Chapter 082. Infections in Patients with Cancer (Part 3) pdf

Infections in Patients with Cancer Part 3 The level of suspicion of infections with certain organisms should depend on the type of cancer diagnosed Table 82-3.. While immunoglobulin r

Chapter 082 Infections in Patients with Cancer

(Part 3)

The level of suspicion of infections with certain organisms should depend

on the type of cancer diagnosed (Table 82-3) Diagnosis of multiple myeloma or CLL should alert the clinician to the possibility of hypogammaglobulinemia While immunoglobulin replacement therapy can be effective, in most cases prophylactic antibiotics are a cheaper, more convenient method of eliminating bacterial infections in CLL patients with hypogammaglobulinemia Patients with acute lymphocytic leukemia (ALL), patients with non-Hodgkin's lymphoma, and all cancer patients treated with high-dose glucocorticoids (or glucocorticoid-containing chemotherapy regimens) should receive antibiotic prophylaxis for

Pneumocystis infection (Table 82-3) for the duration of their chemotherapy In

addition to exhibiting susceptibility to certain infectious organisms, patients with cancer are likely to manifest their infections in characteristic ways

Table 82-3 Infections Associated with Specific Types of Cancer

Cancer Underlying Immune

Abnormality

Organisms Causing Infection

Multiple

myeloma

Hypogammaglobulinemia Streptococcus

pneumoniae, Haemophilus influenzae, Neisseria meningitidis

Chronic

lymphocytic

leukemia

Hypogammaglobulinemia S pneumoniae, H

influenzae, N meningitidis

Acute Granulocytopenia, skin and Extracellular

gram-myelocytic or

lymphocytic

leukemia

mucous-membrane lesions positive and

gram-negative bacteria, fungi

Hodgkin's

disease

Abnormal T cell function Intracellular

pathogens

(Mycobacterium tuberculosis, Listeria, Salmonella, Cryptococcus, Mycobacterium avium)

Non-Hodgkin's

lymphoma and

acute lymphocytic

leukemia

Glucocorticoid chemotherapy, T and B cell dysfunction

Pneumocystis

Colon and

rectal tumors

Local abnormalitiesa

Streptococcus bovis

(bacteremia)

Hairy cell

leukemia

Abnormal T cell function Intracellular

tuberculosis, Listeria, Cryptococcus, M avium)

a

The reason for this association is not well defined

System-Specific Syndromes

Skin-Specific Syndromes

Skin lesions are common in cancer patients, and the appearance of these lesions may permit the diagnosis of systemic bacterial or fungal infection While

cellulitis caused by skin organisms such as Streptococcus or Staphylococcus is

common, neutropenic patients—i.e., those with <500 functional polymorphonuclear leukocytes (PMNs)/µ L—and patients with impaired blood or lymphatic drainage may develop infections with unusual organisms Innocent-looking macules or papules may be the first sign of bacterial or fungal sepsis in immunocompromised patients (Fig 82-1) In the neutropenic host, a macule progresses rapidly to ecthyma gangrenosum, a usually painless, round, necrotic lesion consisting of a central black or gray-black eschar with surrounding erythema Ecthyma gangrenosum, which is located in nonpressure areas (as

distinguished from necrotic lesions associated with lack of circulation), is often

associated with Pseudomonas aeruginosa bacteremia (Chap 145) but may be

caused by other bacteria