Infectious Complications in Bone Marrow Transplantation

As the demographics of the population shift toward an increasingly aged society, the number of individuals with cancer increases and with it the need to give the most comprehensive possible health care delivery. Although much has been written about the specific therapy best suited for the various types of cancer and about the basic and clinical research which has dramatically improved treat ment, overall patient care requires attention to supportive care, which includes such items as pain management, the use of blood products, nutrition, and psychosocial needs. Yet infection remains the leading cause of death in cancer patients and is a major cause of morbidity and hospitaliza tion, making it a major aspect of the supportive care of cancer patients. It therefore deserves a full exposition. Bone marrow transplantation is increasingly being utilized as part of a therapeutic modality in the treatment of cancer patients. Transplantation patients are at such a particularly high risk of developing a wide variety of different types of infection, that they inevitably can serve as an excellent framework for discussion of all the types of infections that occur during the treatment of cancer. The patient undergoing allogeneic bone marrow transplantation is at particularly high risk of infection due to the major perturbations of host defenses, which include granulo cytopenia, cellular immune dysfunction, humoral immune dysfunction, blood product transfusions, and vascular access devices. Each of these perturbations results in a different set of infectious disease problems.

Klappentext

The subject of this book is the problem of infectionfollowing transplantation; it represents the principle causeof death among these patients and hence, its diagnosis,prevention and treatment are critical.The book covers all aspects of infection in these patients.Itis based upon a composite case description with questionson patient management. These were addressed by a panel ofexperts. Each expert prepareda chapter on one or moretopics.

Inhalt
I. Introduction.- Bone Marrow Transplantation for Cancer: An Overview.- Infection in Bone Marrow Transplantation: A Model for Examining Predisposing Factors to Infection in Cancer Patients.- II. Case Presentation.- to Case Presentation.- III. Infection and Granulocytopenia.- Initial Empiric Therapy for Fever in Neutropenia.- Approach to the Patient with Prolonged Granulocytopenia.- Simplification of Empiric Therapy for the Febrile Neutropenic Oncology Patient.- Fever and Granulocytopenia: A Viewpoint from an Academic Setting.- Empiric Antimicrobial Therapy in the Community Hospital Setting for the Cancer Patient with Fever and Neutropenia: The Need for Vigilance and Attention to Detail.- Observations on the Effects of Hematopoietic Colony Stimulating Factors on the Clinical Course of Bone Marrow Transplantation.- Effect of Colony-Stimulating Factors on Granulocyte Function.- Invasive Aspergillosis: Host Defenses.- Invasive Aspergillosis: Serologic Diagnosis.- Aspergillosis in the Immunocompromised: Focus on Treatment.- Invasive Candidiasis During Granulocytopenia.- IV. Infections and Cellular Immune Dysfunction.- Infections in Cancer Patients with Suppressed Cellular Immunity.- Herpes Simplex Infections.- Treatment and Prophylaxis of Cytomegalovirus Infection After Bone Marrow Transplantation.- Varicella Zoster Infections in Bone Marrow Transplants.- Graft-Versus-Host Disease: Basic Considerations.- Graft-Versus-Host Disease: Implications.- V. Infections Related to Humoral Immune Deficiency/ Vascular Access/Transfusions.- Late Bacterial Infections in Humoral Immune Deficiency.- Hepatitis B and C: Influence of Immunosuppression.- Emergence of Gram-Positive Infections: Relationship to Indwelling Catheters and Management During Chemotherapy-Induced Aplasia.- VI. New Pathogens/Resistance/Drug Delivery.- New Pathogens in the Immunocompromised Host.- Resistant Bacterial Infections.- VII. Clinical Trials: Perspectives.- Organization of Clinical Trials: Problems, Controversies, Definitions, and Methodology Related to Infections in Neutropenic Patients.- Organization of Clinical Trials: Problems, Controversies, Definitions, Methodology.- Case Presentation with Answers to Questions.