Anne Blevins

Bacteremia and Fungemia in Patients with the Acquired Immunodeficiency Syndrome

Forty-nine episodes of bacteremia and fungemia occurred in 38 of 336 patients with the acquired immunodeficiency syndrome seen at our institution since 1980. There were five types of infections. Infections commonly associated with a T-cell immunodeficiency disorder comprised 16 episodes and included those with Salmonella species, Listeria monocytogenes, Cryptococcus neoformans, and Histoplasma capsulatum. Infections commonly associated with a B-cell immunodeficiency disorder included those with Streptococcus pneumoniae and Haemophilus influenzae. Infections occurring with neutropenia were caused by Pseudomonas aeruginosa, Staphylococcus epidermidis, and Streptococcus faecalis. Other infections occurring in the hospital were caused by Candida albicans, Staphylococcus epidermidis, enteric gram-negative rods, Staphylococcus aureus, and mixed S. aureus and group G streptococcus. Other infections occurring out of the hospital included those with S. aureus, Clostridium perfringens, Shigella sonnei, Pseudomonas aeruginosa, and group B streptococcus. Because two thirds of the septicemias were caused by organisms other than T-cell opportunists, these pathogens should be anticipated during diagnostic evaluation and when formulating empiric therapy.

Infectious Complications of Neoplastic Disease

Progress has been made in the diagnosis and treatment of infection in patients with neoplastic disease. Among the advances is the appreciation that certain opportunistic infections occur in association with particular host immune defects and epidemiologic factors. Such immune defects are seen secondary to or as a consequence of treatment for the patients basic disease. Improved methods such as serology, open lung biopsy, and fiberoptic bronchoscopy have allowed for earlier diagnosis and treatment of opportunistic infections. The development of empiric antibiotic regimens, particularly aminoglycosides and the antipseudomonal penicillins, have improved the outcome in the febrile neutropenic patient. The benefits of protective environments have been challenged; prophylactic antibiotics and various forms of immunotherapy are of interest but remain investigational.

Nocardia asteroides infection complicating neoplastic disease

Abstract During the decade 1960–1969, Nocardia asteroides was isolated from sputum, abscesses or exudates in twenty-two patients at Memorial Hospital. These patients could be divided into two groups. Group I consisted of thirteen patients with underlying neoplasms receiving radiation or chemotherapy in whom unequivocal evidence of nocardial infection developed. Clinical manifestations included bronchopneumonia, lobar pneumonia, necrotizing pneumonia with single or multiple abscesses, and brain, hepatic or scrotal abscesses. Ten patients had either leukemia or lymphoma. The simultaneous presence of tumor and nocardial infection in the lung was noted in five cases. Sputums or exudates from the patients in group I were positive for organisms simultaneously in both culture and smear in only a third of examinations; this stresses the need for multiple bacteriologic examinations when the diagnosis of nocardiosis is suspected. Although the underlying disease was usually progressively fatal, an excellent response to sulfonamides with resolution of pulmonary disease was noted in several patients who were maintained on anticancer therapy. Group II was composed of nine patients with predominantly respiratory symptoms and fever. Multiple positive cultures were obtained in many of these patients, but all lacked objective pulmonary findings and symptoms usually resolved without treatment. Such cases may represent milder nocardial infections of the upper respiratory tract although a saprophytic role for nocardia cannot be ruled out. These observations indicate that nocardiosis is a significant and often fatal opportunistic infection in patients being treated for cancer, but further studies are needed to define the clinical and epidemiologic spectrum of this disease in man.

GROUPS B, C, AND G STREPTOCOCCAL INFECTIONS IN A CANCER HOSPITAL

Disease due to streptococci other than Lancefield groups A or D has recently been reviewed at various medical centers.1-3 Group G streptococci in one reviewS appeared more commonly in patients with neoplastic disease, and we have noted severe infections due to this group in similar patients? It might be anticipated that in the immunologically altered host these infections would be more frequent and severe. It is the purpose of this paper to report our experience with the isolation and evaluation of organisms belonging to Lancefields groups B, C and G in a hospital caring for patients with neoplastic disease.

Salmonellosis in Patients with Neoplastic Disease.

Excerpt Ninety-six different salmonella isolations from 92 patients occurring over an 11-year period at Memorial Center were reviewed;Salmonella typhimuriumandSalmonella derbyinfections made up alm...

Bacteroides bacteremia. Experience in a hospital for neoplastic diseases

The case records of 55 patients with positive blood cultures for Bacteroides species, between the years 1965 and 1970, at Memorial Hospital for Cancer and Allied Diseases were reviewed. Ninety‐one per cent of patients had a neoplasm most frequently primary in the large bowel, bladder, gynecologic tract, or metastatic from breast. Less often, acute leukemia or lymphoma was present. The bowel was the most common clinical source of bacteroides, but the female pelvis, postoperative incisions, and decubitus ulcers also served as sites of origin for bacteremia. Abdominal or pelvic surgery often closely preceded the onset of bacteremia. Although 25/55 patients died during the 2‐week period following bacteremia, only 17/55 patients died of actual sepsis. The clinical outcome was influenced by the use of antibiotic and drainage therapy. The frequent prolonged incubation period in culture delays the initiation of therapy. Therefore, a high index of suspicion of bacteroides bacteremia should be maintained in the appropriate clinical setting. Tetracycline seemed the best antibiotic with which to initiate treatment pending in vitro sensitivities on the isolate. Bacteroides sp. bacteremia was a relatively frequent cause of sepsis in patients with neoplasms and carried a high mortality rate if not appropriately treated.