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Infections caused by nosocomial pathogens and nonpathogenic, low-virulence microorganisms can result in serious morbidity and even death in patients undergoing treatment of cancer. Neutropenia plays a critical role. Risk of infection is increased in direct proportion to the rate and persistence of neutrophil decline. Outcome depends on the administration of appropriate antimicrobial or antifungal therapy and recovery of functional neutrophil levels.
Infections frequently complicate the course of cancer treatment and often adversely affect outcome. Agents with low potential for virulence may lead to invasive and often life-threatening disease in patients with altered immune responses. Immune response dysfunction may result from an underlying hematologic malignancy, such as leukemia, lymphoma, or myelodysplastic syndrome. It may also be caused by antineoplastic chemotherapy or may emerge following hematopoietic stem cell transplantation.
Prompt diagnosis of infection is difficult because early signs and symptoms may be absent or nonspecific. Therapy often is instituted empirically. To complicate the issue, immunosuppressed patients may have multiple infections during a single clinical presentation, and diagnosis may be delayed. Early laboratory and radiographic findings frequently are unremarkable.
This article presents a detailed review of opportunistic infections associated with neutropenia in critically ill patients with cancer.
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