Respiratory Infection in Immunocompromised Neutropenic Patients

  • Stephen W. Crawford


Neutropenia is increasingly common in the hospital. The rise in incidence is due to proliferation of indications for and centers performing hematopoietic stem cell transplantation, hematologic effects of AIDS, and myelosuppressive side-effects of anti-viral and cancer chemotherapies [Table 1]. As a result, these neutropenic patients are increasingly common in ICUs. These patients are often lymphopenic, anemic, and thrombocytopenic. They are at risk for multiple organ failures and various infections. This chapter will focus on respiratory infections in the neutropenic patient.


Respiratory Syncytial Virus Febrile Neutropenia Clin Infect Absolute Neutrophil Count Candida Species 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Hathorn JW, Lyke K. Empirical treatment of febrile neutropenia: evolution of current therapeutic approaches. Clin Infect Dis 24(Suppl 2): S256, 1997.PubMedCrossRefGoogle Scholar
  2. 2.
    Pizzo PA. Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med 328:1323, 1993.PubMedCrossRefGoogle Scholar
  3. 3.
    Rubin RH, Ferraro MJ. Understanding and diagnosing infectious complications in the immunocompromised host. Current issues and trends. Hematol Oncol Clin North Am 7:795, 1993.PubMedGoogle Scholar
  4. 4.
    Kolbe K, Domkin D, Derigs HG, Bhakdi S, Huber C, Aulitzky WE. Infectious complications during neutropenia subsequent to peripheral blood stem cell transplantation. Bone Marrow Transplant 19:143, 1997.PubMedCrossRefGoogle Scholar
  5. 5.
    Hubel K, Hegener K, Schnell R, et al. Suppressed neutrophil function as a risk factor for severe infection after cytotoxic chemotherapy in patients with acute nonlymphocytic leukemia. Ann Hematol 78:73, 1999.PubMedCrossRefGoogle Scholar
  6. 6.
    Funada H, Matsuda T. Changes in the incidence and etiological patterns of bacteremia associated with acute leukemia over a 25-year period. Intern Med 37:1014, 1998.PubMedCrossRefGoogle Scholar
  7. 7.
    Ramsey PG, Rubin RH, Tolkoff-Rubin NE, et al. The renal transplant patient with fever and pulmonary infiltrates: Etiology, clinical manifestations, and management. Medicine 59:206, 1980.PubMedCrossRefGoogle Scholar
  8. 8.
    Rubin RH, Greene R. Clinical approach to the compromised host with fever and pulmonary infiltrates. In Rubin RH, Young LS (eds). Clinical Approach to Infection in the Compromised Host, 3rd edn. New York: Plenum Press, 1994: 121.CrossRefGoogle Scholar
  9. 9.
    Chanock S. Evolving risk factors for infectious complications of cancer therapy. Hematol Oncol Clin North Am 7:771, 1993.PubMedGoogle Scholar
  10. 10.
    Bochud PY, Eggiman P, Calandra T, Van Melle G, Saghafi L, Francioli P. Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors. Clin Infect Dis 18:25, 1994.PubMedCrossRefGoogle Scholar
  11. 11.
    Goodman JL, Winston DJ, Greenfield RA, et al. A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med 326:845, 1992.PubMedCrossRefGoogle Scholar
  12. 12.
    Oppenheim BA. The changing pattern of infection in neutropenic patients. J Antimicrob Chemother 41:S7, 1998.CrossRefGoogle Scholar
  13. 13.
    Sugar AM. Empiric treatment of fungal infections in the neutropenic host: review of the literature and guidelines for use. Arch Intern Med 150:2258, 1990.PubMedCrossRefGoogle Scholar
  14. 14.
    Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis 29:239, 1999.PubMedCrossRefGoogle Scholar
  15. 15.
