bacterial pneumonia in cancer patients

Sculier J, Evans W, Feld R, et al. Uttamchandani RB, Daikos GL, Reyes RR, et al. J Crit Care. Oncotarget. 2002;16(4):87594, vi. This chapter addresses the mechanisms underlying pneumonia susceptibility in cancer patients, discusses the pathogens most often encountered, and provides an overview of pneumonia preventative, diagnostic, and therapeutic strategies in this vulnerable patient group. https://doi.org/10.1093/ejcts/ezv026. Epub 2015 Jul 15. Correlation between circulating fungal biomarkers and clinical outcome in invasive aspergillosis. Clin Infect Dis. Kontoyiannis DP, Lionakis MS, Lewis RE, et al. Pediatr Blood Cancer. Immune defects, including compromised acellular and cellular (alveolar macrophages, mast cells, neutrophils) innate and/or altered adaptive immune function, leading to either inadequate immmunoglobulin or defective T-cell mediate defenses may promote the development of specific types of pneumonia. El-Solh A, Aquilina A, Dhillon R, Ramadan F, Nowak P, Davies J. Pneumocystis. Khayr W, Haddad RY, Noor SA. Epub 2015 Feb 25. Arch Bronconeumol. https://doi.org/10.3109/00365548.2012.714906. Pulmonary dysfunction in pediatric hematopoietic stem cell transplant patients: overview, diagnostic considerations, and infectious complications. Improved survival of critically ill cancer patients with septic shock. Lung Cancer and Pneumonia at the Same Time - WebMD Bronchoalveolar lavage typically has a high diagnostic yield, though lung biopsy is occasionally needed, as cancer patients typically have lower fungal burden than do HIV-infected patients. Epub 2015 Oct 19. Epub 2017 May 31. https://doi.org/10.21037/atm.2016.10.10. Although cancer patients medical encounters expose them to uncommon, virulent and drug-resistant pathogens, much of the increased risk of pneumonia in this population derives from complex and often concurrent impairments of host defense. Pagano L, et al. Roemer E, Blau IW, Basara N, et al. Malakoplakia of the urinary bladder in a patient with chronic lymphocytic leukemia under Ibrutinib therapy: a case report. Tuberculous. Eur J Haematol. Clipboard, Search History, and several other advanced features are temporarily unavailable. Empiric antibiotic selections for HAP that develop within 7 days of admission should target S. pneumoniae, S. aureus (including MRSA), Streptococcus spp., H. influenzae, and Enterobacteriaceae. 2008;46:181321. Epub 2012 Mar 30. Viral pneumonia causes flu-like symptoms and is more likely to resolve on its own. Pneumonia might cause chest pain or shortness of breath. 2015;10:e0129022. Curr Oral Health Rep. 2015;2:20211. 2012;58:23949. 2013;45:1126. 2015;16:2735. 2023 Mar;20(3):341-353. doi: 10.1513/AnnalsATS.202212-1019ST. S. pyogenes, Cancers (Basel). The https:// ensures that you are connecting to the Lower respiratory tract infections result in unacceptably high mortality among cancer patients. Nonetheless, minimizing immune suppression is essential to clearing the mycobacteria. Br J Haematol. 2010;188:15963. Prolonged therapy (1224 months) with rifampin plus one or two other susceptible antimicrobials is recommended. PubMed Hence, once the diagnosis of tuberculous is established, every effort should be made to discontinue steroid therapy [26]. Influenza in patients with hematological malignancies: experience at two comprehensive cancer centers. J Infect Dis. Ahmed S, Siddiqui AK, Rossoff L, Sison CP, Rai KR. 8600 Rockville Pike Google Scholar. High resolution computed tomography angiography improves the radiographic diagnosis of invasive mold disease in patients with hematological malignancies. government site. Smith JA, Kauffman CA. Health care-associated pneumonia (HCAP; no longer used) referred to pneumonia acquired in health care facilities (eg, nursing homes, hemodialysis centers) or after recent hospitalization. Yet, despite antimicrobial therapy, pulmonary nocardiosis carries a high mortality in high-risk cancer patients [24]. Initial antimicrobial therapy for febrile neutropenia in patients with pulmonary infiltrates should be broad in spectrum and provide antimicrobial activity against drug-resistant strains of S. aureus and Pseudomonas aeruginosa. 