Infections in patients with neoplastic disease

Immune defect (associated neoplastic diseases)	Bacteria	Fungi	Parasites	Viruses
Granulocytopenia	Staphylococcus aureus Streptococcus pneumoniae Streptococcus spp. Pseudomonas aeruginosa Enterobacteriaceae Escherichia coli Klebsiella spp. Stenotrophomonas maltophilia Acinetobacter spp.	Aspergillus fumigatus; non-fumigatus Aspergillus Non-Aspergillus species hyalohyphomycosis such as Pseudallescheria boydii, Fusarium solani Mucorales (zygomycoses) Dematiaceous (Black) fungi such as Alternaria, Bipolaris, Curvularia, Scedosporium apiospermum Scedosporium prolificans		Herpes simplex virus I and II VZV
Cellular immune dysfunction	Nocardia asteroides complex Salmonella typhimurium Salmonella enteritidis Rhodococcus equi Rhodococcus bronchialis Listeria monocytogenes Mycobacterium tuberculosis Nontuberculous mycobacteria Legionella spp.	Aspergillus and non-Aspergillus filamentous molds Pneumocystis jirovecii (P. carinii) Cryptococcus neoformans Endemic mycoses due to Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis	Toxoplasma gondii Microsporidium spp. Leishmania donovani Leishmania infantum Strongyloides stercoralis Cryptosporidium Cyclospora spp.	Human cytomegalovirus Respiratory viruses Influenza A and influenza B Parainfluenza type-3 Respiratory syncytial virus Adenovirus VZV HHV-6 SARS-associated coronavirus? Parvovirus B19 Paramyxovirus? Hantavirus?
Humoral immune dysfunction and splenectomy	S. pneumoniae Haemophilus influenzae Neisseria meningitidis Capnocytophaga canimorsus Campylobacter	P. jirovecii (P. carinii)?	Giardia lamblia Babesia microti	VZV Echovirus Enterovirus
Mixed defects	S. pneumoniae S. aureus H. influenzae Klebsiella pneumoniae P. aeruginosa Acinetobacter spp. Enterobacter spp. S. maltophilia Nocardia asteroides complex L. monocytogenes Legionella spp.	P. jirovecii (P. carinii) Aspergillus spp. Candida spp. C. neoformans Mucorales (zygomycoses) Endemic mycoses (severe systemic dissemination)	T. gondii S. stercoralis	Respiratory viruses Influenza Parainfluenza Respiratory syncytial virus Adenovirus VZV

Abbreviation: HHV-6 = human herpesvirus 6; SARS = severe acute respiratory syndrome; VZV = varicella-zoster virus.

Note: Patients with mixed immune defects include recipients of allogeneic hematopoietic stem cell transplant; acute or chronic graft-versus-host disease; myelodysplastic syndrome; adult T-cell leukemia lymphoma. Antineoplastic agents such as cyclophosphamide, fludarabine, L. donovani, and L. infantum may lead to serious visceral leishmaniasis. L. donovani is seen in Africa and Asia, L. infantum is seen in Africa, Europe, Mediterranean, Central and South America. VZV is rarely associated with systemic dissemination in patients with humoral immune defects, or even those with mixed immune dysfunctions. S. stercoralis may lead to serious, life-threatening hyperinfection syndrome in patients with marked cellular immune defects.

Epidemiology

People may be exposed to a variety of organisms through travel, work, habits, or hobbies; in the home; or in other hospitals, outpatient clinics, and infusion centers. A person with children at home is likely to be exposed to a number of infectious agents such as influenza, parainfluenza, respiratory syncytial virus, varicella-zoster virus (VZV), human herpesvirus 6 (HHV-6), and cytomegalovirus (CMV). Hospitals are a rich source of antibiotic-resistant microorganisms, including multidrug-resistant Staphylococcus aureus (MRSA), vancomycin-resistant and/or vancomycin-tolerant Enterococcus species, multidrug-resistant Pseudomonas and Stenotrophomonas, and extended-spectrum β-lactamase-producing Enterobacteriaceae such as Escherichia coli and Klebsiella species. The recent global spread of carbapenem-resistant Enterobacteriaceae (CRE) has underscored the limitations of antibiotic regimens.

A recent review of 27 reports published since 2008 showed gram-negative bacteria continued to be the most prominent cause of bacteremia in cancer patients, especially patients not receiving broad-spectrum antimicrobial prophylaxis. Furthermore, high prevalence of invasive bacterial disease due to multidrug-resistant gram-negative bacteria has had substantial impact on prolonged hospitalization, higher morbidity, and death. It is important to know where an individual has been hospitalized and what resistance patterns are known to inhabit organisms in that hospital. Furthermore, as the spectrum of infection continues to change, it is imperative to follow these trends; just as community-acquired MRSA has recently surpassed hospitalization as a more common source of these resistant bacteria, other traditional risk factors for acquiring an infection may also change. In this regard, potentially life-threatening Stenotrophomonas maltophilia

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