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Characteristics of Infectious Diseases in Patients with Cancer
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Characteristics of Infectious Diseases in Patients with Cancer
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がん患者における感染症の特徴と背景
#1.
Characteristics of Infectious Diseases in Patients with Cancer Division of Infectious Diseases, Aichi Cancer Center Naoya Itoh MD, DTM&H. itohnaoya0925@ybb.ne.jp
#2.
Today's Goal • To learn how to understand the concept of infections in cancer patients. • To learn the common infections among patients with solid organ tumors. • To learn the classification of immunodeficiency.
#3.
Characteristics of Infectious Diseases in Patients with Cancer 1. Introduction 2. Overview of the background of patients with solid organ tumors 3. Immunodeficiency in patients with solid organ tumors 3-1. Neutropenia 3-2. Cellular immunodeficiency 3-3. Humoral immunodeficiency 4. Barrier impairment 5. Structural abnormality
固形腫瘍患者の緊急受診の原因
#4.
We have a lot of opportunities to see solid organ malignancies than hematologic malignancies Solid tumors >> Hematologic tumors However, not as well studied as infections in patients with hematologic tumors Leukemia. 2006;20:1655–7. Support Care Cancer. 2014;22:527–35. Today I will focus on solid tumors.
#5.
Patients with cancer who visited the emergency room Patients visited the emergency department of Kishiwada Municipal Hospital from April 2012 to March 2013. Of the 15,716 subjects, 1,244 (7.9%) were patients with cancer. ChiefComplaint All patients（n=1244） Patient with metastases（n=491） Gastrointestinal symptoms 15.8% 16.7% Fever 15.0% 28.9% Pain 12.9% 28.1% Respiratory symptoms 12.6% 5.1% Neurological symptoms 10.3% 5.1% Other symptoms 33.4% 16.1% Fever is the most common chief complaint of patients with cancer who visit the emergency room Emergency hospitalization for 37% of all patients with cancer and 44% of patients with cancer with metastases Support Care Cancer. 2017 May;25(5):1409-1415.
#6.
Causes of Emergency Visits for Patients with Cancer 7,288 patients who visited an emergency department for cancer in a tertiary care facility in South Korea from January 2010 to December 2010. Cause Frequency Cancer progression 55.5% Infection 22.8% Treatment-Related 14.7% Non-cancer related 7% Support Care Cancer. 2012 Sep;20(9):2205-10.
固形腫瘍患者の免疫不全の分類
#7.
Characteristics of Infectious Diseases in Patients with Cancer 1. Introduction 2. Overview of the background of patients with solid organ tumors 3. Immunodeficiency in patients with solid organ tumors 3-1. Neutropenia 3-2. Cellular immunodeficiency 3-3. Humoral immunodeficiency 4. Barrier impairment 5. Structural abnormality
#8.
Solid organ tumors and hematologic malignancies Hematologic malignancies Immunodeficiency due to malignancy itself Solid organ tumors Infection due to anatomical factors and immunodeficiency due to treatment
#9.
Course of neutropenia associated with chemotherapy in patients with solid tumors Long-term neutropenia does not occur even with high-risk regimens High-risk regimen Low-risk regimen Days to neutrophil improvement (≥500/µL) High-risk regimen: median 6 days Low-risk regimen: median 4 days Ann Oncol. 2006 Mar;17(3):507-14.
#10.
Characteristics of patients with solid organ tumors (1) Unlike hematologic malignancies, they are not significantly immunosuppressed. Prolonged neutropenia does not occur.
固形腫瘍患者における感染リスクと情報
#11.
Characteristics of patients with solid organ tumors (2) Elderly population is common Underlying disease (e.g., diabetes, obstructive pulmonary disease) Neoplastic and drug fevers are also common Short neutropenic period, function is preserved Multiple treatments including surgery + chemotherapy Multiple immunodeficiencies Infect Dis Ther. 2017 Mar;6(1):69-83.
#12.
Infections in patients with solid tumors are also considered logistically Most important Understanding the patient background Which organ is involved? What are the causative microorganisms? Which antimicrobial agent should be selected? Appropriate follow-up
#13.
Required Information on Infections in Patients with Solid Tumors Procedures within the past 3 months Devices Cancer Type and Stage Patients with Solid Tumors Surgery Chemotherapy Other Cancer Treatments Steroids/Immun osuppressants Radiation Therapy Surgical history: timing, procedure, anatomical changes (urinary tract alteration, duodenal papillary resection, etc.) Chemotherapy: regimen, last dose Radiotherapy: irradiation site and dose Steroids: single dose and total dose (duration) Procedures within the past 3 months: endoscopic procedures, punctures, dental procedures, etc.
