Management of infection in oncology patients

Front Matter......Page 1
Contents......Page 5
Contributors......Page 7
Introduction......Page 11
Section I: Host defenses......Page 13
INTRODUCTION......Page 14
Mucositis......Page 16
Central venous catheters......Page 17
Changes in local anatomy/physiology......Page 18
Phagocytes......Page 19
T cells......Page 20
QUALITATIVE DEFECTS......Page 22
REFERENCES......Page 23
Defects due to underlying disease......Page 27
Impact of therapy......Page 30
Vancomycin-resistant enterococci......Page 32
Role of hematopoietic growth factors......Page 35
HUMORAL AND CELLULAR IMMUNITY......Page 36
SKIN AND MUCOSAL INTEGRITY: ETIOLOGY AND PREVENTION......Page 38
REFERENCES......Page 41
INCIDENCE OF INFECTION WITH AN ALLOGENEIC TRANSPLANT......Page 47
Myeloablative therapy followed by bone marrow rescue......Page 48
Immune reconstitution after infusion of allogeneic bone marrow, PBSC, CD34-selected PBSC or cord blood......Page 49
Non-myeloablative allogeneic regimens......Page 50
Factors influencing the kinetics of engraftment of unselected PBSC after autologous transplantation......Page 51
Overall incidence of infection after infusion of unselected autologous PBSC......Page 52
Increased incidence of CMV infection after autologous CD34-selected PBSCT......Page 54
Incidence of non-CMV infection after autologous CD34-selected PBSCT......Page 57
Incidence of infection after addition of immunotherapy after autologous PBSCT......Page 58
REFERENCES......Page 59
Section II: Infectious syndromes......Page 63
FEBRILE NEUTROPENIA......Page 64
Neutropenic risk groups......Page 65
Alternative risk-assessment strategies......Page 68
Antibiotic regimens......Page 71
CATHETER-ASSOCIATED INFECTIONS......Page 74
PULMONARY INFILTRATES......Page 75
REFERENCES......Page 76
INTRODUCTION: HISTORICAL PERSPECTIVE......Page 80
Changes in the spectrum of bacterial infections......Page 81
CHARACTERISTICS OF FEBRILE NEUTROPENIC EPISODES......Page 83
Definition of fever......Page 84
Isolation......Page 85
Antibacterial chemoprophylaxis......Page 87
Antifungal chemoprophylaxis......Page 88
Infection and the neutrophil count......Page 89
The role of hematopoietic growth factors in acute leukemia......Page 90
Hematopoietic growth factors as prophylaxis......Page 91
Hematopoietic growth factor-stimulated leukocyte transfusions......Page 92
Hepatosplenic fungal infection......Page 93
Treatment of hepatosplenic fungal infection......Page 94
Invasive fungal infection......Page 95
Filamentous fungal infection......Page 96
Central venous access devices and infection......Page 97
Differential diagnoses......Page 99
Respiratory viral infections......Page 100
EMPIRIC ANTIBACTERIAL THERAPY FOR FEBRILE NEUTROPENIC EPISODES......Page 101
Empiric vancomycin......Page 102
Combination therapy versus monotherapy......Page 103
REFERENCES......Page 104
Infection patterns......Page 114
Hypogammaglobulinemia......Page 115
Defects of cellular immunity......Page 117
Other immune defects......Page 118
Purine analogs......Page 119
Monoclonal antibodies......Page 122
Primary prophylaxis......Page 123
Active immunization......Page 125
Hematopoietic growth factors......Page 126
Multiple myeloma......Page 128
Hairy cell leukemia......Page 130
REFERENCES......Page 131
TIMING OF INFECTIOUS SYNDROMES......Page 138
Bloodstream infections......Page 140
Meningitis......Page 142
