Chapter 082. Infections in Patients with Cancer (Part 4)

Figure 82-1A. Papules related to Escherichia coli bacteremia in a neutropenic patient with acute lymphocytic leukemia. B. The same lesion the following day.Candidemia (Chap. 196) is also associated with a variety of skin conditions and commonly presents as a maculopapular rash. Punch biopsy of the skin may be the best method for diagnosis.Cellulitis, an acute spreading inflammation of the skin, is most often caused by infection with group A Streptococcus or Staphylococcus aureus, virulent organisms normally found on the skin (Chap. 119). Although cellulitis tends to be circumscribed in normal hosts, it may spread rapidly in neutropenic patients. ...
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Chapter 082. Infections in Patients with Cancer (Part 4) Chapter 082. Infections in Patients with Cancer (Part 4)Figure 82-1 A. Papules related to Escherichia coli bacteremia in a neutropenic patientwith acute lymphocytic leukemia. B. The same lesion the following day. Candidemia (Chap. 196) is also associated with a variety of skin conditionsand commonly presents as a maculopapular rash. Punch biopsy of the skin may bethe best method for diagnosis. Cellulitis, an acute spreading inflammation of the skin, is most often causedby infection with group A Streptococcus or Staphylococcus aureus, virulentorganisms normally found on the skin (Chap. 119). Although cellulitis tends to becircumscribed in normal hosts, it may spread rapidly in neutropenic patients. Atiny break in the skin may lead to spreading cellulitis, which is characterized bypain and erythema; in the affected patients, signs of infection (e.g., purulence) areoften lacking. What might be a furuncle in a normal host may require amputationbecause of uncontrolled infection in a patient presenting with leukemia. Adramatic response to an infection that might be trivial in a normal host can markthe first sign of leukemia. Fortunately, granulocytopenic patients are likely to beinfected with certain types of organisms (Table 82-4); thus the selection of anantibiotic regimen is somewhat easier than it might otherwise be (see AntiviralTherapy, below). It is essential to recognize cellulitis early and to treat itaggressively. Patients who are neutropenic or have previously received antibioticsfor other reasons may develop cellulitis with unusual organisms (e.g., Escherichiacoli, Pseudomonas, or fungi). Early treatment, even of innocent-looking lesions, isessential to prevent necrosis and loss of tissue. Debridement to prevent spread maysometimes be necessary early in the course of disease, but it can often beperformed after chemotherapy, when the PMN count increases. Table 82-4 Organisms Likely to Cause Infections in GranulocytopenicPatients Gram-positive cocci Staphylococcus epidermidis Staphylococcus aureus Viridans Streptococcus Enterococcus faecalis Streptococcus pneumoniae Gram-negative bacilli Escherichia coli Klebsiella spp. Pseudomonas aeruginosa Non-aeruginosa Pseudomonas spp.a Enterobacter spp. Serratia spp. Acinetobacter spp.a Citrobacter spp.Gram-positive bacilli Diphtheroids JK bacillusaFungi Candida spp. Aspergillus spp.a Often associated with intravenous catheters.