2004b;77:7247. Safdar A, Armstrong D. Listeriosis in patients at a comprehensive cancer center, 1955-1997. Epub 2016 May 10. https://doi.org/10.1038/mi.2013.26. Ibrahim EH, Tracy L, Hill C, Fraser VJ, Kollef MH. Marr KA, Balajee SA, McLaughlin L, Tabouret M, Bentsen C, Walsh TJ. J Infect Dis. Consequently, this distinction provides a framework for decisions regarding the diagnostic evaluation and empiric antimicrobial therapy. CT evidence of perihilar infiltrates may be mistaken for pneumonitis caused by common acquired viral infections (RSV, influenza, parainfluenza type 3) or CMV during the early phase of the infection. Am J Respir Crit Care Med. Venet F, Chung CS, Monneret G, Huang X, Horner B, Garber M, Ayala A. Invasive Pulmonary Mycosis. Fever, night sweats, weight loss, pleuritic chest pain, and pleural effusions are seldom seen. Clin Infect Dis. 2015;53:27182. As a library, NLM provides access to scientific literature. Pulmonary tuberculous may present as an insidious pneumonia that is difficult to distinguish from actinomycetes and eumycetes infection. The severe and oftentimes protracted immune suppression that follows encourages the development of unusual and intractable infections. Fusariosis in a patient with acute myeloid leukemia: a case report and review of the literature. Epub 2012 May 1. Br J Radiol. Dis Mon. Thus, pneumonia in the cancer patient is most often defined as hospital-acquired pneumonia (HAP) or healthcare-associated pneumonia (HCAP), rather than CAP. Chemotherapy drugs treat cancer by killing the fastest-growing cells in the bodyboth cancer cells and good cells. 2012;27:3017. The predictors of outcome in immunocompetent patients with hematogenous candidiasis. https://doi.org/10.1016/j.bbmt.2005.07.007. ECIL guidelines for the diagnosis of Pneumocystis jirovecii pneumonia in patients with haematological malignancies and stem cell transplant recipients. Profound interferon gamma deficiency in patients with chronic pulmonary nontuberculous mycobacteriosis. Atypical bacterial pneumonia - Cancer Therapy Advisor https://doi.org/10.1093/cid/ciu134. https://doi.org/10.1007/s10156-012-0408-5. Because of the frequency with which multiple organisms are identified on a single respiratory sample, recent evidence-based guidelines advocate the use of quantitative or semiquantitative lower respiratory tract cultures obtained either bronchoscopically or noninvasively as part of the initial evaluation of the patients with suspected HAP, VAP, or HCAP [20]. Vallipuram J, et al. Community-acquired pneumonia. CAS https://doi.org/10.1086/423381. Lass-Florl C, Roilides E, Loffler J, Wilflingseder D, Romani L. Minireview: host defence in invasive aspergillosis. Numerous defects of local innate defenses are also described following chemotherapy, including derangements of chemotaxis, phagocytosis, and killing by alveolar macrophages and resident mast cells. Therefore, the clinical diagnosis is often made by inference, as thrombocytopenia and coagulopathies often render biopsies unsafe. Roblot F, et al. Whimbey E, Goodrich J, Bodey GP. https://doi.org/10.1186/cc7713. Ganciclovir or foscarnet are commonly prescribed for systemic CMV and HHV-6 infections. Ups J Med Sci. Providers treat bacterial pneumonia with antibiotics. https://doi.org/10.1136/thx.2009.123612. Eur J Clin Microbiol Infect Dis. Other nonfermentative Gram-negative bacteria (NF-GNB) such as Stenotrophomonas maltophilia [1215], Achromobacter, and Alcaligenes species have also increased in the recent years and often lead to difficult-to-treat infections [14, 16]. Pulmonary Varicella-zoster virus and HHV-6 lung infections are difficult to distinguish from CMV pneumonitis. Marr KA, Balajee SA, McLaughlin L, Tabouret M, Bentsen C, Walsh TJ. muscle pain. https://doi.org/10.1016/j.arbres.2012.11.012. Radiographic presentations of bacterial pneumonia in cancer patients, MeSH Eur J Cardiothorac Surg. Genes Immun. In most cancer patients, Pneumocystis pneumonia presents as a slowly progressive infection accompanied by nonproductive cough, exertional dyspnea, and hypoxemia, although an acute, rapidly progressive form that rapidly progresses to respiratory failure has been reported. Glucocorticoids suppress inflammation but spare innate immune responses in airway epithelium. Blood. Pseudallescheria boydii, and Scedosporium spp. 1995;79:185-210. doi: 10.1007/978-1-4613-1239-0_9. See this image and copyright information in PMC. Blood. 12.1) [11]. 12.3). Lung epithelial cells are essential effectors of inducible resistance to pneumonia. 1996;83:60819. 2016;181:45763. Pseudomonas lung abscess in a patient with acute myelogenous leukemia awaiting bone marrow transplantation. https://doi.org/10.1038/bmt.2016.225. 