Complications of immunosuppression
Match the infection to the immune defect, treat neutropenic fever within the hour, know each immunosuppressant's signature toxicity, and prevent PJP, herpes viruses, hepatitis B, strongyloides and TB before they start.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- The type of immune defect predicts the infection. Neutropenia brings bacteria and moulds; T-cell suppression brings viruses, PJP and intracellular organisms; B-cell depletion brings encapsulated bacteria and hepatitis B reactivation.
- Neutropenic fever is an emergency: blood cultures and an antipseudomonal beta-lactam within 60 minutes.
- Steroids and neutropenia blunt fever, pus and inflammatory signs. A mild-looking patient can be septic.
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Sources
- Antibiotic (Therapeutic Guidelines), febrile neutropenia and sepsis topicsAU/NZTherapeutic Guidelines Ltd, Febrile neutropenia revised April 2026
- Updated Australasian consensus guidelines for the management of invasive fungal disease and use of antifungal agents in the haematology/oncology setting, 2021 (introduction and antifungal prophylaxis chapters)AU/NZChang CC, Teh BW et al., Intern Med J 2021;51 Suppl 7:3-17 and 67-88, 2021
- Consensus guidelines for initial management of neutropenic feverAU/NZDouglas AP et al., Intern Med J 2025;55 Suppl 7:43-67, 2024 (published 2025)
- Australian Immunisation Handbook, vaccination for people who are immunocompromisedAU/NZAustralian Technical Advisory Group on Immunisation, Department of Health, Disability and Ageing
- Australian consensus recommendations for the management of hepatitis B (2022)AU/NZGastroenterological Society of Australia (GESA), 2022
- ECIL guidelines for preventing Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipientsMaertens J et al., J Antimicrob Chemother 2016;71:2397-404, ECIL-5, 2016
- The Multinational Association for Supportive Care in Cancer risk indexKlastersky J et al., J Clin Oncol 2000;18:3038-51, 2000
- Safety of tofacitinib versus TNF inhibitors in rheumatoid arthritis (ORAL Surveillance)Ytterberg SR et al., N Engl J Med 2022;386:316-26, 2022
- Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropeniaCornely OA et al., N Engl J Med 2007;356:348-59, 2007
- Posaconazole or fluconazole for prophylaxis in severe graft-versus-host diseaseUllmann AJ et al., N Engl J Med 2007;356:335-47, 2007
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy