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Chapter 89 Clinical Approach to Infections in the Compromised Host 1449

Malignant and Select Nonmalignant Hematologic TABLE Host Defense Impairments and Their Associated
TABLE Diseases and Their Associated Infection-Predisposing 89.2 Infectious Pathogens
89.1 Host Defects
Host Defense Defect Pathogen Categories
Hematologic Condition Infection-Predisposing Host Defects Neutropenia Enteric gram-negative organisms
Gram-positive staphylococci and
Acute myeloid leukemia Neutropenia; therapies such as dose- streptococci
intensive chemotherapy and Anaerobes
hematopoietic stem cell transplant may Yeast, particularly Candida species
result in additional anatomic disruptions, Molds, particularly Aspergillus species
cell-mediated defects, and humoral
defects Abnormal cell-mediated Atypical bacteria: Legionella, Nocardia
immunity Salmonella species
Acute lymphocytic Neutropenia; therapy effects similar to Mycobacteria (M. tuberculosis and
leukemia acute myeloid leukemia
atypical mycobacteria)
Hairy cell leukemia Neutropenia (also monocytopenia); Disseminated infection from live bacilli
abnormal humoral immunity; T-cell Calmette-Guérin (BCG) vaccine
suppressing therapy Environmental fungi, including
Chronic lymphocytic Hypogammaglobulinemia; abnormal Cryptococcus neoformans, Histoplasma
leukemia cell-mediated immunity capsulatum, Coccidioides immitis
Chronic myeloid No prominent host defects unless Endogenous yeast, particularly Candida
leukemia aggressive therapy, advanced stage, or species
postsplenectomy Herpesviruses
Infections from live-virus vaccines
Multiple myeloma Hypogammaglobulinemia; other host defects Pneumocystis jirovecii
may occur with aggressive therapy or Toxoplasma gondii
advanced stage
Cryptosporidium
Hodgkin/non-Hodgkin Abnormal cell-mediated immunity, Strongyloides stercoralis
lymphomas therapy-related neutropenia, splenic Immunoglobulin Gram-positive Streptococcus pneumoniae,
dysfunction (if splenectomy or radiation)
abnormalities Staphylococcus aureus
Myelodysplastic Functional or absolute neutropenia Gram-negative Haemophilus influenzae,
syndromes Neisseria species, enteric organisms
Aplastic anemia Neutropenia; abnormal cell-mediated Enteroviruses
immunity from immunosuppressive Disseminated infections from live-virus
therapies (e.g., steroids, antithymocyte vaccines
globulin, cyclosporine, hematopoietic Giardia lamblia
stem cell transplantation) Complement Gram-positive S. pneumoniae,
Paroxysmal nocturnal Deficient Fc receptor may contribute to abnormalities C3, C5 staphylococci
hemoglobinuria abnormal cell-mediated immunity Gram-negative H. influenzae, Neisseria
species, enteric organisms
Hemolytic states Gallstones may serve as a nidus for
(thalassemia) infection; splenic dysfunction or Complement Neisseria species
splenectomy abnormalities C5–C9
Sickle cell disease Can be neutropenic with aplastic crisis; Anatomic Disruption Pathogen Categories
bone infarcts may serve as a nidus for Oral cavity α-Hemolytic streptococci, oral anaerobes
infection; splenic dysfunction with poor Candida species
complement activation and opsonization Herpes simplex virus
from autosplenectomy Esophagus Candida species,
Herpes simplex virus, cytomegalovirus
Lower gastrointestinal Enterococcus, gram-negative enteric
tract organisms,
Anaerobes (Bacteroides fragilis,
who survive into adulthood are at risk for severe infections. Chronic Clostridium perfringens),
granulomatous disease is a heterogeneous group of disorders resulting Candida species, Strongyloides stercoralis
from defective or malfunctioning oxidative metabolism capacity of Skin (IV catheter) Gram-positive staphylococci and
phagocytes. Recurrent infections with bacteria and fungi are common streptococci, Corynebacterium, Bacillus
and occasionally life threatening, despite optimal antimicrobial Atypical mycobacteria
therapy. Infections with Staphylococcus species and Aspergillus species
6
can be particularly aggressive. Granulomata may form in response Urinary tract Enterococcus,
to infection, especially in the gastrointestinal (GI) and genitourinary Gram-negative enteric organisms
tracts. Candida species
Splenectomy Encapsulated organisms: S. pneumoniae,
H. influenzae, Neisseria,
Erythrocyte Disorders Capnocytophaga canimorsus
Salmonella (especially sickle cell disease),
Glucose-6-phosphate dehydrogenase deficiency is a sex-linked disor- Babesia
der. Deficiency of this enzyme limits glucose metabolism through the
hexose monophosphate shunt, resulting in an abnormal respiratory
burst in neutrophils. Bacterial infections can occur if the deficiency
is severe.