30 Questions
What is the most common genotype of Hepatitis C in North America and Western Europe?
Genotype 1A
What is the threshold level for HCV-RNA to indicate an active infection?
15 IU/mL
Which drug is a pan-genotypic, ribavirin-free treatment option for Hepatitis C that can be given as short as 8 weeks of treatment for naive, non-cirrhotic patients?
Mavyret (glecaprevir/pibrentasvir)
What is the recommended therapeutic monitoring frequency during Hepatitis C treatment?
Every 4 weeks (CBC, INR, hepatic function, GFR)
What is the most common route of transmission for Hepatitis B?
IVDU
What is the age eligibility for pediatric HCV management?
3-17 years
Which antibody is a T-cell non-depleting monoclonal antibody?
Basiliximab (Simulect)
Which agent is used as an alternative for patients at low immunologic risk or in patients with known intolerance to other agents?
Basiliximab (Simulect)
Which antibody causes both T-cell depletion and has effects on B-cells and dendritic cells?
Rabbit anti-thymocyte globulin (Thymoglobulin)
Which antifungal agent requires hepatic dose adjustments?
Caspofungin
Which antifungal agent is not broad enough for reliable coverage and should not be used if Voriconazole is the first line?
Fluconazole
Which medication is used to prevent rejection and preserve graft function in transplant patients?
Basiliximab (Simulect)
Which drug binds to the CD52 receptor and acts against T and B lymphocytes, macrophages, monocytes, and NK cells?
Alemtuzumab
Which drug is most commonly used as an induction agent but cannot be used in patients with a rabbit allergy?
Alemtuzumab
Which drug is given once at transplant and requires premedication with corticosteroids, diphenhydramine, and acetaminophen?
Alemtuzumab
Which drug is part of the maintenance immunosuppression and belongs to the class of calcineurin inhibitors?
Tacrolimus
Which drug binds to FK binding proteins and has different formulations including immediate release and delayed release?
Tacrolimus
Which drug's trough monitoring is correlated with efficacy and toxicity and is first line for organ transplantation?
Tacrolimus
How long does the passive anti-HBs and acute protection provided by Hepatitis B-specific immune globulin (HBIG) last?
3-6 months
What is the recommended number of doses for Hepatitis A vaccination?
2 doses
At what age is the Hepatitis B vaccine recommended for non-vaccinated adults?
19-65
What is the effectiveness rate of the Hepatitis B vaccination after the third dose?
Over 90%
Which of the following is NOT a recommended treatment option for chronic hepatitis B (CHB) in patients without HIV co-infection?
Lamivudine
When is post-vaccination serologic testing recommended for infants?
Born to positive mothers
What is the threshold absolute neutrophil count (ANC) for diagnosing neutropenic fever in cancer patients?
100 cells/mm3
What is the most common type of pathogen found in positive cultures of neutropenic fever patients?
Gram-positive bacteria
When should antibiotic therapy be initiated for neutropenic fever patients?
Within 2 hours of presentation
What is the recommended empiric therapy for patients with a history of MRSA or high suspicion of catheter-related infection?
Vancomycin
Which antibiotic resistance pattern should be considered when selecting appropriate antibiotics for neutropenic fever patients?
Extended-spectrum beta-lactamase (ESBL)
What potential side effect should be monitored in patients receiving colony stimulating factors (CSFs) for neutropenic fever?
Diarrhea
Study Notes
Neutropenic Fever in Cancer Patients: Diagnosis and Treatment
- Neutropenic fever is a common complication in cancer patients, with a threshold of 100 cells/mm3 ANC for diagnosis.
- The pathophysiology involves bone marrow suppression due to treatments or disease, leading to impaired cell-mediated immunity and susceptibility to opportunistic infections.
- Diagnosis involves a thorough history and physical examination, clinical signs of infection, and cultures from various sources before antibiotic initiation.
- The majority of cultures are negative, with Gram-positive bacteria being the most common pathogens in positive cultures.
- Antibiotic therapy should be initiated urgently within 2 hours of presentation, targeting gram-negative and methicillin-sensitive Staphylococcus aureus (MSSA) infections.
- Risk assessment categorizes patients into high and low-risk groups, with corresponding hospitalization or outpatient treatment options.
- Initial treatment options include monotherapy with various antibiotics or oral therapy for low-risk patients.
- Vancomycin is indicated as empiric therapy for patients with a history of methicillin-resistant Staphylococcus aureus (MRSA) or high suspicion of catheter-related infection.
- Patients require daily re-evaluation of fever, absolute neutrophil count (ANC), and culture results for adjustment of antibiotic regimen if needed.
- Antibiotic resistance patterns should guide the selection of appropriate antibiotics, considering MRSA, vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase (ESBL), and severe penicillin allergy.
- General treatment measures include good handwashing, avoidance of invasive procedures, and systemic prophylaxis for bacterial, fungal, and viral infections.
- Colony stimulating factors (CSFs) may be continued or initiated based on clinical status and ANC, with available biosimilars for CSFs. Diarrhea, a potential side effect, should be monitored and treated accordingly.
Test your knowledge on the diagnosis and treatment of neutropenic fever in cancer patients. Explore the pathophysiology, risk assessment, antibiotic therapy, and general treatment measures through this informative quiz.
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