TAILIEUCHUNG - Chapter 082. Infections in Patients with Cancer (Part 9)

Diffuse interstitial infiltrates suggest viral, parasitic, or Pneumocystis pneumonia. If the patient has a diffuse interstitial pattern on chest x-ray, it may be reasonable to institute empirical treatment with TMP-SMX (for Pneumocystis) and a quinolone (for Chlamydophila, Mycoplasma, and Legionella) or an erythromycin derivative (., azithromycin) while considering invasive diagnostic procedures. Noninvasive procedures, such as staining of sputum smears for Pneumocystis, serum cryptococcal antigen tests, and urine testing for Legionella antigen, may be helpful. In transplant recipients who are seropositive for cytomegalovirus (CMV), a determination of CMV load in the serum should be considered. Viral load studies (which allow. | Chapter 082. Infections in Patients with Cancer Part 9 Diffuse interstitial infiltrates suggest viral parasitic or Pneumocystis pneumonia. If the patient has a diffuse interstitial pattern on chest x-ray it may be reasonable to institute empirical treatment with TMP-SMX for Pneumocystis and a quinolone for Chlamydophila Mycoplasma and Legionella or an erythromycin derivative . azithromycin while considering invasive diagnostic procedures. Noninvasive procedures such as staining of sputum smears for Pneumocystis serum cryptococcal antigen tests and urine testing for Legionella antigen may be helpful. In transplant recipients who are seropositive for cytomegalovirus CMV a determination of CMV load in the serum should be considered. Viral load studies which allow physicians to quantitate viruses have superseded simple measurement of serum IgG which merely documents prior exposure to virus. Infections with viruses that cause only upper respiratory symptoms in immunocompetent hosts such as respiratory syncytial virus RSV influenza viruses and parainfluenza viruses may be associated with fatal pneumonitis in immunocompromised hosts. An attempt at early diagnosis by nasopharyngeal aspiration should be considered so that appropriate treatment can be instituted. Bleomycin is the most common cause of chemotherapy-induced lung disease. Other causes include alkylating agents such as cyclophosphamide chlorambucil and melphalan nitrosoureas carmustine BCNU lomustine CCNU and methyl-CCNU busulfan procarbazine methotrexate and hydroxyurea. Both infectious and noninfectious drug- and or radiation-induced pneumonitis can cause fever and abnormalities on chest x-ray thus the differential diagnosis of an infiltrate in a patient receiving chemotherapy encompasses a broad range of conditions Table 82-7 . Since the treatment of radiation pneumonitis which may respond dramatically to glucocorticoids or drug-induced pneumonitis is different from that of infectious pneumonia a biopsy may

• Y học thường thức
• Infections in Patients with Cancer
• bệnh học và điều trị
• bài giảng bệnh học
• tài liệu y khoa
• Harrisons Internal Medicine
• Nosocomial infection
• Intensive care unit
• Regional cancer center
• Nosocomial infections
• Molecular diagnosis of bacterial resistance
• Patients admitted
• Oncology Patients
• Cancer Illness
• Pediatric Infectious
• Fungal Infections
• Patients of Paediatric Age
• Infantile Chronic
• Mycobacterium tuberculosis direct test
• Mycobacteria growth indicator tube
• TB infections
• Cancer patients
• Conventional diagnostic methods