Table 82-1 lists the normal barriers to infection whose disruption may permit infections in immunocompromised pts, with particular relevance for the noted cancers. Infection-associated mortality rates among cancer pts have decreased as a result of an evolving approach entailing early use of empirical broad-spectrum antibiotics; empirical antifungal therapy in neutropenic pts who, after 4–7 days of antibiotic treatment, remain febrile without positive cultures; and use of antibiotics for afebrile neutropenic pts as broad-spectrum prophylaxis against infections.

TABLE 82-1: Disruption of Normal Barriers in Pts with Cancer That May Predispose Them to Infections
Physical barrierBreaks in skinSkin epithelial cellsStaphylococci, streptococciHead and neck, squamous cell carcinomaCellulitis, extensive skin infection
Emptying of fluid collectionsOcclusion of orifices: ureters, bile duct, colonLuminal epithelial cellsGram-negative bacilliRenal, ovarian, biliary tree, metastatic diseases of many cancersRapid, overwhelming bacteremia; urinary tract infection
Lymphatic functionNode dissectionLymph nodesStaphylococci, streptococciBreast cancer surgeryCellulitis
Splenic clearance of microorganismsSplenectomySplenic reticuloendothelial cellsStreptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Babesia, Capnocytophaga canimorsusHodgkin’s disease, leukemiaRapid, overwhelming sepsis
PhagocytosisLack of granulocytesGranulocytes (neutrophils)Staphylococci, streptococci, enteric organisms, fungiAcute myeloid and acute lymphocytic leukemias, hairy cell leukemiaBacteremia
Humoral immunityLack of antibodyB cellsS. pneumoniae, H. influenzae, N. meningitidisChronic lymphocytic leukemia, multiple myelomaInfections with encapsulated organisms, sinusitis, pneumonia
Cellular immunityLack of T cellsT cells and macrophagesMycobacterium tuberculosis, Listeria, herpesviruses, fungi, intracellular parasitesHodgkin’s disease, leukemia, T cell lymphomaInfections with intracellular bacteria, fungi, parasites; virus reactivation

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