2012;17:91326. This article addresses host factors that contribute to pneumonia susceptibility, summarizes diagnostic recommendations, and reviews current guidelines for management of bacterial pneumonia in patients with cancer. New immunosuppressive therapies produce a variety of immune vulnerabilities that form the basis of opportunistic infections. Susceptibility to pneumonia in the cancer patient is not only conditioned by the type and degree of immune suppression, but also by its duration. Bacterial pneumonias cause disproportionate morbidity and mortality in cancer patients, despite the current aggressive use of prophylactic antibiotics and environmental hygiene measures in this population [ 1 - 5 ]. As a consequence of disordered inflammatory responses, the typical clinical observations of pneumonia, including purulent respiratory secretions and early radiographic findings, may be inapparent or absent. Chest CT scans are frequently abnormal in asymptomatic patients with newly diagnosed acute myeloid leukemia. https://doi.org/10.1002/cam4.240. Epub 2015 Jan 5. The safety of interferon-gamma-1b therapy for invasive fungal infections after hematopoietic stem cell transplantation. Critically ill patients with cancer and sepsis: clinical course and prognostic factors. Vaccination of chemotherapy patientseffect of guideline implementation. Acinetobacter baumannii-complex, Enterobacter spp., and emerging strains of MDR NF-GNB such as S. maltophilia, Burkholderia cepacia complex, and Alcaligenes (Achromobacter) species, which may be difficult to treat. 2014;3:96270. Hachem RY, Kontoyiannis DP, Boktour MR, et al. Further, while prompt initiation of adequate antimicrobial therapy is essential to improved pneumonia outcomes, the initial diagnosis of pneumonia is often challenging in this population, as cancer patients with pneumonia frequently present with attenuated clinical signs and symptoms and very often have competing diagnoses that might explain new radiographic infiltrates, fever, or respiratory symptoms. Severe pneumonia is associated with high mortality (short and long term), as well as pulmonary and extrapulmonary complications. Schnetzke U, et al. PubMed Central https://doi.org/10.1259/bjr/70800575. Sensitivity, specificity, and positivity predictors of the pneumococcal urinary antigen test in community-acquired Pneumonia. https://doi.org/10.1086/522998. Google Scholar. Bacterial Pneumonia: Symptoms, Causes, and Treatment - Healthline Bronchoalveolar lavage in immunocompromised patients with haematological malignancyvalue of new microbiological methods. Pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography. 2016;71:238696. 2007;25:57639. Chest computed tomography of late invasive aspergillosis after allogeneic hematopoietic stem cell transplantation. The absence of consolidated infiltrates on chest radiographs does not exclude an evolving occult pneumonia, particularly in the setting of profound neutropenia (<100 cells/L). In addition to neutropenia, cytotoxic antineoplastic therapies and hematologic malignancies may cause severe depression of humoral and cell-mediated adaptive immunity, resulting in inadequate immunoglobulin production and/or a variety of defective T and B cell-mediated defects. Martino R, et al. Pneumonia is an infection in your lungs caused by a virus, bacteria, or fungus. Torres HA, Reddy BT, Raad II, et al. In general, this appearance is distinct from the nonspecific infiltrates associated with hematogenous dissemination of distant site infections, as discussed previously. Clin Infect Dis. Clinical significance of non-Candida fungal blood isolation in patients undergoing high-risk allogeneic hematopoietic stem cell transplantation (19932001). Pneumonia, Bacterial / complications (. How Lung Cancer and Pneumonia Are Similar Symptoms of lung cancer and. Mycobacterium tuberculous is a rare cause of pulmonary infection in the developed world, but is still occasionally found in severely immunosuppressed cancer patients and in foreign-born individuals receiving cancer care in nonendemic regions of the world [26]. Gilbert CR, Lerner A, Baram M, Awsare BK. Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Vincent JL. Bacterial Pneumonia in Patients with Cancer: Novel Risk - PubMed 2004;36:84854. An official website of the United States government. https://doi.org/10.1016/j.ccm.2017.04.009. Due to associated architectural derangements and possibly because of impaired phagocytosis by alveolar macrophages, pneumoconioses are well-established predisposing conditions for NTM infection. Lancet Oncol. 2005;74:20311. However, recent advances in the management of neutropenic pneumonia offer hope for improved outcomes in the cancer setting. