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Chapter 082. Infections in Patients with Cancer (Part 2)

A similar problem can affect patients whose lymph node integrity has been disrupted by radical surgery, particularly patients who have had radical node dissections. A common clinical problem following radical mastectomy is the development of cellulitis (usually caused by streptococci or staphylococci) because of lymphedema and/or inadequate lymph drainage. In most cases, this problem can be addressed by local measures designed to prevent fluid accumulation and breaks in the skin, but antibiotic prophylaxis has been necessary in refractory cases. A life-threatening problem common to many cancer patients is the loss of the reticuloendothelial capacity to clear microorganisms after splenectomy. . | Chapter 082. Infections in Patients with Cancer Part 2 A similar problem can affect patients whose lymph node integrity has been disrupted by radical surgery particularly patients who have had radical node dissections. A common clinical problem following radical mastectomy is the development of cellulitis usually caused by streptococci or staphylococci because of lymphedema and or inadequate lymph drainage. In most cases this problem can be addressed by local measures designed to prevent fluid accumulation and breaks in the skin but antibiotic prophylaxis has been necessary in refractory cases. A life-threatening problem common to many cancer patients is the loss of the reticuloendothelial capacity to clear microorganisms after splenectomy. Splenectomy may be performed as part of the management of hairy cell leukemia chronic lymphocytic leukemia CLL and chronic myelocytic leukemia CML and in Hodgkin s disease. Even after curative therapy for the underlying disease the lack of a spleen predisposes such patients to rapidly fatal infections. The loss of the spleen through trauma similarly predisposes the normal host to overwhelming infection for life after splenectomy. The splenectomized patient should be counseled about the risks of infection with certain organisms such as the protozoan Babesia Chap. 204 and Capnocytophaga canimorsus formerly dysgonic fermenter 2 or DF-2 a bacterium carried in the mouths of animals Chaps. 140 and e14 . Since encapsulated bacteria Streptococcus pneumoniae Haemophilus influenzae and Neisseria meningitidis are the organisms most commonly associated with postsplenectomy sepsis splenectomized persons should be vaccinated and revaccinated Table 82-2 and Chap. 116 against the capsular polysaccharides of these organisms. Many clinicians recommend giving splenectomized patients a small supply of antibiotics effective against S. pneumoniae N. meningitidis and H. influenzae to avert rapid overwhelming sepsis in the event that they cannot .