#14.
Risks for Patients with Solid Tumors Structural abnormality Immunodeficiency Barrier disruption/device 1. Structural abnormalities: obstruction by tumor, anatomical changes 2. Device / barrier disruption: all devices, skin and mucosa have maximal immune function 3. Immunodeficiency: neutropenia, cellular immunodeficiency, humoral immunodeficiency
固形腫瘍患者における一般的な感染部位
#15.
What are the most common infections in patients with solid organ tumors?
#16.
Common sites of infection in patients with solid tumors Infection site Comments Bloodstream Often associated with vascular access catheters and neutropenia. Changing epidemiology, with resistant Gram-negative organisms emerging Breast Generally related to breast cancer surgery, including reconstruction and implants. Changing epidemiology with MRSA and Gram-negative organisms common Often surgery- or prosthetic device-related. May require device removal and/or long-term suppressive therapy Including ventriculitis, meningitis, shunt-related infections, and post-surgical infections Bone, cartilage, joints Central nervous system Skin and skin structure Lower gastro-intestinal, pelvic Most often related to surgery, including invasive diagnostic procedures. May be chronic or persistent in irradiated areas. Poly-microbial infections are common Aspiration pneumonia in patients with loss of gag reflex or ciliary function. Post-obstructive pneumonia (with empyema or fistula formation wit
#17.
Characteristics of Infectious Diseases in Patients with Cancer 1. Introduction 2. Overview of the background of patients with solid organ tumors 3. Immunodeficiency in patients with solid organ tumors 3-1. Neutropenia 3-2. Cellular immunodeficiency 3-3. Humoral immunodeficiency 4. Barrier impairment 5. Structural abnormality
#18.
Overview of the Immune System Immune System Innate Immunity Acquired Immunity （non-specific） （Specific）
#19.
Innate Immunity and Acquired Immunity Innate Immunity External Skin Mucous membrane Secretions Internal Phagocytic cells Acquired Immunity Humoral immunity Antimicrobial proteins Inflammatory response Natural killer cells Complement Cell-mediated immunity
#20.
Rough Classification of Immunodeficiency Barrier disruption Neutropenia Humoral immunodeficiency Cellular immunodeficiency Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 305, 3617-3627.e2
発熱性好中球減少症のリスク評価要因
#21.
Cautions for clinical practice In clinical practice, one patient often has multiple immunodeficiencies (e.g., neutropenia + cellular immunodeficiency, etc.). Be aware of what is impaired in the individual case.
#22.
Neutropenia Neutrophils: - Innate immunity - Migration to inflammatory site, phagocytosis of foreign substances
#23.
Background of neutropenia and associated microorganisms Background Associated microorganisms Chemotherapy Radiotherapy Drugs (e.g., antithyroid drugs) <Bacteria> CNS, Staphylococcus aureus, Streptococcus (alpha hemolytic, GroupD) Enterobacterales (Klebsiella, E. coli, Enterobacter, Citrobacter), Pseudomonas aeruginosa, Acinetobacter, Anaerobic Streptococcus, Clostridium, Bacteroides. <Fungus> Candida Aspergillus Trichosporon Fusarium Mucor Chemotherapy for solid organ tumors does not cause long-term neutropenia. Neutrophils usually improve within 7 days. Principles and Practice of Cancer Infectious Diseases. Humana Press, 2011.
#24.
Febrile neutropenia Fever Oral temperature ≥38.3℃ Oral temperature ≥38.0℃ for more than 1 hour (In Japan, axillary temperature ≥37.5℃ or oral temperature ≥38.0℃) Neutropenia Neutrophil count <500/μL Neutrophil count is expected to be <500/μL within 48 hours FN is just a condition of fever during neutropenia. FN is not a diagnosis. Clin Infect Dis. 2011 Feb 15;52(4):427-31.
#25.
Neutrophil count and risk of infection Proportion of Infectious Diseases (%) Peripheral blood neutrophil count (μL) Decreased neutrophil counts increase the risk of infection. Ann Intern Med. 1966 Feb;64(2):328-40.
#26.