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Efficacy and safety of caspofungin for treatment of invasive aspergillosis in patients refractory to or intolerant of conventional antifungal therapy. Similarly, isolation of fungi in respiratory samples may misrepresent the etiology of underlying pulmonary infiltrates. This has largely been attributed to effective prophylaxis with fluconazole in immunosuppressed cancer patients. Clin Infect Dis. 2017;14. https://doi.org/10.3390/ijerph14030223. Efficacy and safety of caspofungin for treatment of invasive aspergillosis in patients refractory to or intolerant of conventional antifungal therapy. Nakamae H, et al. Lung. 2011;183:96128. Infect Dis Clin North Am. Symptoms and signs depend on the pathogen and on the conditions compromising the immune system. Chemoradiation therapy can be similarly effective in relieving some obstructions, but the effect of these therapies is also delayed relative to bronchoscopic debulking. 03.2013/JCPSP.229230. https://doi.org/10.2214/ajr.181.2.1810507. Clin Chest Med. 2015;125:17249. 2004;83:4413. The germ is usually a bacterium or a virus (viral pneumonia). Malignancy and treatment-related impairments of host immune responses and the emergence of multidrug-resistant organisms associated with recurrent exposures to hospital environments may not only enhance the risks of mortality, but also exacerbate the difficulty of diagnosing pneumonia in the cancer setting. Lung cancer develops due to the. 2003;29:168895. Chemotherapy. HCAP includes patients hospitalized in an acute care hospital for 2 or more days within 90 days of the current infection, patients treated in a hospital or hemodialysis clinic within 30 days of the pneumonia diagnosis, nursing home, or long-term care facility residents, and recipients of intravenous antibiotics, chemotherapy, or wound care within 30 days of the current infection. Central venous catheter and. Lung infections that occur more than 48 h after hospital admission in patients without antecedent clinical symptoms or radiographic findings suggestive of pneumonia are referred to as HAP. https://doi.org/10.1177/0885066613476454. Toxoplasmosis, a severe complication in allogeneic hematopoietic stem cell transplantation: successful treatment strategies during a 5-year single-center experience. Risk factors analysis for pneumocystis jiroveci pneumonia (PCP) in patients with haematological malignancies and pneumonia. Alveolar hemorrhage may occasionally herald an invasive pulmonary fungal infection. Upper airway suctioning, pulmonary toilet, and if necessary, positive pressure ventilation comprise the mainstays of therapy. Biol Blood Marrow Transplant. The availability of voriconazole as primary therapy for invasive pulmonary aspergillosis [36] and caspofungin for salvage therapy of refractory invasive aspergillosis [37] is a promising addition to the antifungal armamentarium. Pneumonia vs. Lung Cancer: Differences, Symptoms, Causes - Verywell Health Endemic areas for M. kansasii infections in the US include the urban Southeast and Midwestern States. Department of Pulmonary Medicine, The University of Texas, M.D. If you have a blood cancer like leukemia or myeloma, you may be at greater risk for getting a fungal infection than people with other types of cancer. varies widely with patient age and geographic location. The measurement of fungal antigens such as serum galactomannan levels may be helpful in the detection of pulmonary mycosis. Epub 2017 Mar 14. Utility of flexible bronchoscopy in the evaluation of pulmonary infiltrates in the hematopoietic stem cell transplant population a single center fourteen year experience. 2014;29:20012. An official website of the United States government. 2013;144:191322. The distinction of CAP from nosocomial pneumonia remains important, as it allows prediction of likely pathogens and permits prognostic estimations based on epidemiologic descriptions of the underlying cause. Tschernig T. Hospital-acquired pneumonia and community-acquired pneumonia: two guys? Further, concurrent alterations in systemic defense mechanisms, such as impairment of the circulating leukocytes of the innate immune system, are exceedingly common. Chellapandian D, et al. This is a preview of subscription content, access via your institution. Nat Immunol. De Pauw B, et al. The many causes of pneumonia include bacteria, viruses, fungi, and parasites. Rosolem MM, et al. Tracheal and bronchial polymeric immunoglobulin secretory immune system (PISIS) development in a porcine model. Epub 2017 May 31. In the United States, the rapidly growing mycobacteria (particularly M. abscessus and less frequently M. fortuitum, M. smegmatis, and M. goodii) have emerged as less frequent causes of NTM infections. The so-called Lady Windermere syndrome, characterized by relapsing or refractory pulmonary NTM due to slow-growing mycobacteria, may be seen in patients with defects in endogenous interferon-gamma activity [27]. 