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 Abnormality Organisms Causing Infection Multiple myeloma Hypogammaglobulinemia Streptococcus pneumoniae , Haemophilus influenzae, Neisseria meningitidis Chronic lymphocytic leukemia Hypogammaglobulinemia S. pneumoniae, H. influenzae, N. meningitidis Acute Granulocytopenia, skin and Extracellular gram- myelocytic or lymphocytic leukemia mucous-membrane lesions positive and gram- negative bacteria, fungi Hodgkin's disease Abnormal T cell function Intracellular pathogens (Mycobacterium tuberculosis, Listeria , Salmonella, Cryptococcus , Mycobacterium avium ) Non- Hodgkin's lymphoma and acute lymphocytic leukemia Glucocorticoid chemotherapy, T and B cell dysfunction Pneumocystis Colon and rectal tumors Local abnormalities a Streptococcus bovis (bacteremia) Hairy cell leukemia Abnormal T cell function Intracellular 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 <500 functional polymorphonuclear leukocytes (PMNs)/µ L—and patients with impaired blood or lymphatic drainage may develop infections with unusual organisms. Innocent- looking macules or papules may be the first sign of bacterial or fungal sepsis in immunocompromised patients (Fig. 82-1). In the neutropenic host, a macule progresses rapidly to ecthyma gangrenosum, a usually painless, round, necrotic lesion consisting of a central black or gray-black eschar with surrounding erythema. Ecthyma gangrenosum, which is located in nonpressure areas (as 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. . 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. eliminating bacterial infections in CLL patients with hypogammaglobulinemia. Patients with acute lymphocytic leukemia (ALL), patients with non-Hodgkin's lymphoma, and all cancer patients. 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