Infections are common complications of systemic therapy in hematologic and oncologic patients. However, there are few uniform definitions and little information on how to effectively treat them.
The topic of infections has been treated rather stepmotherly in oncology in the past. They are associated with high morbidity, significantly impair quality of life, and can lead to significant mortality. Herpes zoster infections, for example, occur in approximately 20% of all cases with acute lymphoblastic leukemia. After allogeneic stem cell transplantation, up to 80% of patients are affected. Therefore, all patients should be screened for hepatitis B before chemotherapy so that antiviral prophylaxis can be given if needed. If this is not possible or has not been done, monitoring should be done at least every two months. Hepatitis C should be detected especially in lymphatic disease. However, screening should also be performed for certain risk factors, such as increased aminotransferase activity, hemodialysis, or in transplant recipients.
Counteract pulmonary infiltrates in time
Pneumonia is defined as a microbial infection of the lung parenchyma. New or increasing infiltrates may be seen on chest x-ray, and the affected person also has some additional clinical signs such as fever or dyspnea. The microbial etiology often remains unexplained. Both multi-resistant bacteria and filamentous fungi or viruses can be responsible for an infection. Pulmonary infiltrates are responsible for mortality in up to 25% of patients with febrile neutropenia. Therefore, a mold-active antifungal agent should be administered primarily in addition to a broad-spectrum antibiotic. Diagnosis is made by computed tomography due to its higher sensitivity. Especially if there is evidence of lower respiratory tract infection, conventional chest x-ray is not recommended. A compaction, a yard, an aerial crescent, an inverted yard, or a budding tree can always be assumed to be infected with filamentous fungus. In contrast, diffuse bilateral perihilar infiltrates, uneven milk glass opacities, cysts, and centrilobular nodules indicate Pneumocystis jirovecii infection.
Source: Annual Meeting of the German-Speaking Societies of Hematology and Medical Oncology (DGHO) 2019
InFo ONCOLOGY & HEMATOLOGY 2019; 7(6): 24 (published 7/12/19, ahead of print).