Factors to Consider in Risk Assessment for FN (Patient Characteristics) Factors Risk Factors associated with FN Patient Characteristics Advanced age Performance status Nutritional status History of FN Comorbidity Risk Effects ≧65 y/o ≧2 Alb<3.5g/dL FN episodes within 1 cycle ≥4 times in cycles 2-6. Odds of FN increase 27%, 67%, 125% with each additional comorbidity. J Clin Oncol. 2018 Oct 20;36(30):3043-3054.
好中球減少症患者の特徴と感染の進行
#27.
Factors to consider in risk assessment of FN (underlying malignancy) Factors associated with FN Risk Factors Diagnosis Reporting rate of FN (%) Underlying malignancy Cancer diagnosis Acute leukemia/MDS 85.0-95.0 High-grade lymphoma 35.0-71.0 Soft tissue sarcoma 27.0 Non-Hodgkin's lymphoma/myeloma 23.0 Ovarian cancer 12.0 Lung cancer 10.0 Colorectal cancer 5.5 Head and neck cancer 4.6 Breast cancer 4.4 Prostate cancer 1.0 Solid tumors have relatively low reporting rates of FN Cancer Stage SRisk increases for advanced stage (≥2) Remission status Risk increases if not in remission Cancer treatment response Risk is lowest if patient has a CR If patient has a PR, FN risk is greater for acute leukemia than for solid tissue malignancies FN risk is higher if persistent, refractory, or progressive disease despite Treatment J Clin Oncol. 2018 Oct 20;36(30):3043-3054.
#28.
Factors to consider in risk assessment for FN (chemotherapy) Factors associated with FN Risk Factors Effect on Risk Chemotherapy Cytotoxic regimens Risk is higher with regimens that administer: Anthracyclines at doses ≧ 90 mg/m2 Cisplatin at doses ≧ 100 mg/m2 Ifosfamide at doses ≧ 9 g/m2 Cyclophosphamide at doses ≧ 1 g/m2 Etoposide at doses ≧ 500 mg/m2 Cytarabine at doses ≧ 1 g/m2 High dose density Anthracycline + taxane, and cyclophosphamide or gemcitabine, for breast Cancer Dose >85% of planned dose is increased risk Degree and duration of GI and/or oral mucositis National Cancer Institute mucositis grade ≥3, peak score ≥2 on the oral mucositis assessment scale (OMAS) is associated with increased risk Degree and duration of cytopenia Neutrophil count <100/μL ≥7 days Lymphocyte count <700/μL Monocyte count <150/μL J Clin Oncol. 2018 Oct 20;36(30):3043-3054.
#29.
Characteristics of neutropenic patients (1) Lack of symptoms and findings (2) Rapid progression (3) Infections occur at sites not usually seen (4) Rare microbial infections Int J Antimicrob Agents. 2000 Oct;16(2):93-5.
#30.
Characteristics of neutropenic patients (1) Lack of symptoms and findings About 60% of patients have no symptoms or findings, and the source of fever is unknown. About 70% of cases respond to antimicrobial therapy. Undetectable infection in most cases Int J Antimicrob Agents. 2000 Oct;16(2):93-5.
#31.
Characteristics of neutropenic patients 1) Lack of symptoms and findings Diseases Findings Peripheral blood granulocyte count (/μL) <100 101-1000 >1000 Cellulitis Exudate 5% 44% 92% Pneumonia Purulent sputum 8% 67% 84% Cough 67% 69% 93% Purulent urine 11% 63% 97% Urinary tract infections Int J Antimicrob Agents. 2000 Oct;16(2):93-5.
#32.
Characteristics of neutropenic patients (1) Lack of symptoms and findings Bacterial pneumonia caused by gram-negative rods in patients with cancer. Neutrophils <1000/mm3: about 40% have normal first x-ray Medicine (Baltimore). 1977 May;56(3):241-54.
#33.
Characteristics of neutropenic patients (2) Rapid progression Fever in patients with neutropenia ⇒ Rapidly progressive and fatal if untreated
#34.
Bacteremia and mortality during neutropenia Bacteria Frequency Mortality Gram-negative rods 34% 18% Escherichia coli 14% 18% Klebsiella spp. 4% 10% Pseudomonas aeruginosa 8% 31% 57% 5% Coagulase-negative staphylococci 28% 6% Streptococcus spp. 15% 4% Gram-positive cocci Arch Intern Med. 1975 May;135(5):715-9.
発熱性好中球減少症の原因と微生物
#35.