2014;57:51924. High-resolution CT findings of respiratory syncytial virus pneumonia after bone marrow transplantation. Pneumonia is a ubiquitous killer in all patient populations but presents a particular risk for morbidity and mortality among immunosuppressed cancer patients. The isolation of CMV antigen from lower respiratory tract secretions may not, however, necessarily indicate pulmonary infection, as patients with cellular immune defects may have intermittent low-level viral replication and shed virus without developing end-organ disease. This article is about bacterial causes of pneumonia as it is the major cause of mortality and morbidity by pneumonia. 2017;177:35774. Oral atovaquone and parenteral pentamidine may be given to patients who are intolerant to sulfa-containing regimens. ARDS, respiratory failure, and death may rapidly follow. Correspondence to Oikonomou A, Muller NL, Nantel S. Radiographic and high-resolution CT findings of influenza virus pneumonia in patients with hematologic malignancies. The severity of bacterial pneumonia symptoms can vary. FOIA Severe neutropenia, defined as an absolute neutrophil count of 500 cells/L, is associated with refractory lung infections caused by bacterial and fungal organisms [9]. Characteristics and outcomes of cancer patients in European ICUs. Treatment depends on the type of cold virus you have. Breach of the respiratory epithelial barrier function and altered mucociliary clearance of secretions may occur as a result of cancer therapy, both through cell-specific injury and through generalized mucositis. Recurrent pneumonias - Cancer Therapy Advisor AJR Am J Roentgenol. Google Scholar. Epub 2003 Sep 12. Waghmare A, Pergam SA, Jerome KR, Englund JA, Boeckh M, Kuypers J. Pneumonia in the neutropenic cancer patient - PubMed In a recent study of HSCT recipients, serum galactomannan levels were diagnostic in >85% of patients. Google Scholar. Prospective study of the incidence, clinical features, and outcome of symptomatic upper and lower respiratory tract infections by respiratory viruses in adult recipients of hematopoietic stem cell transplants for hematologic malignancies. Mucosal Immunol. Chest CT findings demonstrating the characteristic tree-in-bud appearance may also be seen in patients with chronic infection. Cross-reactivity of Fusarium spp. Antifungal combinations may be prescribed for high-risk cancer patients and HSCT recipients with invasive mycosis. An update on pulmonary complications of hematopoietic stem cell transplantation. Pre-transplant cytomegalovirus (CMV) serostatus remains the most important determinant of CMV reactivation after allogeneic hematopoietic stem cell transplantation in the era of surveillance and preemptive therapy. Hohenthal U, et al. Bodey GP, Buckley M, Sathe YS, Freireich EJ. In addition, the rapidity of onset of neutropenia and delay in neutrophil recovery play a role in the infection severity. 2012;18:7228. Epub 2010 May 11. Patterns of infection and infection-related mortality in patients with steroid-refractory acute graft versus host disease. Causality is suggested by identification of NTM in sterile lower respiratory tract samples coupled with nonspecific clinical features, such as chronic nonproductive cough and exertional dyspnea. Nambu A, Ozawa K, Kobayashi N, Tago M. Imaging of community-acquired pneumonia: roles of imaging examinations, imaging diagnosis of specific pathogens and discrimination from noninfectious diseases. https://doi.org/10.1200/JCO.2007.14.0947. Due to the lack of prospective randomized trials, there is no consensus in recommending preferred antifungal combinations. Garcia-Cadenas I, et al. Viral antigen detection in nasal washes, tracheal aspirates, and bronchial specimens is most frequently used in determining active viral replication. Careers, Unable to load your collection due to an error. The .gov means its official. https://doi.org/10.1182/blood-2014-12-616516. Empirical antifungal therapy new options, new tradeoffs. 2002;122:211521. Aisenberg G, Rolston KV, Dickey BF, Kontoyiannis DP, Raad II, Safdar A. Boktour M, Hanna H, Ansari S, et al. Pneumonia in the neutropenic cancer patient. Google Scholar. More than 10% of patients with febrile neutropenia present with pulmonary infiltrates and infection remains the most frequent cause of radiographic abnormalities in these patients. Endemic fungal infections in solid organ and hematopoietic cell transplant recipients enrolled in the Transplant-Associated Infection Surveillance Network (TRANSNET).
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