Managing Infections in Patients With Hematological Malignancies (eBook)

Preface 6
Contents 8
Contributors 10
Introduction: Approach to the Patient 12
1. Introduction 12
2. Treatment of Infections in Neutropenic Patients: A Brief History 13
3. Centrality of the Host and Immune Deficiency 15
4. Expectations 15
5. Attributable Success and Attributable Failure 18
6. Approach to the Patient 20
References 21
Pathogens 24
Viruses 25
1. Herpesviruses 25
2. Herpes Simplex Virus, Type 1 and 2 26
3. Varicella-Zoster Virus 30
4. Cytomegalovirus 33
5. Human Herpesvirus-6 and -7 37
6. Epstein-Barr Virus 38
7. Human Herpesvirus-8 (Kaposi’s Sarcoma Herpesvirus) 41
8. Respiratory Viruses 43
9. Adenovirus 44
10. Influenza, Parainfluenza, and Respiratory Syncytial Virus 47
11. Human Metapneumovirus 51
12. Other Respiratory Viruses 52
13. Viral Hepatitides 55
14. Hepatitis A 56
15. Hepatitis B 56
16. Hepatitis C 59
17. Retroviruses 60
18. Human Immunodeficiency Virus 60
19. Human T-Cell Lymphotropic Virus 61
20. Polyomaviruses 62
21. JC Virus 62
22. BK Virus 63
References 65
Bacteria 80
1. Introduction 80
2. Gram-Positive Bacteria 84
3. Gram-Negative Bacteria 91
4. Nocardia 97
5. Mycobacteria 98
6. Anaerobic Organisms 102
7. Polymicrobial Infection 102
8. Diagnosis 103
9. Vascular-Catheter Related Infection 104
References 105
Fungal and Parasitic Infections 122
1. Fungal Infections 122
2. Parasitic Diseases 136
References 138
Hematological Malignancies 144
Acute Myelogenous Leukemia and Febrile Neutropenia 145
1. Introduction 146
2. Management of New Fever and Infections 147
3. Management of Fever After the Empiric Episode 159
4. Cessation of Antimicrobial Therapy 169
5. Concluding Remarks 170
References 171
Lymphomas and Chronic Lymphocytic Leukemia 180
1. Introduction 180
2. Risk Assessment 181
3. Infections in Patients with Non-Hodgkin’s Lymphomas 183
4. Infections in Patients with Hodgkin’s Disease 185
5. Infections in Patients with Chronic Lymphocytic Leukemia 185
6. Site of Care 186
7. Specific Recommendations 188
8. Summary 190
References 190
Multiple Myeloma 195
1. Introduction 195
2. Infection in Different Phases of the Treatment of MM ( Table 7- 2) 196
3. Changing Spectrum of Infections in Multiple Myeloma 201
4. Approach to Infection in MM 202
5. Special Considerations 209
6. Conclusions 210
References 210
Stem Cell Transplantation 216
1. Hematopoietic Cell Transplantation 216
2. Effects of HCT on Host Defenses: A Dynamic Scenario 218
3. Major Infectious Syndromes: Clinical Manifestations and Diagnostic Approaches 219
4. Management Strategies 226
References 230
Special Topics 237
Modulation of Immune Function 238
1. Introduction 238
2. Augmentation of Neutrophil Number 241
3. Immunoglobulin Therapy 246
4. Recombinant Interferon- y 247
5. Innate Pathogen Recognition Receptors 249
6. Adoptive Immunotherapy in HSCT Recipients 250
7. Vaccine Development 251
8. Conclusions 252
References 253
Prophylaxis 262
1. Introduction 263
2. Protected Environments 264
3. Antibacterial Chemoprophylaxis for Severely Neutropaenic Patients 266
4. Role of Hematopoietic Growth Factors for the Prevention of Infection in Neutropenic Cancer Patients 277
5. Antifungal Chemoprophylaxis 281
6. Antiviral Chemoprophylaxis 289
References 297
Infection Control and Prevention 312
1. General Infection Control Measures 312
2. Rules for Health Care Workers and Visitors 314
3. Patient Measures 316
4. Specific Nosocomial Infections 319
References 328
Immunizations 334
1. Recommendations for Immunization of the Oncology Patient 334
2. Bone Marrow and Stem Cell Transplantation 335
3. Immunization in the Non-transplant Setting 340
4. Immunization in Other Oncology Patient Populations 342
5. Future Directions 343
References 344
Issues in Anti-infective Management 347
1. Establishing an Infectious Diseases Program for Patients with Hematological Malignancies 347
2. Microbiology Laboratory 349
3. Anti-infective Stewardship Program 351
4. Managing Anti-infective Toxicities and Drug– Drug Interactions 354
5. Antiretroviral Therapy for HIV Patients with Hematological Malignancies 359
References 362
Index 367