tailieunhanh - Chapter 082. Infections in Patients with Cancer (Part 4)

Figure 82-1 A. Papules related to Escherichia coli bacteremia in a neutropenic patient with acute lymphocytic leukemia. B. The same lesion the following day. Candidemia (Chap. 196) is also associated with a variety of skin conditions and commonly presents as a maculopapular rash. Punch biopsy of the skin may be the best method for diagnosis. Cellulitis, an acute spreading inflammation of the skin, is most often caused by infection with group A Streptococcus or Staphylococcus aureus, virulent organisms normally found on the skin (Chap. 119). Although cellulitis tends to be circumscribed in normal hosts, it may spread rapidly in neutropenic patients. . | Chapter 082. Infections in Patients with Cancer Part 4 Figure 82-1 A Sourcoi F uo AS. K tp r Pl. F H ui r 4L. Longo PL. J m on JU Lo c l o Ji Harrison s frioaplas of Internsf Hadieina 17th Edtilon http Copyright C Th Mi Snw-Hill Componlti. Int All tight c rv tf. A. Papules related to Escherichia coli bacteremia in a neutropenic patient with acute lymphocytic leukemia. B. The same lesion the following day. Candidemia Chap. 196 is also associated with a variety of skin conditions and commonly presents as a maculopapular rash. Punch biopsy of the skin may be the best method for diagnosis. Cellulitis an acute spreading inflammation of the skin is most often caused by infection with group A Streptococcus or Staphylococcus aureus virulent organisms normally found on the skin Chap. 119 . Although cellulitis tends to be circumscribed in normal hosts it may spread rapidly in neutropenic patients. A tiny break in the skin may lead to spreading cellulitis which is characterized by pain and erythema in the affected patients signs of infection . purulence are often lacking. What might be a furuncle in a normal host may require amputation because of uncontrolled infection in a patient presenting with leukemia. A dramatic response to an infection that might be trivial in a normal host can mark the first sign of leukemia. Fortunately granulocytopenic patients are likely to be infected with certain types of organisms Table 82-4 thus the selection of an antibiotic regimen is somewhat easier than it might otherwise be see Antiviral Therapy below . It is essential to recognize cellulitis early and to treat it aggressively. Patients who are neutropenic or have previously received antibiotics for other reasons may develop cellulitis with unusual organisms . Escherichia coli Pseudomonas or fungi . Early treatment even of innocent-looking lesions is essential to prevent necrosis and loss of tissue. Debridement to prevent spread may sometimes be necessary .