Management Of Infections In Patients Research Articles

Management of Infection in Patients with Acute Leukemia

Substantial improvements have occurred in the infectious diseases management of patients with acute leukemia. It is now unusual for patients receiving initial induction chemotherapy at a major center to die of infectious complications without receiving an adequate course of antineoplastic treatment. Many patients also receive reinduction chemotherapy with prolonged periods of neutropenia without succumbing to major infectious complications. However, the area of management of infections in patients with acute leukemia has remained a dynamic process, with infection management issues that remain complex and controversial.

Advances in the Management of Major Opportunistic Infections in Patients with Human Immunodeficiency Virus Infection

Advances in the Management of Major Opportunistic Infections in Patients with Human Immunodeficiency Virus Infection

Problems in the management of cytomegalovirus infection in patients with AIDS.

Problems in the management of cytomegalovirus infection in patients with AIDS.

Surgical Management of Anorectal Infection in the Leukemic Patient

Anorectal infections are a common complication in immunocompromised patients. Such infections are multifactorial in etiology, often promoted by breaks in the anorectal mucosa and depressed leukocyte counts, both secondary to chemotherapy. Because of altered immune response to infection, diagnosis of anorectal infections in leukemic patients is often delayed, with a resultant mortality of up to 78%. Management is typically supportive for fears of extension of infection or non-healing of wounds with surgical intervention. We recently encountered a 17-year-old woman who presented with an anorectal infection heralding the onset of acute nonlymphocytic leukemia. Because of her unusual presentation, chemotherapeutic induction occurred subsequent to surgical drainage of an anorectal abscess. She demonstrated adequate healing of her wounds in the early post-operative, post-induction period. Her case and a review of the current management of anorectal infections in patients with leukemia are presented.

Clinical management of fungal infection in patients with AIDS

The frequency of disseminated fungal infection in patients with the Acquired Immune Deficiency Syndrome (AIDS) has provided a major impetus for the reevaluation of standard antifungal protocols as well as accelerating the development and clinical testing of new agents. As a result, useful clinical guidelines regarding the use of amphotericin B and flucytosine in cryptococcosis are beginning to emerge that relate specifically to patients with AIDS. Oral agents, most notably fluconazole have shown promise and are now being evaluated in controlled clinical trials. Histoplasmosis and coccidioidomycosis have emerged as significant infections and pose new problems in both diagnosis and management. Although amphotericin B and flucytosine must still be used for induction therapy in patients with these infections, preliminary studies of itraconazole suggest that it could be useful for maintenance therapy. Despite there being considerably less clinical experience with histoplasmosis and coccidioidomycosis than with cryptococcosis, it is hoped that the lessons learnt with cryptococcosis will accelerate the development of new diagnostic assays and improved therapeutic approaches.

Serum C-reactive protein concentration in the management of infection in patients treated by continuous ambulatory peritoneal dialysis.

In a prospective study over 21 months, serum C-reactive protein (CRP) concentration was measured serially in 39 consecutive patients undergoing continuous ambulatory peritoneal dialysis. All patients with peritonitis mounted a CRP response, and the height of the response correlated well with the severity and extent of the peritoneal damage. Patients who recovered uneventfully after antimicrobial treatment showed a prompt fall in CRP from its peak value towards normal. In contrast, each patient in whom the serum CRP value remained raised after antimicrobial treatment had a complicated course. During routine outpatient follow up the serum CRP value remained within the normal range in the absence of intercurrent complications. These results, together with the commercial availability of rapid and precise assays for CRP, indicate that serial CRP measurements may be useful in monitoring the efficacy of antimicrobial treatment during episodes of peritonitis and in the recognition of intercurrent complications in patients undergoing continuous ambulatory peritoneal dialysis.

Intravenous gentamicin therapy for infections in patients with cancer.

Gentamicin sulfate was administered intravenously to 60 patients during 75 episodes of infection. A dose of 30 mg of gentamicin/m2 was given every 6 hr, after an initial dose of 40 mg/m2. Forty-one of the infections (55%) responded favorably. Only 32% of the infections in patients with an initial neutrophil count of less than 100/mm3 responded favorably, as compared to 60% of the infections in patients with an initial neutrophil count of more than 1,000/mm3. Azotemia occurred in 21 of the 57 patients who had normal initial levels of blood urea nitrogen and who received gentamicin for at least seven days. Gentamicin appears to be an effective antibiotic in cancer patients unless they have severe neutropenia. The drug can be administered safely by the intravenous route. Since effective therapy is now available for some malignant diseases, successful management of infections in patients with cancer has become increasingly important. Although the cancer patient is susceptible to a wide variety of organisms, the majority of infections are caused by gramnegative bacilli. During the three-year period from 1967 to 1969, 85% of the 493 episodes of bacteremia observed at our institution were caused by gram-negative bacilli [1]. The organisms cultured most frequently from specimens of blood