Aspergillus infections......Page 143
Herpes simplex virus......Page 144
Cytomegalovirus......Page 145
Epstein?Barr virus......Page 146
Other respiratory viruses......Page 147
Other viruses......Page 148
Conclusions......Page 149
REFERENCES......Page 150
Section III: Management strategies......Page 154
Introduction......Page 155
Prevention......Page 156
Clinical significance......Page 157
Therapeutic approach......Page 158
Epidemiology......Page 159
Resistance patterns......Page 160
Clinical significance......Page 161
Therapeutic approach......Page 162
Epidemiology......Page 163
Clinical significance......Page 164
Therapeutic approach......Page 165
EMPIRIC ANTIBACTERIAL TREATMENT FOR FEBRILE NEUTROPENIA IN CANCER PATIENTS Table 8.2......Page 166
REFERENCES......Page 167
INTRODUCTION......Page 172
Oral candidiasis......Page 173
Candidemia......Page 174
Hepatosplenic candidiasis......Page 175
Prophylaxis and empiric antifungal therapy......Page 176
Immunomodulation......Page 178
Candidemia......Page 179
SUMMARY......Page 181
REFERENCES......Page 182
MICROBIOLOGY......Page 185
Pathogenesis......Page 187
CLINICAL EPIDEMIOLOGY......Page 188
Pulmonary aspergillosis......Page 189
Disseminated aspergillosis......Page 191
DIAGNOSIS OF INVASIVE ASPERGILLOSIS......Page 192
Early interventions: prophylactic and empiric antifungal therapy......Page 195
Treatment of invasive pulmonary aspergillosis......Page 196
Recurrent pulmonary aspergillosis......Page 198
Treatment of extrapulmonary aspergillosis......Page 199
IMMUNOMODULATION......Page 200
REFERENCES......Page 201
Trichosporon......Page 209
Cryptococcus......Page 212
Saccharomyces......Page 213
Fusarium......Page 214
Scedosporium......Page 215
DERMATOPHYTES......Page 216
DARKLY PIGMENTED DEMATIACEOUSFUNGI......Page 217
ZYGOMYCETES......Page 218
PNEUMOCYSTIS CARINII......Page 219
ANTIFUNGAL AGENTS......Page 220
CONCLUSIONS......Page 221
REFERENCES......Page 222
PATHOGENESIS......Page 228
Esophagitis......Page 229
DIAGNOSIS......Page 230
Absorption, distribution, and elimination......Page 231
Chemistry, mechanism of action, and antiviral activity......Page 232
Prophylaxis......Page 233
ANTIVIRAL RESISTANCE......Page 234
REFERENCES......Page 235
Varicella......Page 238
Zoster......Page 240
Zoster after transplantation......Page 241
LABORATORY DIAGNOSIS OF VZV INFECTION......Page 242
ANTIVIRAL THERAPY FOR VZV INFECTIONS Table 13.4......Page 243
ACTIVE IMMUNIZATION AGAINST VZV INFECTIONS......Page 244
Efficacy of varicella vaccine in healthy populations......Page 245
Implications of universal immunization for cancer patients......Page 246
REFERENCES......Page 247
EPIDEMIOLOGY AND RISK FACTORS......Page 252
METHODS OF CMV DETECTION......Page 254
Principles of prevention......Page 255
Ganciclovir......Page 256
Cidofovir......Page 259
Prophylaxis with immunoglobulin and CMV monoclonal antibodies......Page 260
Prevention in autologous transplantation......Page 262
Other manifestations of CMV diseases......Page 263
SUMMARY AND FUTURE PERSPECTIVES......Page 266
REFERENCES......Page 267
EBV infection of B cells......Page 273
T-cell interactions with EBV-infected B cells......Page 274
PATHOGENESIS OF EBV INFECTION IN THE IMMUNOCOMPROMISED PATIENT......Page 275
INCIDENCE AND RISK FACTORS......Page 277
CLINICAL PRESENTATION......Page 278
Imaging studies......Page 279
Diagnosis Table 15.5......Page 280
TREATMENT STRATEGIES Table 15.6......Page 282
