Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
INFECTION IN IMMUNOSUPPRESSED PATIENTS
Current Therapy in Hematology-Oncology-3. Brain MC, Carbone PP, eds. Current Therapy Series, Toronto, B.C. Decker, p. 243-50, 1988.. Unique Identifier : AIDSLINE ICDB/89657373 Walsh TJ; Schimpff SC; Div. of Cancer Treatment, NCI, Bethesda, MD
Abstract:
Infections develop in immunocompromised patients (pts) as a function of specific deficits in immunologic, anatomic, or physiologic integrity. Management of infections is discussed, including: treatment of infections associated with granulocytopenia (combination therapy, monotherapy, vancomycin, mixed aerobic-anaerobic infections, antifungal therapy, pulmonary infiltrates, and granulocyte transfusions); treatment of infections associated with defective B-lymphocyte immunity; and treatment of infections associated with defective T-lymphocyte immunity (AIDS, Hodgkin's lymphoma [HL], and corticosteroid-induced immunosuppression). Most immunocompromised pts with neoplastic diseases must be managed for combined deficits in host defense. Granulocytopenic pts frequently develop herpes simplex infections, often have indwelling Silastic catheters, and sustain disruptions of normal mucosal barriers following chemotherapy. Pts with chronic lymphocytic leukemia have defective B- and T-cell immunity, which increases the risk of infections due to encapsulated bacteria and Pneumocystis carinii, respectively. Pts with HL often become granulocytopenic from chemotherapy. Those with hairy cell leukemia have a high risk of infections due to atypical mycobacteria (Mycobacterium kansasii). Pts with mycosis fungoides may have serious Staphylococcus aureus infections due to disrupted cutaneous barriers. Management of immunocompromised cancer pts requires recognition of specific immunologic, mechanical, or neurologic defects, which predispose the pt to a relatively predictable pattern of infections with specific pathogens and sites of infection. Fever and granulocytopenia must be treated empirically following clinical evaluation and cultures, since untreated infections may be catastrophic. Pts with humoral immune deficiencies must be evaluated and treated for encapsulated bacterial infections. Pts with AIDS and other T-cell dysfunctional states seldom need empirical therapy, but instead require a thoughtful evaluation for several organisms associated with defective cell-mediated immunity.
Keywords: Acquired Immunodeficiency Syndrome/THERAPY Agranulocytosis/COMPLICATIONS Antibiotics/THERAPEUTIC USE Antifungal Agents/THERAPEUTIC USE Bacterial Infections/DRUG THERAPY Blood Transfusion Granulocytes/TRANSPLANTATION Human Immune Tolerance Mycoses/DRUG THERAPY Neoplasms/*COMPLICATIONS Opportunistic Infections/*THERAPY MONOGRAPH
891230
M89C0826
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Important note: Information in this article was accurate in 1989. The state of the art may have changed since the publication date.