Characteristics of neutropenic patients (3) Infections occur at sites not usually seen Infection site Frequency Respiratory infections 35-40% Bloodstream infections 15-35% Urinary tract infections 5-15% Skin and soft tissue infections 5-10% Digestive tract infections 5-10% Others 5-10% Infection. 2014 Feb;42(1):5-13.
#36.
Characteristics of neutropenic patients (3) Infections occur at sites not usually seen In a study of FN patients with hematologic malignancies, perianal infections were found in 3-6%. →Examination of these areas is also important. Lancet Haematol. 2017 Dec;4(12):e573-e583.
#37.
Characteristics of neutropenic patients (3) Infections occur at sites not usually seen Neutropenic enterocolitis Neutropenic enterocolitis occurs in 5.3% of patients admitted for chemotherapy for hematologic malignancies and solid tumors. Mortality rate is 30-50%. Reported to occur in AML (44%), ALL (18%), and breast cancer (10%). Intern Med 2005 ;44(5):467-70. / Eur J Haematol. 2005; 75: 1– 13. / Surg Infect (Larchmt). 2009; 10: 307– 14. Clin Infect Dis. 2013; 56: 711– 7. / World J Gastroenterol. 2017; 23: 42– 7. / Clin Transl Oncol. 2006; 8: 31– 8.
#38.
Characteristics of neutropenic patients (4) Rare microbial infections Less pathogenic or commensal bacteria that do not cause infection under normal immunocompetence can cause infection in a neutropenic state. The detection of unfamiliar or commensal organisms in blood cultures should be considered as a potential source of the true pathogen.
#39.
Causes of febrile neutropenia Non infectious causes ＜5% Microbiologically documented infections 20-25% Unexplained fever 45-50% Clinically documented infections 20-25% Infection. 2014 Feb;42(1):5-13.
#40.
Frequent causative organisms in patients with FN Gram-positive infection Frequency Gram Negative Infections Frequency CoNS 20-50％ Escherichia coli 18-45% Staphylococcus aureus 10-30％ Klebsiella species 11-18% Enterococcus species 5-15％ Other Enterobacteriaceae 15-18% VGS 3-27％ Pseudomonas aeruginosa 18-24% Micrococcus species 5-8% Stenotrophomonas maltophilia 2-5% Corynebacterium species 2-5% Acinetobacter species ＜3% β hemolytic streptococci 4-6% Other NFGNB ＜3% Bacillus species 4-6% Aerococcus species Streptococcus pneumoniae Stomatococcus mucilaginosus Lactobacillus species Leuconostoc species Pediococcus species ＜3% Infection. 2014 Feb;42(1):5-13.
細胞性免疫不全と関連微生物の概要
#41.
Don't stop with FN = cefepime administration. Examine the patient carefully.
#42.
Characteristics of Infectious Diseases in Patients with Cancer 1. Introduction 2. Overview of the background of patients with solid organ tumors 3. Immunodeficiency in patients with solid organ tumors 3-1. Neutropenia 3-2. Cellular immunodeficiency 3-3. Humoral immunodeficiency 4. Barrier impairment 5. Structural abnormality
#43.
Cellular and Humoral immunity Cellular immunity - T lymphocytes - Elimination of intracellular bacteria Humoral immunity - B lymphocytes - Antibodies - Removal of extracellular bacteria and toxins
#44.
Cellular Immunodeficiency and Related Microorganisms Background Related Microorganisms Malignant Diseases and Infectious Diseases - Acute Lymphocytic Leukemia - Malignant Lymphoma - HIV Infection Bacteria - Legionella, Salmonella, Nocardia, Listeria - Mycobacteria (tuberculosis, non-tuberculous mycobacteriosis) Viruses - VZV, CMV, HSV, HHV6, EBV - Respiratory viruses Fungi - Cryptococcus - Histoplasma - Coccidioides - Candida - Pneumocystis - Talaromyces Others Toxoplasma - Toxoplasma - Cryptosporidium - Strongyloidiasis Medical treatment - Transplantation (blood stem cells, solid organs) - Steroid administration - Immunosuppressive drugs - Administration of biological agents Other - Renal failure - Liver failure - Diabetes mellitus - Pregnancy Amar Safdar. Principles and Practice of Cancer Infectious Diseases. Humana Press, 2011. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 305, 3617-3627.e2
#45.
Cellular Immunodeficiency and Related Microorganisms 2LMN2S Listeria Legionella Mycobacterium Nocardia Salmonella Staphylococcus aureus
#46.
