TAILIEUCHUNG - Chapter 061. Disorders of Granulocytes and Monocytes (Part 12)

Patients with leukopenias or leukocyte dysfunction often have delayed inflammatory responses. Therefore, clinical manifestations may be minimal despite overwhelming infection, and unusual infections must always be suspected. Early signs of infection demand prompt, aggressive culturing for microorganisms, use of antibiotics, and surgical drainage of abscesses. Prolonged courses of antibiotics are often required. In patients with CGD, prophylactic antibiotics (trimethoprim-sulfamethoxazole) and antifungals (itraconazole) markedly diminish the frequency of life-threatening infections. Short courses of glucocorticoids may relieve gastrointestinal or genitourinary tract obstruction by granulomas in patients with CGD. . | Chapter 061. Disorders of Granulocytes and Monocytes Part 12 Patients with leukopenias or leukocyte dysfunction often have delayed inflammatory responses. Therefore clinical manifestations may be minimal despite overwhelming infection and unusual infections must always be suspected. Early signs of infection demand prompt aggressive culturing for microorganisms use of antibiotics and surgical drainage of abscesses. Prolonged courses of antibiotics are often required. In patients with CGD prophylactic antibiotics trimethoprim-sulfamethoxazole and antifungals itraconazole markedly diminish the frequency of life-threatening infections. Short courses of glucocorticoids may relieve gastrointestinal or genitourinary tract obstruction by granulomas in patients with CGD. Recombinant human IFN-y which nonspecifically stimulates phagocytic cell function reduces the frequency of infections in patients with CGD by 70 and reduces the severity of infection. This effect of IFN-y in CGD is additive to the effect of prophylactic antibiotics. The recommended dose is 50 pg m2 subcutaneously three times weekly. IFN-y has also been used successfully in the treatment of leprosy nontuberculous mycobacteria and visceral leishmaniasis. Rigorous oral hygiene reduces but does not eliminate the discomfort of gingivitis periodontal disease and aphthous ulcers chlorhexidine mouthwash and tooth brushing with a hydrogen peroxide-sodium bicarbonate paste helps many patients. Oral antifungal agents fluconazole or itraconazole have reduced mucocutaneous candidiasis in patients with Job s syndrome. Androgens glucocorticoids lithium and immunosuppressive therapy have been used to restore myelopoiesis in patients with neutropenia due to impaired production. Recombinant G-CSF is useful in the management of certain forms of neutropenia due to depressed neutrophil production especially those related to cancer chemotherapy. Patients with chronic neutropenia with evidence of a good bone marrow reserve need .

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