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

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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 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) 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 Organisms Abnormality Causing Infection Multiple Hypogammaglobulinemia Streptococcus myeloma 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, fungi leukemia Hodgkin's Abnormal T cell function Intracellular disease pathogens (Mycobacterium tuberculosis, Listeria, Salmonella, Cryptococcus, Mycobacterium avium) Non- Glucocorticoid Pneumocystis Hodgkin's chemotherapy, T and B cell lymphoma and dysfunction acute lymphocytic leukemia Colon and Local abnormalitiesa Streptococcus bovis rectal tumors (bacteremia)
Hairy cell Abnormal T cell function Intracellular leukemia 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 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
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.