Chapter 082. Infections in Patients with Cancer (Part 2) doc

Infections in Patients with Cancer Part 2 A similar problem can affect patients whose lymph node integrity has been disrupted by radical surgery, particularly patients who have had rad

Chapter 082 Infections in Patients with Cancer

(Part 2)

A similar problem can affect patients whose lymph node integrity has been disrupted by radical surgery, particularly patients who have had radical node dissections A common clinical problem following radical mastectomy is the development of cellulitis (usually caused by streptococci or staphylococci) because of lymphedema and/or inadequate lymph drainage In most cases, this problem can be addressed by local measures designed to prevent fluid accumulation and breaks in the skin, but antibiotic prophylaxis has been necessary

in refractory cases

A life-threatening problem common to many cancer patients is the loss of the reticuloendothelial capacity to clear microorganisms after splenectomy

Splenectomy may be performed as part of the management of hairy cell leukemia, chronic lymphocytic leukemia (CLL), and chronic myelocytic leukemia (CML) and in Hodgkin's disease Even after curative therapy for the underlying disease, the lack of a spleen predisposes such patients to rapidly fatal infections The loss

of the spleen through trauma similarly predisposes the normal host to overwhelming infection for life after splenectomy The splenectomized patient should be counseled about the risks of infection with certain organisms, such as

the protozoan Babesia (Chap 204) and Capnocytophaga canimorsus (formerly

dysgonic fermenter 2, or DF-2), a bacterium carried in the mouths of animals

(Chaps 140 and e14) Since encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis) are the organisms most

commonly associated with postsplenectomy sepsis, splenectomized persons should

be vaccinated (and revaccinated; Table 82-2 and Chap 116) against the capsular polysaccharides of these organisms Many clinicians recommend giving

splenectomized patients a small supply of antibiotics effective against S pneumoniae, N meningitidis, and H influenzae to avert rapid, overwhelming

sepsis in the event that they cannot present for medical attention immediately after the onset of fever or other symptoms of bacterial infection A few amoxicillin/clavulanic acid tablets are a reasonable choice for this purpose

Table 82-2 Vaccination of Cancer Patients Receiving Chemotherapy

Use in Indicated Patients

Vaccine Intensive

Chemotherapy

Hodgkin's Disease

Hematopo ietic Stem Cell Transplantation

Diphtheria-tetanusa

Primary series and boosters

as necessary

No special recommendation

12, 14, and

24 months after transplantation

Poliomyelitisb Complete

primary series and boosters

No special recommendation

12, 14, and

24 months after transplantation

Haemophilus

influenzae type b

conjugate

Primary series and booster for children

Immunizati

treatment and booster 3 months afterward

12, 14, and

24 months after transplantation

Hepatitis A Not

routinely recommended

Not routinely recommended

Not routinely recommended

series

No special recommendation

12, 14, and

24 months after transplantation

23-Valent

pneumococcal

polysaccharidec

Every 5 years

Immunizati

treatment and booster 3 months afterward

12 and 24 months after transplantation

4-Valent

meningococcal

conjugated

Should be administered to splenectomized patients and patients living in endemic areas, including college

Should be administered to splenectomized patients and patients living in endemic areas, including college

Should be administered to splenectomized patients and patients living in endemic areas, including college

students in dormitories

students in dormitories

students in dormitories

immunization

Seasonal immunization

Seasonal immunization

Measles/mumps/r

ubella

Contraindic ated

Contraindi cated during chemotherapy

After 24 months in patients without graft-versus-host

disease

Varicella-zoster

virus

Contraindic atede

Contraindi cated

Contraindi cated

a

The Td (tetanus-diphtheria) combination is currently recommended for adults Pertussis vaccines have not been recommended for people >6 years of age

in the past However, recent data indicate that the Tdap (tetanus–diphtheria– acellular pertussis) product is both safe and efficacious in adults

b

Live-virus vaccine is contraindicated; inactivated vaccine should be used

The seven-serotype pneumococcal conjugate vaccine is currently recommended only for children It is anticipated that future vaccines will include more serotypes and will be recommended for adults

d

Currently licensed for people 11–55 years of age

e

Contact the manufacturer for more information on use in children with acute lymphocytic leukemia