Skip to main content

Enteric Infections

  • Chapter
  • First Online:
Infectious Complications in Cancer Patients

Part of the book series: Cancer Treatment and Research ((CTAR,volume 161))

Abstract

Cancer patients, particularly those with neutropenia, are at risk for enteric and intra-abdominal infections. Specific infections and infectious syndromes in this setting include neutropenic enterocolitis, bacterial infections such as Clostridium difficile infection (CDI), viral infections such as CMV colitis, and parasitic infections such as strongyloidiasis. Diagnosing and gauging the severity of CDI presents challenges, as chemotherapy may produce symptoms that mimic CDI and laboratory findings such as leukocytosis are not reliable in this population. Treatment for enteric infections should be pathogen specific, although broad-spectrum antibiotics are often required as initial empiric therapy in patients with neutropenia.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wade DS, Douglass H Jr, Nava HR, Piedmonte M (1990) Abdominal pain in neutropenic patients. Arch Surg 125:1119–1127

    Article  PubMed  CAS  Google Scholar 

  2. Reuter S, Kern WV, Sigge A et al (2005) Impact of fluoroquinolone prophylaxis on reduced infection-related mortality among patients with neutropenia and hematologic malignancies. Clin Infect Dis 40:1087–1093

    Article  PubMed  CAS  Google Scholar 

  3. Badgwell BD, Cormier JN, Wray CJ et al (2008) Challenges in surgical management of abdominal pain in the neutropenic cancer patient. Ann Surg 248:104–109

    Article  PubMed  Google Scholar 

  4. Gorschluter M, Hahn C, Ziske C et al (2002) Low frequency of enteric infections by Salmonella, Shigella, Yersinia and Campylobacter in patients with acute leukemia. Infection 30:22–25

    Article  PubMed  CAS  Google Scholar 

  5. Gomez L, Martino R, Rolston KV (1998) Neutropenic enterocolitis: spectrum of the disease and comparison of definite and possible cases. Clin Infect Dis 27:695–699

    Article  PubMed  CAS  Google Scholar 

  6. Wade DS, Nava HR, Douglass HO Jr (1992) Neutropenic enterocolitis. Clinical diagnosis and treatment. Cancer 69:17–23

    Article  PubMed  CAS  Google Scholar 

  7. Gorschluter M, Mey U, Strehl J et al (2005) Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol 75:1–13

    Article  PubMed  Google Scholar 

  8. Aksoy DY, Tanriover MD, Uzun O et al (2007) Diarrhea in neutropenic patients: a prospective cohort study with emphasis on neutropenic enterocolitis. Ann Oncol 18:183–189

    Article  PubMed  CAS  Google Scholar 

  9. Cartoni C, Dragoni F, Micozzi A et al (2001) Neutropenic enterocolitis in patients with acute leukemia: prognostic significance of bowel wall thickening detected by ultrasonography. J Clin Oncol 19:756–761

    PubMed  CAS  Google Scholar 

  10. Picardi M, Camera A, Pane F, Rotoli B (2007) Improved management of neutropenic enterocolitis using early ultrasound scan and vigorous medical treatment. Clin Infect Dis 45:403–404

    Article  PubMed  Google Scholar 

  11. Starnes HF Jr, Moore FD Jr, Mentzer S, Osteen RT, Steele GD Jr, Wilson RE (1986) Abdominal pain in neutropenic cancer patients. Cancer 57:616–621

    Article  PubMed  Google Scholar 

  12. Gorbach S (1998) Editorial response: neutropenic enterocolitis. Clin Infect Dis 27(4):700–701

    Article  PubMed  CAS  Google Scholar 

  13. Boland GW, Lee MJ, Cats AM, Gaa JA, Saini S, Mueller PR (1994) Antibiotic-induced diarrhea: specificity of abdominal CT for the diagnosis of Clostridium difficile disease. Radiology 191:103–106

    PubMed  CAS  Google Scholar 

  14. Hughes WT, Armstrong D, Bodey GP et al (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751

    Article  PubMed  Google Scholar 

  15. Solomkin JS, Mazuski JE, Bradley JS et al (2010) Diagnosis and management of complicated intra-abdominal infections in adults and children: guidelines by the surgical infectious society and the infectious diseases society of America. Clin Infect Dis 50:133–164

