Chapter 40 Clinical Approach to Infections in the Compromised Host

Samuel A. Shelburne, Russell E. Lewis, Dimitrios P. Kontoyiannis

Figure 40-1 CONSTELLATION OF FACTORS CONTRIBUTING TO INCREASED RISK FOR INFECTION IN IMMUNOCOMPROMISED HOSTS.

Table 40-1 Malignant and Select Nonmalignant Hematologic Diseases and Their Associated Infection-Predisposing Host Defects

Hematologic Condition	Infection-Predisposing Host Defects
Acute myeloid leukemia	Neutropenia; therapies such as dose-intensive chemotherapy and hematopoietic stem cell transplant may result in additional anatomic disruptions, cell-mediated defects, and humoral defects
Acute lymphocytic leukemia	Neutropenia; therapy effects similar to acute myeloid leukemia
Hairy cell leukemia	Neutropenia (also monocytopenia); abnormal humoral immunity; T-cell suppressing therapy
Chronic lymphocytic leukemia	Hypogammaglobulinemia; abnormal cell-mediated immunity
Chronic myeloid leukemia	No prominent host defects unless aggressive therapy, advanced stage, or postsplenectomy
Multiple myeloma	Hypogammaglobulinemia; other host defects may occur with aggressive therapy or advanced stage
Hodgkin/non-Hodgkin lymphomas	Abnormal cell-mediated immunity, therapy-related neutropenia, splenic dysfunction (if splenectomy or radiation)
Myelodysplastic syndromes	Functional or absolute neutropenia
Aplastic anemia	Neutropenia; abnormal cell-mediated immunity from immunosuppressive therapies (e.g., steroids, antithymocyte globulin, cyclosporine, hematopoietic stem cell transplantation)
Paroxysmal nocturnal hemoglobinuria	Deficient Fc receptor may contribute to abnormal cell-mediated immunity
Hemolytic states (thalassemia)	Gallstones may serve as a nidus for infection; splenic dysfunction or splenectomy
Sickle cell disease	Can be neutropenic with aplastic crisis; bone infarcts may serve as a nidus for infection; splenic dysfunction with poor complement activation and opsonization from autosplenectomy