Case 60 years old, male. Fever, cough, dyspnea. Currently taking Lindelon 4 mg for brain tumor and brain edema. What’s your diagnosis? A. Pneumocystis jirovecii pneumonia
細胞性免疫不全の課題と感染症
#47.
Challenges of opportunistic infections in non-HIV patients No clear indicator such as CD4 lymphocyte count Humoral and cellular immunodeficiency caused by new drugs (immunosuppressants, biologics, etc.) being developed continuously. We have no choice but to examine them on every occasion.
#48.
Steroid-induced depression of cellular immunity Pneumocystis pneumonia (PjP) in non-HIV patients:. PSL 16 mg/day ≥ 8 weeks → increased risk of PjP N Engl J Med. 2004 Jun 10;350(24):2487-98. Prednisone 20 mg/day ≥ 1 month → eligible for PjP prophylaxis J Clin Oncol. 2013 Feb 20;31(6):794-810. Other than PjP PSL <10mg/day or total dose <700mg → No increased risk of infection Rev Infect Dis.1989;11(6):954-63.
#49.
Case 70 years old, female. Fever and loss of consciousness. She was diagnosed with cervical cancer 3 years ago. She was treated with chemotherapy and radiotherapy, but she appeared normal until the day before she came to the hospital. On the morning of admission, her family found her collapsed in her room and sent her to the emergency room because she was unresponsive to their calls. The total dose of steroids was about 1000 mg of prednisolone equivalent. CSF findings: initial pressure 18 cmH2O, cell count 500 cells/mm3 (polynuclear cells 92%: mononuclear cells 8%), protein 270 mg/dL, glucose 70 mg/dL (blood glucose 203 mg/dL) Gram stain after centrifugation; Gram-positive rods. A. Listeria meningitis
#50.
Disseminated herpes zoster Under cellular immunodeficiency, specific cellular immunity to VZV is reduced Disseminated herpes zoster with spread of the rash over 3 or more areas, including the primary site. Patients with disseminated herpes zoster should be monitored until all lesions have crusted over. Standard precautions + contact infection precautions + airborne infection precautions https://www.cdc.gov/shingles/hcp/hc-settings.html#patients
#51.
Characteristics of Infectious Diseases in Patients with Cancer 1. Introduction 2. Overview of the background of patients with solid organ tumors 3. Immunodeficiency in patients with solid organ tumors 3-1. Neutropenia 3-2. Cellular immunodeficiency 3-3. Humoral immunodeficiency 4. Barrier impairment 5. Structural abnormality
#52.
Cellular and Humoral immunity Cellular immunity - T lymphocytes - Elimination of intracellular bacteria Humoral immunity - B lymphocytes - Antibodies - Removal of extracellular bacteria and toxins
皮膚・粘膜バリアの破壊と感染リスク
#53.
Humoral immunodeficiency and related microorganisms Background Related Microorganisms Malignant Diseases and Infections - Multiple Myeloma - Chronic lymphocytic leukemia - HIV infection <Bacteria> Streptococcus pneumoniae Staphylococcus aureus Staphylococcus aureus Meningococci Capnocytophaga Medical Practice - Hematopoietic stem cell transplantation - Post splenectomy <Viruses> Enterovirus <Others> Giardia Amar Safdar. Principles and Practice of Cancer Infectious Diseases. Humana Press, 2011. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 305, 3617-3627.e2
#54.
Humoral immunodeficiency and related microorganisms Humoral immunodeficiency makes the patient vulnerable to "capsular bacteria".
#55.
Indicated disease cases for splenectomy Blood Disorders: 1. idiopathic thrombocytopenic purpura 2. hemolytic anemia (hereditary spherocytosis, autoimmune hemolytic anemia) 3. malignant lymphoma Portal hypertension: 1. idiopathic portal hypertension 2. extrahepatic portal vein occlusion Neoplastic disease: 1. benign splenic tumor 2. primary malignant tumor 3. metastatic tumor Splenic injury/rupture Splenic artery aneurysm Infectious splenomegaly 1. tuberculosis 2. kala-azar 3. malaria Metabolic diseases: Gaucher's disease, Niemann-Pick disease, etc. Complicated resection in gastric cancer and pancreatic cancer
#56.
Patients with splenectomies should be vaccinated! Please let me know if you have a patient scheduled for splenectomy. OK！ Pneumococcal vaccine, Hib/Meningococcal vaccine
#57.