    Pfaller MA, Messer SA, Hollis RJ, Jones RN, Doern GV, Brandt ME, Hajjeh RA. Trends in species distribution and susceptibility to fluconazole among blood stream isolates of Candida species in the United States. Diagn Microbiol Infect Dis 33:217, 1999.PubMedCrossRefGoogle Scholar
  16. 16.
    Digiovine B, Chenoweth C, Watts C, Higgins M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 160:976, 1999.PubMedCrossRefGoogle Scholar
  17. 17.
    Fraser VJ, Jones M, Dunkel J, Storfer S, Medoff G, Dunagan WC. Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality. Clin Infect Dis 15:414, 1992.PubMedCrossRefGoogle Scholar
  18. 18.
    Anaissie EJ, Rex JH, Uzun O, Vartivarian S. Predictors of adverse outcome in cancer patients with candidemia. Am J Med 104:238, 1998.PubMedCrossRefGoogle Scholar
  19. 19.
    Haron E, Vartivarian S, Anaissie E, Dekmezian R, Bodey GP. Primary Candida pneumonia. Experience at a large cancer center and review of the literature. Medicine 1993.Google Scholar
  20. 20.
    Rex JH, Bennett JE, Sugar AM, Pappas PG, van der Horst CM, Edwards JE, Washburn RG, Scheld WM, Karchmer AW, Dine AP, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. Candidemia Study Group and the National Institute. N Engl J Med 331:1325, 1994.PubMedCrossRefGoogle Scholar
  21. 21.
    Richardson SE, Bannatyne RM, Summerbell RC, et al. Disseminated fusarial infection in the immunocompromised host. Rev Infect Dis 10: 1171, 1988.PubMedCrossRefGoogle Scholar
  22. 22.
    Boutai EI, Anaissie EJ. Fusarium, a significant emerging pathogen in patients with hematologic malignancy: ten years’ experience at a cancer center and implications for management. Blood 90:999, 1997.Google Scholar
  23. 23.
    Krcmery V Jr, Kunova E, Jesenska Z, et al. Invasive mold infections in cancer patients: Five years’ experience with Aspergillus,Mucor, Fusarium and Acremonium infections. Support Care Cancer 4:39, 1996.PubMedCrossRefGoogle Scholar
  24. 24.
    Martino P, Gastaldi R, Raccah R, et al. Clinical patterns of Fusarium infections in immunocompromised patients. J Infect 28:7, 1994.PubMedCrossRefGoogle Scholar
  25. 25.
    Walsh TJ, Hiemenz JW, Seibel NL, et al. Amphotericin B lipid complex for invasive fungal infections: Analysis of safety and efficacy in 556 cases. Clin Infect Dis 26:1383, 1996.CrossRefGoogle Scholar
  26. 26.
    Kaiser L, Huguenin T, Lew PD, Chapuis B, Pittet D. Invasive aspergillosis. Clinical features of 35 proven cases at a single institution. Medicine 77:188, 1998.PubMedCrossRefGoogle Scholar
  27. 27.
    Whimbey E, Couch RB, Englund JA, Andreeff M, Goodrich JM, Raad II, Lewis V, Mirza N, Luna MA, Baxter B, et al. Respiratory syncytial virus pneumonia in hospitalized adult patients with leukemia. Clin Infect Dis 21:376, 1995.PubMedCrossRefGoogle Scholar
  28. 28.
    Won HJ, et al. Invasive pulmonary aspegillosis: Prediction at thin-section CT in patients with neutropenia — A prospective study. Radiology 208:777, 1998.PubMedGoogle Scholar
  29. 29.
    Jamzen DL, Adler BD, Padley SPG, et al. Diagnostic success of bronchoscopic biopsy in immunocompromised patients with acute pulmonary disease: Predictive value of disease distribution as shown on CT. Am J Roentgenol 160:21, 1993.CrossRefGoogle Scholar
  30. 30.
    Scott WW, Kuhlman JE. Focal pulmonary lesions in patients with AIDS: Percutaneous transthoracic needle biopsy. Radiology 180:419, 1991.PubMedGoogle Scholar
  31. 31.
    Pizzo PA, Hathorn JW, Hiemenz J, et al. A randomized trial comparing ceftazidime alone with combination antibiotic therapy in cancer patients with fever and neutropenia. N Engl J Med 315:552, 1986.PubMedCrossRefGoogle Scholar
