Infection active ou non gérée nécessitant une résolution avant de commencer temozolomide (TMZ) c...

Vue déterministe de l'entité source de la LJAM. L'autorité clinique demeure avec les ID de la source cités et l'état d'approbation de l ́examinateur.

ID	`RF-GBM-INFECTION-SCREENING`
Type	Signal d’alerte
État	reviewed 2026-04-27 \| pending_clinical_signoff
Maladies	`DIS-GBM`
Sources	`SRC-EANO-GBM-2024` `SRC-NCCN-CNS-2025`

Origine du drapeau rouge

Définition	Active or unmanaged infection requiring resolution before initiating temozolomide (TMZ) chemoradiation in glioblastoma: HBsAg-positive (HBV reactivation risk on prolonged TMZ + corticosteroid co-therapy is real though lower than B-cell-depleting therapy), HCV-RNA-positive, HIV-positive (CD4 informs PJP / opportunistic risk on TMZ + corticosteroids), latent TB, or post-craniotomy surgical-site infection.
Direction clinique	en attente
Catégorie	dépistage des infections

Logique de déclenchement

{
  "any_of": [
    {
      "finding": "hbsag",
      "value": "positive"
    },
    {
      "finding": "hcv_rna",
      "value": "positive"
    },
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "active_tb",
      "value": true
    },
    {
      "finding": "post_craniotomy_ssi",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

GBM patients on Stupp protocol (TMZ + RT + adjuvant TMZ + dexamethasone) develop profound CD4 lymphopenia — PJP prophylaxis (TMP-SMX 3x/week or pentamidine inhaled) routine throughout TMZ phase per NCCN CNS. HBV reactivation risk lower than rituximab regimens but real on prolonged steroid; entecavir prophylaxis if HBsAg+. Post-craniotomy SSI requires full antimicrobial course + neurosurgical clearance before initiating RT into surgical bed (RT into infected field worsens necrosis and precipitates abscess). Active TB: full anti-TB course before chemo when feasible (RT to brain may proceed; TMZ defer).

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