Case Case: 40-year-old male The patient underwent splenectomy due to splenic injury at 18 y/o. Fever, loss of consciousness, shock, and DIC. He had purpura all over his body. What’s your diagnosis? A. Overwhelming postsplenectomy infection Tokai J Exp Clin Med. 2017 Sep 20;42(3):130-132.
#58.
Infections caused by bacteria with capsular bacteria (PSS/OPSI) PSS: postsplenectomy sepsis OPSI: overwhelming postsplenectomy infection
#59.
Infections caused by bacteria with capsular bacteria (PSS/OPSI) Capsular Bacteria Streptococcus pneumoniae >>> Haemophilus influenzae, Meningococci Children >>Adults (Under 16 years: 4.4%, Adults 0.9%) ・2-3 years after splenectomy is the most likely time to develop the disease. ・50% within 2 years, 76% within 8 years ・3.1% of cases occur more than 20 years after splenectomy Br J Surg, 1991. 78(9): p. 1031-8.
#60.
Infections caused by bacteria with capsular bacteria (PSS/OPSI) An infectious disease that begins with fever and rapidly worsens. Initially, upper/lower respiratory tract symptoms, headache, and gastrointestinal symptoms are seen, followed rapidly by sepsis. Hemorrhagic plaques/purpura may occur. Mortality rate is 38-69%. Clin Microbiol Infect, 2001. 7(12): p. 657-60.
#61.
Characteristics of Infectious Diseases in Patients with Cancer 1. Introduction 2. Overview of the background of patients with solid organ tumors 3. Immunodeficiency in patients with solid organ tumors 3-1. Neutropenia 3-2. Cellular immunodeficiency 3-3. Humoral immunodeficiency 4. Barrier impairment 5. Structural abnormality
#62.
Disruption of the skin-mucosa barrier Skin/mucosa: Barrier to prevent entry of microorganisms from outside Its breakdown allows microorganisms to enter the body
#63.
Disruption of the skin-mucosa barrier Background Related Microorganisms Indwelling Vascular Catheters Atopic Dermatitis Radiotherapy Burns Severe Drug Eruption <Bacteria> Staphylococcus Corynebacterium Pseudomonas aeruginosa Enterobacterales <Mycobacterium> M. abscesses M. fortuitum M. Chalonei <Fungi> Candida Aspergillus Principles and Practice of Cancer Infectious Diseases. Humana Press, 2011.
#64.
Case Fever in a colorectal cancer patient with an indwelling short-term central venous catheter. Blood Gram stain (×1,000)
#65.
Central line‒associated blood stream infection Any local inflammatory findings. Sensitivity: 0-3%. Specificity: 94-98%. Infection is established even in the absence of local findings Crit Care Med. 2002 Dec;30(12):2632-5.
#66.
Examples of skin barrier lesions Radiation dermatitis (Neck of a patient undergoing radiotherapy) Peripheral phlebitis of the right forearm (after catheter removal) All of these are easily recognizable. We must go to the bedside! Erythema at port entry site
#67.
Characteristics of Infectious Diseases in Patients with Cancer 1. Introduction 2. Overview of the background of patients with solid organ tumors 3. Immunodeficiency in patients with solid organ tumors 3-1. Neutropenia 3-2. Cellular immunodeficiency 3-3. Humoral immunodeficiency 4. Barrier impairment 5. Structural abnormality
#68.
Risks for Patients with Solid Tumors Structural abnormality Immunodeficiency Barrier disruption/device 1. Structural abnormalities: obstruction by tumor, anatomical changes 2. Device / barrier disruption: all devices, skin and mucosa have maximal immune function 3. Immunodeficiency: neutropenia, cellular immunodeficiency, humoral immunodeficiency
#69.
Structural abnormality Where there's cancer, there's infection
#70.
Obstruction of the lumen by tumor and related infections Lumen Pathology Airway obstructive pneumonia, lung abscess, empyema Biliary tract obstructive cholangitis, liver abscess, cholecystitis, pancreatic abscess intestinal tract Intestinal obstruction, necrosis, perforation, peritonitis Urinary tract obstructive pyelonephritis, renal abscess, prostatitis, prostatic abscess Cholangiocarcinoma + liver abscess Bladder cancer + obstructive urinary tract infection Infect Dis Ther. 2017 Mar;6(1):69-83.
#71.
Today's Goal • To learn how to understand the concept of infections in cancer patients. • To learn the common infections among patients with solid organ tumors. • To learn the classification of immunodeficiency.
#72.