herpes simplex re-­‐ac-va-e (mucosi-s) Clostridium difficile (10-­‐20% van infec-euze diarree) Pneumonie: •  Nodulair: infec-eus (bacteriëel, C. albicans, later aspergillus) •  Diffuus: longoedeem, longschade door medica-e, engraPment syndrome, viraal Early postengra6ment •  Acute graP versus host •  Restschade natuurlijke barrière (huid, mucosa) •  Niet-­‐opportunis-sche infec-es •  Bacterieel, viraal •  Opportunis-sche infec-es •  Candida, aspergillus, respiratoire/enterale virussen, CMV, EBV, PCP •  Re-­‐ac-va-e •  HSV, HBV/HCV Late postengra6ment Vooral na allogene transplanta-es Chronische GVH (HR 2.9) Soorten infec-es vergelijkbaar met early postengraPment COP (chronische GVH) Ingekapselde bacteriën (S. pneumoniae, H. influenzae, Neisseria meningi/dis) •  VZV • 
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Robin M, Porcher R, De Castro Araujo R, et al. Risk factors for late infec/ons a@er allogeneic hematopoie/c stem cell transplanta/on from a matched related donor. Biol Blood Marrow Transplant 2007; 13:1304. Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preven/ng infec/ous complica/ons among hematopoie/c cell transplanta/on recipients: a global perspec/ve. Biol Blood Marrow Transplant 2009; 15:1143. Referen&es www.uptodate.com Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preven/ng infec/ous complica/ons among hematopoie/c cell transplanta/on recipients: a global perspec/ve. Biol Blood Marrow Transplant 2009; 15:1143. Robin M, Porcher R, De Castro Araujo R, et al. Risk factors for late infec/ons a@er allogeneic hematopoie/c stem cell transplanta/on from a matched related donor. Biol Blood Marrow Transplant 2007; 13:1304.