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-Hodgkins lymphoma, and all cancer patients treated with high-dose glucocorticoids (or glucocorticoidcontaining chemotherapy regimens) should receive antibiotic prophylaxis for Pneumocystis infection (Table 82-3) for the duration of their chemotherapy. ...
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Chapter 082. Infections in Patients with Cancer (Part 3) Chapter 082. Infections in Patients with Cancer (Part 3) The level of suspicion of infections with certain organisms should dependon the type of cancer diagnosed (Table 82-3). Diagnosis of multiple myeloma orCLL should alert the clinician to the possibility of hypogammaglobulinemia.While immunoglobulin replacement therapy can be effective, in most casesprophylactic antibiotics are a cheaper, more convenient method of eliminatingbacterial infections in CLL patients with hypogammaglobulinemia. Patients withacute lymphocytic leukemia (ALL), patients with non-Hodgkins lymphoma, andall cancer patients treated with high-dose glucocorticoids (or glucocorticoid-containing chemotherapy regimens) should receive antibiotic prophylaxis forPneumocystis infection (Table 82-3) for the duration of their chemotherapy. Inaddition to exhibiting susceptibility to certain infectious organisms, patients withcancer are likely to manifest their infections in characteristic ways. Table 82-3 Infections Associated with Specific Types of Cancer Cancer Underlying Immune Organisms Abnormality Causing Infection Multiple Hypogammaglobulinemia Streptococcusmyeloma pneumoniae, Haemophilus influenzae, Neisseria meningitidis Chronic Hypogammaglobulinemia S. pneumoniae, H.lymphocytic influenzae, N.leukemia meningitidis Acute Granulocytopenia, skin and Extracellular gram-myelocytic or mucous-membrane lesions positive and gram-lymphocytic negative bacteria, fungileukemia Hodgkins Abnormal T cell function Intracellulardisease pathogens (Mycobacterium tuberculosis, Listeria, Salmonella, Cryptococcus, Mycobacterium avium) Non- Glucocorticoid PneumocystisHodgkins chemotherapy, T and B celllymphoma and dysfunctionacute lymphocyticleukemia Colon and Local abnormalitiesa Streptococcus bovisrectal tumors (bacteremia) Hairy cell Abnormal T cell function Intracellularleukemia pathogens (M. 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 theselesions may permit the diagnosis of systemic bacterial or fungal infection. Whilecellulitis caused by skin organisms such as Streptococcus or Staphylococcus iscommon, neutropenic patients—i.e., those with distinguished from necrotic lesions associated with lack of circulation), is oftenassociated with Pseudomonas aeruginosa bacteremia (Chap. 145) but may becaused by other bacteria.