    Article  PubMed  CAS  Google Scholar 

  16. Gorschluter M, Mey U, Strehl J et al (2006) Invasive fungal infections in neutropenic enterocolitis: a systematic analysis of pathogens, incidence, treatment and mortality in adult patients. BMC Infect Dis 6:35

    Article  PubMed Central  PubMed  Google Scholar 

  17. Walsh TJ, Teppler H, Donowitz GR et al (2004) Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. N Engl J Med 351:1391–1402

    Article  PubMed  CAS  Google Scholar 

  18. McDonald LC, Killgore GE, Thompson A et al (2005) An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 353:2433–2441

    Article  PubMed  CAS  Google Scholar 

  19. Gorschluter M, Glasmacher A, Hahn C et al (2001) Clostridium difficile infection in patients with neutropenia. Clin Infect Dis 33:786–791

    Article  PubMed  CAS  Google Scholar 

  20. McDonald LC (2005) Clostridium difficile: responding to a new threat from an old enemy. Infect Control Hosp Epidemiol 26:672–675

    Article  PubMed  Google Scholar 

  21. Dubberke ER, Reske KA, Yan Y, Olsen MA, McDonald LC, Fraser VJ (2007) Clostridium difficile–associated disease in a setting of endemicity: identification of novel risk factors. Clin Infect Dis 45:1543–1549

    Article  PubMed  Google Scholar 

  22. Johnson S, Samore MH, Farrow KA et al (1999) Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals. N Engl J Med 341:1645–1651

    Article  PubMed  CAS  Google Scholar 

  23. Palmore TN, Sohn S, Malak SF, Eagan J, Sepkowitz KA (2005) Risk factors for acquisition of Clostridium difficile-associated diarrhea among outpatients at a cancer hospital. Infect Control Hosp Epidemiol 26:680–684

    Article  PubMed  Google Scholar 

  24. Gerding DN (2004) Clindamycin, cephalosporins, fluoroquinolones, and Clostridium difficile-associated diarrhea: this is an antimicrobial resistance problem. Clin Infect Dis 38:646–648

    Article  PubMed  Google Scholar 

  25. Pepin J, Saheb N, Coulombe MA et al (2005) Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 41:1254–1260

    Article  PubMed  CAS  Google Scholar 

  26. Muto CA, Pokrywka M, Shutt K et al (2005) A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 26:273–280

    Article  PubMed  Google Scholar 

  27. Biller P, Shank B, Lind L et al (2007) Moxifloxacin therapy as a risk factor for Clostridium difficile-associated disease during an outbreak: attempts to control a new epidemic strain. Infect Control Hosp Epidemiol 28:198–201

    Article  PubMed  Google Scholar 

  28. Gaynes R, Rimland D, Killum E et al (2004) Outbreak of Clostridium difficile infection in a long-term care facility: association with gatifloxacin use. Clin Infect Dis 38:640–645

    Article  PubMed  Google Scholar 

  29. Blot E, Escande MC, Besson D et al (2003) Outbreak of Clostridium difficile-related diarrhoea in an adult oncology unit: risk factors and microbiological characteristics. J Hosp Infect 53:187–192

    Article  PubMed  CAS  Google Scholar 

  30. Husain A, Aptaker L, Spriggs DR, Barakat RR (1998) Gastrointestinal toxicity and Clostridium difficile diarrhea in patients treated with paclitaxel-containing chemotherapy regimens. Gynecol Oncol 71:104–107

    Article  PubMed  CAS  Google Scholar 

  31. Emoto M, Kawarabayashi T, Hachisuga MD, Eguchi F, Shirakawa K (1996) Clostridium difficile colitis associated with cisplatin-based chemotherapy in ovarian cancer patients. Gynecol Oncol 61:369–372

    Article  PubMed  CAS  Google Scholar 

  32. Anand A, Glatt AE (1993) Clostridium difficile infection associated with antineoplastic chemotherapy: a review. Clin Infect Dis 17:109–113

    Article  PubMed  CAS  Google Scholar 

  33. Bartlett JG (2002) Clinical practice. Antibiotic-associated diarrhea. N Engl J Med 346:334–339

    Article  PubMed  Google Scholar 

  34. Mohan SS, McDermott BP, Parchuri S, Cunha BA (2006) Lack of value of repeat stool testing for Clostridium difficile toxin. Am J Med 119(356):e7–e8

