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INTRODUCTION

The immunocompromised pt is at increased risk for infection with both common and opportunistic pathogens.

INFECTIONS IN CANCER PTS

Table 88-1 lists the normal barriers to infection whose disruption may permit infections in immunocompromised pts, with particular relevance for the noted cancers. Infection-associated mortality rates among cancer pts have decreased as a result of an evolving approach entailing early use of empirical broad-spectrum antibiotics; empirical antifungal therapy in neutropenic pts who, after 4–7 days of antibiotic treatment, remain febrile without positive cultures; and use of antibiotics for afebrile neutropenic pts as broad-spectrum prophylaxis against infections.

TABLE 88-1DISRUPTION OF NORMAL BARRIERS THAT MAY PREDISPOSE TO INFECTIONS IN PATIENTS WITH CANCER

SYSTEM-SPECIFIC SYNDROMES

  • Skin infections Skin lesions of various types are common in pts with cancer and may be the first sign of bacterial or fungal sepsis, particularly in neutropenic pts (those with <500 functional neutrophils/μL).

    • Cellulitis: most often caused by group A Streptococcus and Staphylococcus aureus. Unusual organisms (e.g., Escherichia coli, Pseudomonas, fungi) may be involved in neutropenic pts.

    • Macules or papules: due to bacteria (e.g., Pseudomonas aeruginosa causing ecthyma gangrenosum) or fungi (e.g., Candida)

    • Sweet's syndrome or febrile neutrophilic dermatosis: Most often seen in neutropenic leukemic pts, it presents as red or bluish-red papules or nodules that form sharply bordered plaques; high fever; and an elevated ESR. The skin lesions are most common on the face, neck, and arms.

    • Erythema multiforme with mucous membrane involvement: Often due to HSV infection, it is distinct from Stevens-Johnson syndrome, which is associated with drugs and has a more widespread distribution; both conditions are common in pts with cancer.

    • Drug rashes: Rashes associated with ...

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