Active or unmanaged infection requiring resolution before initiating temozolomide (TMZ) c...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-GBM-INFECTION-SCREENING`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-GBM`
Sources	`SRC-EANO-GBM-2024` `SRC-NCCN-CNS-2025`

Red Flag Origin

Definition	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.
Clinical direction	hold
Category	infection-screening

Trigger Logic

{
  "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).

Used By

No reverse references found in the YAML corpus.