    PubMed  Google Scholar 

  35. Aichinger E, Schleck CD, Harmsen WS, Nyre LM, Patel R (2008) Nonutility of repeat laboratory testing for detection of Clostridium difficile by use of PCR or enzyme immunoassay. J Clin Microbiol 46:3795–3797

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  36. Ticehurst JR, Aird DZ, Dam LM, Borek AP, Hargrove JT, Carroll KC (2006) Effective detection of toxigenic Clostridium difficile by a two-step algorithm including tests for antigen and cytotoxin. J Clin Microbiol 44:1145–1149

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  37. Peterson LR, Manson RU, Paule SM et al (2007) Detection of toxigenic Clostridium difficile in stool samples by real-time polymerase chain reaction for the diagnosis of C. difficile-associated diarrhea. Clin Infect Dis 45:1152–1160

    Article  PubMed  CAS  Google Scholar 

  38. Wang M, Evans CT, Rodriguez T, Gerding DN, Johnson S (2013) Clostridium difficile infection (CDI) and limitations of markers for severity in patients with hematologic malignancy. Infect Cont Hosp Epidemiol 34:127–132

    Google Scholar 

  39. Pepin J, Alary ME, Valiquette L et al (2005) Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 40:1591–1597

    Article  PubMed  CAS  Google Scholar 

  40. Musher DM, Aslam S, Logan N et al (2005) Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis 40:1586–1590

    Article  PubMed  CAS  Google Scholar 

  41. Zar FA, Bakkanagari SR, Moorthi KM, Davis MB (2007) A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis 45:302–307

    Article  PubMed  CAS  Google Scholar 

  42. Kelly CP, LaMont JT (2008) Clostridium difficile–more difficult than ever. N Engl J Med 359:1932–1940

    Article  PubMed  CAS  Google Scholar 

  43. Louie TJ, Miller MA, Mullane KM, Weiss K, Lentnek A, Golan Y et al (2011) Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med 364:422–431

    Article  PubMed  CAS  Google Scholar 

  44. Pepin J, Routhier S, Gagnon S, Brazeau I (2006) Management and outcomes of a first recurrence of Clostridium difficile-associated disease in Quebec, Canada. Clin Infect Dis 42:758–764

    Article  PubMed  Google Scholar 

  45. Surawicz CM, McFarland LV, Greenberg RN et al (2000) The search for a better treatment for recurrent Clostridium difficile disease: use of high-dose vancomycin combined with Saccharomyces boulardii. Clin Infect Dis 31:1012–1017

    Article  PubMed  CAS  Google Scholar 

  46. Johnson S, Schriever C, Galang M, Kelly CP, Gerding DN (2007) Interruption of recurrent Clostridium difficile-associated diarrhea episodes by serial therapy with vancomycin and rifaximin. Clin Infect Dis 44:846–848

    Article  PubMed  CAS  Google Scholar 

  47. Musher DM, Logan N, Hamill RJ et al (2006) Nitazoxanide for the treatment of Clostridium difficile colitis. Clin Infect Dis 43:421–427

    Article  PubMed  CAS  Google Scholar 

  48. Aas J, Gessert CE, Bakken JS (2003) Recurrent Clostridium difficile colitis: case series involving 18 patients treated with donor stool administered via a nasogastric tube. Clin Infect Dis 36:580–585

    Article  PubMed  Google Scholar 

  49. Munoz P, Bouza E, Cuenca-Estrella M et al (2005) Saccharomyces cerevisiae fungemia: an emerging infectious disease. Clin Infect Dis 40:1625–1634

    Article  PubMed  Google Scholar 

  50. Rechner PM, Agger WA, Mruz K, Cogbill TH (2001) Clinical features of clostridial bacteremia: a review from a rural area. Clin Infect Dis 33:349–353

    Article  PubMed  CAS  Google Scholar 

  51. Leal J, Gregson DB, Ross T, Church DL, Laupland KB (2008) Epidemiology of Clostridium species bacteremia in Calgary, Canada, 2000–2006. J Infect 57:198–203

    Article  PubMed  CAS  Google Scholar 

  52. Chew SS, Lubowski DZ (2001) Clostridium septicum and malignancy. ANZ J Surg 71:647–649

    Article  PubMed  CAS  Google Scholar 

  53. Larson CM, Bubrick MP, Jacobs DM, West MA (1995) Malignancy, mortality, and medicosurgical management of Clostridium septicum infection. Surgery 118:592–597; discussion 7–8

