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 glucocorticoidcontaining chemotherapy regimens) should receive antibiotic prophylaxis for Pneumocystis infection (Table 82-3) for the duration of their chemotherapy. . | 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 glucocorticoidcontaining 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 Streptococcus bovis bacteremia