Antiviral agents......Page 283
Adoptive T-cell immunotherapy......Page 284
REFERENCES......Page 286
INTRODUCTION......Page 290
CLINICAL IMPACT IN CANCER PATIENTS AND IMMUNOCOMPROMISED HOSTS......Page 291
Specimens......Page 292
IMMUNITY AGAINST RESPIRATORY VIRUSES......Page 293
TREATMENT......Page 294
Adenoviruses: epidemiology......Page 295
Adenoviruses: clinical features......Page 296
Adenoviruses: treatment......Page 298
Influenza: clinical features......Page 299
Influenza: detection......Page 300
Influenza: treatment......Page 301
Influenza: prevention......Page 302
PIVs: virology......Page 304
PIVs: detection......Page 305
RSV: virology......Page 306
RSV: detection......Page 307
RSV: treatment......Page 308
Rhinoviruses: virology......Page 310
Rhinoviruses: prevention......Page 312
CONCLUSIONS......Page 313
REFERENCES......Page 314
Natural history of hepatitis B virus in patients with cancer Table 17.1......Page 323
Natural history of hepatitis B virus infection after HSCT......Page 324
Management strategies......Page 325
Natural history of hepatitis C virus in patients treated for cancer......Page 332
Natural history of hepatitis C virus infection after HSCT......Page 333
Management strategies......Page 334
LIVER BIOPSY IS OFTEN DEFINITIVE IN DETERMINING CAUSATION......Page 337
REFERENCES......Page 339
Section IV: Other therapies......Page 345
BIOLOGIC EFFECTS OF CSFs......Page 346
Primary prophylaxis......Page 347
Secondary prophylaxis......Page 348
Therapeutic use......Page 349
Acute lymphoblastic leukemia......Page 350
Myelodysplasia......Page 351
Granulocyte transfusions......Page 352
Use after stem cell transplantation......Page 353
Graft failure......Page 354
PEGFILGRASTIM......Page 355
REFERENCES......Page 358
COLLECTION METHOD......Page 363
GRANULOCYTE DONORS......Page 364
GRANULOCYTE STORAGE......Page 365
CLINICAL EFFICACY OF GRANULOCYTE TRANSFUSION THERAPY......Page 366
Granulocyte transfusion donors......Page 368
REFERENCES......Page 369
THERAPEUTIC IMMUNOGLOBULIN PREPARATIONS......Page 373
IVIG IN CHRONIC LYMPHOCYTIC LEUKEMIA......Page 376
IVIG IN MULTIPLE MYELOMA......Page 379
CMV infection and disease......Page 380
CMV hyperimmune globulin......Page 381
IVIG in the prevention of CMV disease......Page 386
IVIG and CMVIG in the treatment of CMV disease......Page 388
IVIG for the prevention of infectious complications following HSCT......Page 392
RESPIRATORY SYNCYTIAL VIRUS IMMUNOGLOBULIN IN ONCOLOGY PATIENTS......Page 394
NOVEL USES FOR MONOCLONAL ANTIBODIES......Page 398
REFERENCES......Page 399
ENVIRONMENTAL MEASURES......Page 405
Construction......Page 406
WATER AND LEGIONELLOSIS......Page 407
Hand hygiene......Page 408
Flowers, plants, and decorative items......Page 410
REFERENCES......Page 412
INTRODUCTION......Page 416
Patients with leukemia, lymphoma, multiple myeloma, or solid tumors......Page 417
Patients with leukemia, lymphoma, or solid tumors......Page 418
Tetanus and diphtheria toxoid......Page 419
Influenza......Page 420
Allogeneic HSCT recipients......Page 421
Autologous HSCT patients......Page 422
Allogeneic HSCT patients......Page 423
Allogeneic HSCT patients......Page 424
REFERENCES......Page 425
Viral transmission......Page 429
Cytomegalovirus infection......Page 431
DONOR SCREENING......Page 433
LEUKOREDUCTION OF BLOOD COMPONENTS......Page 434
REFERENCES......Page 436
Index......Page 440