    Google Scholar 

  54. Stevens DL, Bisno AL, Chambers HF et al (2005) Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 41:1373–1406

    Article  PubMed  Google Scholar 

  55. Gold JS, Bayar S, Salem RR (2004) Association of Streptococcus bovis bacteremia with colonic neoplasia and extracolonic malignancy. Arch Surg 139:760–765

    Article  PubMed  Google Scholar 

  56. Burnett-Hartman AN, Newcomb PA, Potter JD (2008) Infectious agents and colorectal cancer: a review of Helicobacter pylori, Streptococcus bovis, JC virus, and human papillomavirus. Cancer Epidemiol Biomarkers Prev 17:2970–2979

    Article  PubMed Central  PubMed  Google Scholar 

  57. Klein RS, Recco RA, Catalano MT, Edberg SC, Casey JI, Steigbigel NH (1977) Association of Streptococcus bovis with carcinoma of the colon. N Engl J Med 297:800–802

    Article  PubMed  CAS  Google Scholar 

  58. Mead GM, Sweetenham JW, Ewins DL, Furlong M, Lowes JA (1986) Intestinal cryptosporidiosis: a complication of cancer treatment. Cancer Treat Rep 70:769–770

    PubMed  CAS  Google Scholar 

  59. Hunter PR, Nichols G (2002) Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients. Clin Microbiol Rev 15:145–154

    Article  PubMed Central  PubMed  Google Scholar 

  60. Leav BA, Mackay M, Ward HD (2003) Cryptosporidium species: new insights and old challenges. Clin Infect Dis 36:903–908

    Article  PubMed  Google Scholar 

  61. Gentile G, Venditti M, Micozzi A et al (1991) Cryptosporidiosis in patients with hematologic malignancies. Rev Infect Dis 13:842–846

    Article  PubMed  CAS  Google Scholar 

  62. Mac Kenzie WR, Hoxie NJ, Proctor ME et al (1994) A massive outbreak in Milwaukee of cryptosporidium infection transmitted through the public water supply. N Engl J Med 331:161–167

    Article  PubMed  CAS  Google Scholar 

  63. Rossignol JF, Ayoub A, Ayers MS (2001) Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of Nitazoxanide. J Infect Dis 184:103–106

    Article  PubMed  CAS  Google Scholar 

  64. Fox LM, Saravolatz LD (2005) Nitazoxanide: a new thiazolide antiparasitic agent. Clin Infect Dis 40:1173–1180

    Article  PubMed  CAS  Google Scholar 

  65. Siddiqui AA, Berk SL (2001) Diagnosis of Strongyloides stercoralis infection. Clin Infect Dis 33:1040–1047

    Article  PubMed  CAS  Google Scholar 

  66. Safdar A, Malathum K, Rodriguez SJ, Husni R, Rolston KV (2004) Strongyloidiasis in patients at a comprehensive cancer center in the United States. Cancer 100:1531–1536

    Article  PubMed  Google Scholar 

  67. Nucci M, Portugal R, Pulcheri W et al (1995) Strongyloidiasis in patients with hematologic malignancies. Clin Infect Dis 21:675–677

    Article  PubMed  CAS  Google Scholar 

  68. Lam CS, Tong MK, Chan KM, Siu YP (2006) Disseminated strongyloidiasis: a retrospective study of clinical course and outcome. Eur J Clin Microbiol Infect Dis 25:14–18

    Article  PubMed  CAS  Google Scholar 

  69. Machado ER, Teixeira EM, Goncalves-Pires Mdo R, Loureiro ZM, Araujo RA, Costa-Cruz JM (2008) Parasitological and immunological diagnosis of Strongyloides stercoralis in patients with gastrointestinal cancer. Scand J Infect Dis. 40:154–158

    Google Scholar 

  70. Roxby A, Gottlieb G, Limaye A (2009) Strongyloidiasis in transplant patients. Clin Infect Dis 48:1411–1423

    Article  Google Scholar 

  71. Boeckh M, Leisenring W, Riddell SR et al (2003) Late cytomegalovirus disease and mortality in recipients of allogeneic hematopoietic stem cell transplants: importance of viral load and T-cell immunity. Blood 101:407–414

