The immunocompromised pt is at increased risk for infection with both common and opportunistic pathogens.
Table 82-1 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 82-1Disruption of Normal Barriers in Pts with Cancer That May Predispose Them to Infections ||Download (.pdf) TABLE 82-1 Disruption of Normal Barriers in Pts with Cancer That May Predispose Them to Infections
|TYPE OF DEFENSE ||SPECIFIC LESION ||CELLS INVOLVED ||ORGANISM ||CANCER ASSOCIATION ||DISEASE |
|Physical barrier ||Breaks in skin ||Skin epithelial cells ||Staphylococci, streptococci ||Head and neck, squamous cell carcinoma ||Cellulitis, extensive skin infection |
|Emptying of fluid collections ||Occlusion of orifices: ureters, bile duct, colon ||Luminal epithelial cells ||Gram-negative bacilli ||Renal, ovarian, biliary tree, metastatic diseases of many cancers ||Rapid, overwhelming bacteremia; urinary tract infection |
|Lymphatic function ||Node dissection ||Lymph nodes ||Staphylococci, streptococci ||Breast cancer surgery ||Cellulitis |
|Splenic clearance of microorganisms ||Splenectomy ||Splenic reticuloendothelial cells ||Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Babesia, Capnocytophaga canimorsus ||Hodgkin’s disease, leukemia ||Rapid, overwhelming sepsis |
|Phagocytosis ||Lack of granulocytes ||Granulocytes (neutrophils) ||Staphylococci, streptococci, enteric organisms, fungi ||Acute myeloid and acute lymphocytic leukemias, hairy cell leukemia ||Bacteremia |
|Humoral immunity ||Lack of antibody ||B cells ||S. pneumoniae, H. influenzae, N. meningitidis ||Chronic lymphocytic leukemia, multiple myeloma ||Infections with encapsulated organisms, sinusitis, pneumonia |
|Cellular immunity ||Lack of T cells ||T cells and macrophages ||Mycobacterium tuberculosis, Listeria, herpesviruses, fungi, intracellular parasites ||Hodgkin’s disease, leukemia, T cell lymphoma ||Infections with intracellular bacteria, fungi, parasites; virus reactivation |