Microbiologic aspects in patients with leukemia

Abstract

Fever usually heralds the onset of infection in patients with leukemia. Neutropenia, inadequate synthesis of normal immunoglobulins, and chemotherapeutic agents all play a role in increasing the susceptibility of leukemic patients to infection. Most episodes of septicemia are caused by gram negative bacilli, especially E. coli, Klebsiella sp., and Pseudomonas aeruginosa. common organisms may cause uncommon types of infection in leukemic patients, and some infections are caused by organisms ordinarily considered to be nonpathogenic. It is advisable to obtain appropriate cultures regularly as long as fever persists. Several relatively new laboratory tests may allow more rapid detection of infection than is possible with routine microbiologic techniques. Serologic techniques show promise of aiding in the diagnosis of systemic fungal infections, especially of candidiasis. Recent attempts to prevent infections in highly susceptible leukemic patients have employed laminar air flow rooms to isolate the patient from nosocomial organisms, and oral doses of nonabsorbable antibiotics have been used along with topical administration of antibiotics in order to suppress the endogenous microbial flora. Studies to date have shown that the use of these prophylactic techniques can reduce the frequency of infections and help to prolong remissions in leukemic patients.