ABSTRACT
Intensive chemotherapy regimens, widespread prophylactic and therapeutic administration of antibiotics, reliance on intravascular catheters, increased use of immunomodulators, and increased outpatient management have altered the epidemiology of infections in patients with neoplastic disease. At many centers, bacteremias due to gram-positive organisms have replaced bacteremias due to gram-negative organisms as the most frequent infections in patients with cancer. Isolation of gram-negative bacilli other than Enterobacteriaceae and Pseudomonas aeruginosa has increased in frequency, and these organisms have become important pathogens. Fungal infections have become a leading cause of morbidity and mortality, and nosocomial fungemias have become more common than nosocomial bacteremias due to gram-negative bacilli in some centers. Mycobacterium tuberculosis, Pneumocystis carinii, and rubeola virus have reemerged as disease-causing entities in patients with cancer. Multiresistant organisms have developed over the past decade. Anticipated trends in infections in patients with cancer also are discussed.
Subject(s)
Cancer Care Facilities , Communicable Diseases/epidemiology , Agranulocytosis/etiology , Catheterization/adverse effects , Communicable Diseases/immunology , Humans , Immunologic Deficiency Syndromes/complications , Splenectomy/adverse effects , United StatesABSTRACT
Infectious complications have become frequent causes of morbidity and mortality in cancer patients, often replacing the primary disease as the leading cause of death. Intensive chemotherapy regimens, widespread prophylactic and therapeutic administration of antibiotics, and reliance on intravascular catheters have altered the epidemiology of infections in these patients. The authors review how gram-positive bacteremias have replaced gram-negative bacteremias as the leading causes of infections in many patients with cancer, and how fungal infections have become a leading cause of morbidity and mortality as bacterial infections are better controlled. Multiresistant organisms that have developed during the past decade and future trends in infectious complications of cancer patients are also discussed.
Subject(s)
Immunocompromised Host , Infections/etiology , Neoplasms/immunology , Bacterial Infections/etiology , Humans , Mycobacterium Infections/etiology , Mycoses/etiology , Protozoan Infections/etiology , Virus Diseases/etiologyABSTRACT
An unusual case of disseminated Nocardia brasiliensis infection is presented. The patient, who had been receiving chronic dexamethasone therapy for 4 years, had pneumonia and septic arthritis of the left knee due to N. brasiliensis. To our knowledge, this is the first report from the United States of a synovial joint infection with this organism. Disseminated disease due to N. brasiliensis is infrequently reported; it is most often seen in the immunocompromised patient and is often unresponsive to therapy.