  32. 32.
    Cometta A, Calandra T, Gaya H, et al. Monotherapy with meropenem versus combination therapy with ceftazidime plus amikacin as empiric therapy for fever in granulocytopenic patients with cancer. The International Antim-crobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer and the Gruppo Italiano Malattie Ematologiche Maligne dell’ Adulto Infection Program. Antimicrob Agents Chemother 40:1108, 1996.PubMedGoogle Scholar
  33. 33.
    Lindblad R, Rodjeer S, Adriansson M, et al. Empiric monotherapy for febrile neutropenia — A randomized study comparing meropenem with ceftazidime. Scand J Infect Dis 30:237, 1998.PubMedCrossRefGoogle Scholar
  34. 34.
    Marie JP, et al. Neutropenic infections: Review of the French Febrile Aplasia Study Group trials in 608 febrile neutropenic patients. J Antimicrob Chemo 4l(Suppl D):57, 1998.CrossRefGoogle Scholar
  35. 35.
    Dompeling EC, Donnelly JP, Deresinski SC, et al. Early identification of neutropenic patients at risk of gram-positive bacteraemia and the impact of empirical administration of vancomycin. Eur J Cancer 32:1332, 1996.CrossRefGoogle Scholar
  36. 36.
    Kibbler CC. Empirical antifungal therapy in febrile neutropenic patients: Current status. Current Topics in Medical Mycology 8:5, 1997.PubMedGoogle Scholar
  37. 37.
    Rotstein C, Bow EJ, Laverdiere M, et al. Randomized placebo-controlled trial of fluconazole prophylaxis for neutropenic cancer patients: Benefit based on purpose and intensity of cytotoxic therapy. Clin Infect Dis 28:331, 1999.PubMedCrossRefGoogle Scholar
  38. 38.
    Malik IA, Moid I, Aziz Z, et al. A randomized comparison of fluconazole with amphotericin B as empiric anti-fungal agents in cancer patients with prolonged fever and neutropenia. Am J Med 105:478, 1998.PubMedCrossRefGoogle Scholar
  39. 39.
    Abi-Said D, Anaissie E, Uzun O, et al. The epidemiology of hematogenous candidiasis caused by different Candida species. Clin Infect Dis 24:1122, 1997.PubMedCrossRefGoogle Scholar
  40. 40.
    Einsele H, Hebart H, Roller G, Loffler J, Rothenhofer I, Muller CA, Bowden RA, van Burik J, Engelhard D, Kanz L, Schumacher U. Detection and identification of fungal pathogens in blood by using molecular probes. J Clin Microbiol 35:1353, 1997.PubMedGoogle Scholar
  41. 41.
    Walsh TJ, Finberg RW, Arndt C, et al. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. N Engl J Med 340:764, 1999.PubMedCrossRefGoogle Scholar
  42. 42.
    Maher DW, Lieschke GJ, Green M, et al. Filgrastim in patients with chemotherapy-induced febrile neutropenia. A double-blind, placebo-controlled trial. Ann Intern Med 121:492, 1994.PubMedCrossRefGoogle Scholar
  43. 43.
    Rowe JM. Treatment of acute myeloid leukemia with cytokines: Effects on duration of neutropenia and response to infections. Clin Infect Dis 26:1290, 1998.PubMedCrossRefGoogle Scholar
  44. 44.
    Rodriguez-Adrian LJ, Grazziutti ML, Rex JH, Anaissie EJ. The potential role of cytokine therapy for fungal infections in patients with cancer: Is recovery from neutropenia all that is needed? Clin Infect Dis 26:1270, 1998.PubMedCrossRefGoogle Scholar
  45. 45.
    Hughes WT, Armstrong D, Bodey GP, et al. 1997 Guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. Clin Infect Dis 25:551, 1997.Google Scholar

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© Springer Science+Business Media New York 2001

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  • Stephen W. Crawford

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