MANAGEMENT OF INFECTION IN ONCOLOGY PATIENTS; ED. BY JOHN R. WINGARD

Content: HOST DEFENSES Treatment Strategies for Solid Tumors and Impact on Host Defenses Treatment Strategies for Hematological Malignancies: Impact on Host Defenses and Infection Risk Blood and Marrow Transplantation INFECTIOUS SYNDROMES Infectious Syndromes in Solid Tumour Therapy Infectious Complications in Patients Receiving Cytotoxic Therapy for Acute Leukemia: History, Background and Approaches to Management Infections in Chronic Leukemias and other Hematological Malignancies Infections in Hematopoietic Stem Cell Transplant Patients MANAGEMENT STRATEGIES Infections Caused by Gram-positive Cocci and Gram-negative Rods Management Strategies for Infections Caused by Candida Species Invasive Aspergillosis Complicating Neoplastic Diseases and Hematopoietic Stem Cell Transplantation Fungi other than Candida and Aspergillus Management Strategies for Herpes Simplex Viruses in Cancer Patients and Hematopoietic Stem Cell Transplant Recipients Management Strategies for Varicella-zoster Infections in Patients with Cancer Management of CMV Infection in Hematopoietic Stem Cell Transplant Recipients Epstein-Barr Virus Infections in the Oncology Patient Respiratory Viruses in Immunocompromised Hosts Hepatitis Virus Infections in Patients with Cancer OTHER THERAPIES Use of Hematopoietic Growth Factors in the Management of Infection in Oncology Patients Granulocyte (Neutrophil) Transfusion Therapy Uses of Immunoglobulins in the Management of Infection in Oncology Patients Infection Control Vaccinations in Oncology Patients Transfusion Considerations Index 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 Knowledge of infection management is an essential skill for the effective modern oncologist. Despite major advances in antibacterial, antifungal, and antiviral therapeutics, infection has continued to grow as a problem of medical progress through the last five decades and remains with us today. John Wingard and Raleigh Bowden present a comprehensive review of the range of infectious complications that can arise in oncology patients as a result of their malignancy, as well as from the treatment they are undergoing. This text is practical and informative, and management approaches are detailed for each type of infection and the settings in which they occur