    Article  PubMed  CAS  Google Scholar 

  72. Reed EC, Wolford JL, Kopecky KJ et al (1990) Ganciclovir for the treatment of cytomegalovirus gastroenteritis in bone marrow transplant patients. A randomized, placebo-controlled trial. Ann Intern Med 112:505–510

    Article  PubMed  CAS  Google Scholar 

  73. Nomura K, Kamitsuji Y, Kono E et al (2005) Severe cytomegalovirus enterocolitis after standard chemotherapy for non-Hodgkin’s lymphoma. Scand J Gastroenterol 40:604–606

    Article  PubMed  Google Scholar 

  74. Van den Brande J, Schrijvers D, Colpaert C, Vermorken JB (1999) Cytomegalovirus colitis after administration of docetaxel-5-fluorouracil-cisplatin chemotherapy for locally advanced hypopharyngeal cancer. Ann Oncol 10:1369–1372

    Article  PubMed  Google Scholar 

  75. Matthes T, Kaiser L, Weber D, Kurt AM, Dietrich PY (2002) Cytomegalovirus colitis–a severe complication after standard chemotherapy. Acta Oncol 41:704–706

    Article  PubMed  Google Scholar 

  76. Wade JC (2006) Viral infections in patients with hematological malignancies. Hematology Am Soc Hematol Educ Program 368–374

    Google Scholar 

  77. Goodrich JM, Bowden RA, Fisher L, Keller C, Schoch G, Meyers JD (1993) Ganciclovir prophylaxis to prevent cytomegalovirus disease after allogeneic marrow transplant. Ann Intern Med 118:173–178

    Article  PubMed  CAS  Google Scholar 

  78. Aksoy S, Hartuputluoglu H, Kilickap S et al (2007) Rituximab-related viral infections in lymphoma patients. Leuk Lymphoma 48(7):1307–1312

    Article  PubMed  CAS  Google Scholar 

  79. Martin S, Marty F, Fiumara K (2006) Infectious complications associated with alemtuzumab use for lymphoproliferative disorders. Clin Infect Dis 43:16–24

    Article  PubMed  CAS  Google Scholar 

  80. Caliendo AM, George KS, Allega J, Bullotta AC, Gilbane L, Rinaldo CR (2002) Distinguishing cytomegalovirus (CMV) infection and disease with CMV nucleic acid assays. J Clin Microbiol 40:1581–1586

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  81. Lesprit P, Scieux C, Lemann M, Carbonelle E, Modai J, Molina JM (1998) Use of the cytomegalovirus (CMV) antigenemia assay for the rapid diagnosis of primary CMV infection in hospitalized adults. Clin Infect Dis 26:646–650

    Article  PubMed  CAS  Google Scholar 

  82. Yoshida A, Hitomi S, Fukui T et al (2001) Diagnosis and monitoring of human cytomegalovirus diseases in patients with human immunodeficiency virus infection by use of a real-time PCR assay. Clin Infect Dis 33:1756–1761

    Article  PubMed  CAS  Google Scholar 

  83. Michel D, Marre E, Hampl W et al (1995) Intestinal cytomegalovirus disease in immunocompromised patients may be ruled out by search for cytomegalovirus DNA in stool samples. J Clin Microbiol 33:3064–3067

    PubMed Central  PubMed  CAS  Google Scholar 

  84. Torres-Madriz G, Boucher HW (2008) Immunocompromised hosts: perspectives in the treatment and prophylaxis of cytomegalovirus disease in solid-organ transplant recipients. Clin Infect Dis 47:702–711

    Article  PubMed  Google Scholar 

  85. Zaia JA (2002) Prevention of cytomegalovirus disease in hematopoietic stem cell transplantation. Clin Infect Dis 35:999–1004

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Stuart Johnson .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer International Publishing Switzerland (outside USA)

About this chapter

Cite this chapter

Wang, M., Johnson, S. (2014). Enteric Infections. In: Stosor, V., Zembower, T. (eds) Infectious Complications in Cancer Patients. Cancer Treatment and Research, vol 161. Springer, Cham. https://doi.org/10.1007/978-3-319-04220-6_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-04220-6_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-04219-0

  • Online ISBN: 978-3-319-04220-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics