 Treatment can lower immunity by decreasing the number
and function of immune cells. Also, immune suppression is
associated with the increased risk of lymphoma, and the disease itself can
reduce immune competence and make one prone to invasive infection.
Here we provide resources for serious
infections related to late stage or advanced disease and associated
with aggressive treatments.
It is particularly
important for immune-compromised patients to avoid sources of
infection, such as crowded public location, and to take other
precautions. See Avoiding infection.
Symptoms
of infection may include: Fever, chills, shaking, lethargy, poor appetite,
dizziness, confusion, inflammation, sensation of heat, and organ-specific signs - mucous-producing cough, painful urination,
and so on. When in doubt, please notify your doctor.
Sepsis
is a blood infection that can lead to shock and death. Symptoms may
include: Fever (but sometimes normal or low temperature), chills, severe shaking, fast heart rate, rapid breathing, confusion, disorientation, agitation, dizziness, decreased urination, rash,
and joint pain.
NIH: Guidance:
Call your doctor right away
if you have any of these symptoms:
 |
Fever
over 100° F or 38° C. |
|
Chills,
especially shaking chills. |
|
Sweating. |
|
Loose
bowel movements. |
|
Frequent
urgency to urinate or a burning feeling when you urinate. |
|
A
severe cough or sore throat. |
|
Unusual
vaginal discharge or itching. |
|
Redness,
swelling, or tenderness, especially around a wound, sore,
ostomy (surgical opening), pimple, rectal area or catheter site. |
|
Sinus
pain or pressure. |
|
Earaches,
headaches, or stiff neck. |
|
Blisters
on the lips or skin. |
|
Mouth
sores. |
Source:
Chemotherapy and You cancer.gov
pdf
Resources:
TOPIC SEARCH:
ASCO
| ASH
| Medscape
|
Fever and Rash Diagnosis of the dangerously ill patient
ucdavis.edu
|
|
Managing Infections in Patients With Hematologic Malignancies
Content Development Co-Chairs: Kenneth V. Rolston, MD, John R.
Wingard, MD Medscape 2003
(free login req.)
|
| Sepsis (blood infection) emedicine
|
|
Understanding your Complete Blood Count cc.nih.gov
pdf | PAL
|
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Avoiding Infection
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NEW: Infectious
Pulmonary Complications
TOPIC SEARCH: PubMed
"Pulmonary complications of cancer
and cancer therapy represent a broad spectrum of disease. Early
diagnosis and treatment are essential to achieve an optimal outcome."
2
Following Stem Cell
Transplant:
"Despite the introduction of
numerous prophylactic [preventive] strategies and advances in
diagnosis and treatment, pneumonia remains the leading infectious
cause of death after HSC transplantation.
... Factors that enhance the
vulnerability of the recipient to pneumonia include protracted [long
lasting] neutropenia [low immune cell count] before engraftment,
impaired humoral [b-cell] and cellular [t-cell] immunity associated
with the administration of exogenous immunosuppressive agents, and
GVHD [Graft versus Host Disease]." 1, Page
33
Early recognition and correct
treatment of the pulmonary complications should minimize the
significant mortality and morbidity. This review aims to discuss the
role of radiology in the diagnosis and management of pulmonary
complications following BMT. 3
-
-
Pulmonary complications in cancer patients.
CA Cancer J Clin. 1996 Sep-Oct;46(5):303-20. Review. PMID: 8806395
-
Pulmonary complications following bone marrow transplantation.
Br J Radiol. 2003 Jun;76(906):373-9. Review. PMID: 12814922
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Fungal Infections
Susceptibility
to fungal infections can be a complication of immune suppression caused
by treatment and the
underlying disease.
| Antifungal
Treatment Delays Responsible For Excess Deaths From Fungal
Infection: Presented at ICAAC
"Among patients who received effective therapy within
6 hours of hypotension onset, the in-hospital survival rate
exceeded 60%, with no marked difference between types of
infection. Survival rates for both fungal and bacterial infection
decreased dramatically as treatment delays grew longer."
|
| FDA Approves Novel Medicine to Prevent Invasive
Fungal Infections fda.gov
2006
The safety and efficacy of Noxafil were evaluated in clinical
trials consisting of 1,844 patients between 13 and 82 years of
age. In two, randomized, controlled studies of patients who had
compromised immunity and were at high risk for invasive fungal
infections, those patients who received Noxafil had comparable or
lower rates of invasive Aspergillus and Candida infections than
those patients who received other antifungal medications.
|
| Aspergillosis MedlinePlus
Aspergillus, a fungus, "causes illness in three ways: as an allergic reaction in people with asthma (Pulmonary aspergillosis - allergic bronchopulmonary type); as a colonization and growth in an old healed lung cavity from previous disease (such as tuberculosis or lung abscess) where it produces a fungus ball called aspergilloma; and as an invasive infection with pneumonia that is spread to other parts of the body by the bloodstream (Pulmonary aspergillosis - invasive type)."
~ MedlinePlus
|
|
|
|
Fungal Infections in Immunocompromised Hosts
Focus on Epidemiologic Aspects of Infection nfid.org
As the population of Immunosuppressed individuals increases,
so do the numbers and types of fungal
infections noted in these
patients."
|
Treating Fungal Infections
"Itraconazole and
amphotericin B have at least equivalent efficacy as empirical antifungal
therapy in neutropenic patients with cancer. However, itraconazole is
associated with significantly less toxicity."
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Viral infections
|
Also see Shingles
- a viral infection that presents in the skin
|
|
Rituximab-related viral infections in lymphoma patients.
Leuk Lymphoma. 2007 Jul;48(7):1307-12. Review. PMID: 17613758
Close monitoring for viral infection, particularly HBV and CMV,
in patients treated with
rituximab should be recommended.
|
|
Monitoring of cytomegalovirus reactivation after allogeneic
stem cell transplantation: comparison of an antigenemia assay and
quantitative real-time polymerase chain reaction nature.com
|
|
Adoptive transfer of cytomegalovirus-specific CTL to stem cell
transplant patients after selection by HLA–peptide tetramers jem.org
CMV viremia was reduced in every case and eight patients
cleared the infection, including one patient who had a
prolonged history of CMV infection that was refractory
to antiviral therapy. This novel approach to adoptive
transfer has considerable potential for
antigen-specific T cell therapy.
|
| Hepatitis B virus reactivation in a case of
non-Hodgkin's lymphoma treated with chemotherapy and rituximab:
necessity of prophylaxis for hepatitis B virus reactivation in
rituximab therapy.
Leuk Lymphoma. 2004 Mar;45(3):627-9. PMID:
15160930 | Related
articles
|
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Pseudomonas
|
Improved prognosis of Pseudomonas aeruginosa
bacteremia in 127 consecutive neutropenic patients with
hematologic malignancies. Int J Infect Dis. 1998-99
Winter;3(2):99-104.PMID: 10225988 PubMed
"recognition of the risk factors and more careful management,
the prognosis of P. aeruginosa bacteremia in neutropenic patients
with hematologic malignancies has improved in recent years.
|
|
|
Research News
| Cystitis: Successful treatment of severe
hemorrhagic cystitis after hemopoietic cell transplantation by
selective embolization of the vesical arteries. Bone Marrow
Transplant. 2003 May; 31(10): 923-5. PMID: 12748670
| Related
articles
|
|
|
|
Pathophysiology -- Fungal Infections in Patients with Cancer
merckmedicus.com
|
|
T Cells Augment Monocyte and Neutrophil Function in Host
Resistance
against Oropharyngeal Candidiasis iai.asm.org
|
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|
