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Mucosal Barrier Injury and Infections

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Book cover Principles and Practice of Cancer Infectious Diseases

Part of the book series: Current Clinical Oncology ((CCO))

Abstract

Neutropenia is well known as a risk factor for infectious complications of patients treated for hematological malignancies. Less is known about the impact of intensive chemotherapy on the epithelial innate immunity that protects us from infections due to opportunistic pathogens that reside on the mucosal surfaces. Injury to the mucosal barrier leads to barrier dysfunction, perturbed microbial signaling and inadequate host responses all of which increase the risk for life-threatening clinically- and microbilogically-defined infections. Greater awareness of mucosal barrier injury should help the physician to know better when and how to act when fever occurs during neutropenia.

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References

  1. Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med. 1966;64(2):328–40.

    Article  PubMed  CAS  Google Scholar 

  2. Schimpff SC, Satterlee W, Young VM, Serpick A. Empiric therapy with carbenicillin and gentamicin for febrile patients with cancer and granulocytopenia. N Engl J Med. 1971;284:1061–5.

    Article  PubMed  CAS  Google Scholar 

  3. De Pauw BE, Deresinski SC, Feld R, lane-Allman EF, Donnelly JP. Ceftazidime compared with piperacillin and trobramycin for the empiric treatment of fever in neutropenic patients with cancer – a multicenter randomized trial. Ann Intern Med. 1994;120:834–44.

    Article  PubMed  Google Scholar 

  4. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, et al. 2002 Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002;34(6):730–51.

    Article  PubMed  Google Scholar 

  5. De Pauw BE, Raemaekers JM, Schattenberg A, Donnelly JP. Empirical and subsequent use of antibacterial agents in the febrile neutropenic patient. J Intern Med. 1997;242 Suppl 740:69–77.

    Google Scholar 

  6. Fainstein V, Rodriguez V, Turck M, Hermann G, Rosenbaum B, Bodey GP. Patterns of oropharyngeal and fecal flora in patients with adult leukemia. J Infect Dis. 1981;144:82–6.

    Google Scholar 

  7. Blijlevens NMA, Donnelly JP, De Pauw BE. Mucosal barrier injury: biology, pathology, clinical counterparts and consequences of intensive treatment for haematological malignancy: an overview. Bone Marrow Transplant. 2000;25:1269–78.

    Article  PubMed  CAS  Google Scholar 

  8. Gafter-Gvili A, Fraser A, Paul M, Leibovici L. Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Intern Med. 2005;142(12 Pt 1):979–95.

    Article  PubMed  Google Scholar 

  9. Marchetti O, Calandra T. Infections in neutropenic cancer patients. Lancet. 2002;359(9308):723–5.

    Article  PubMed  Google Scholar 

  10. Wisplinghoff H, Seifert H, Wenzel RP, Edmond MB. Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis. 2003;36:1103–10.

    Article  PubMed  Google Scholar 

  11. Vardakas KZ, Samonis G, Chrysanthopoulou SA, Bliziotis IA, Falagas ME. Role of glycopeptides as part of initial empirical treatment of febrile neutropenic patients: a meta-analysis of randomised controlled trials. Lancet Infect Dis. 2005;5(7):431–9.

    Article  PubMed  CAS  Google Scholar 

  12. Erjavec Z, De Vries-Hospers HG, Laseur M, Halie R, Daenen S. A prospective, randomized, double-blinded, placebo-controlled trial of empirical teicoplanin in febrile neutropenia with persistent fever after imipenem monotherapy. J Antimicrob Chemother. 2000;45:843–9.

    Article  PubMed  CAS  Google Scholar 

  13. Paul M, Borok S, Fraser A, Vidal L, Leibovici L. Empirical ­antibiotics against Gram-positive infections for febrile neutropenia: systematic review and meta-analysis of randomized controlled ­trials. J Antimicrob Chemother. 2005;55(4):436–44.

    Article  PubMed  CAS  Google Scholar 

  14. Smith TJ, Khatcheressian J, Lyman GH, Ozer H, Armitage JO, Balducci L, et al. 2006 Update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol. 2006;24(19):3187–205.

    Article  PubMed  CAS  Google Scholar 

  15. Dekker A, Bulley S, Beyene J, Dupuis LL, Doyle JJ, Sung L. Meta-analysis of randomized controlled trials of prophylactic granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor after autologous and allogeneic stem cell transplantation. J Clin Oncol. 2006;24(33):5207–15.

    Article  PubMed  CAS  Google Scholar 

  16. Eckmann L. Innate immunity and mucosal bacterial interactions in the intestine. Curr Opin Gastroenterol. 2004;20(2):82–8.

    Article  PubMed  CAS  Google Scholar 

  17. Weindl G, Naglik JR, Kaesler S, Biedermann T, Hube B, Korting HC, et al. Human epithelial cells establish direct antifungal defense through TLR4-mediated signaling. J Clin Invest. 2007;117(12):3664–72.

    PubMed  CAS  Google Scholar 

  18. Rocha V, Franco RF, Porcher R, Bittencourt H, Silva Jr WA, Latouche A, et al. Host defense and inflammatory gene polymorphisms are associated with outcomes after HLA-identical sibling bone marrow transplantation. Blood. 2002;100(12):3908–18.

    Article  PubMed  CAS  Google Scholar 

  19. Mullighan CG, Heatley SL, Danner S, Dean MM, Doherty K, Hahn U, et al. Mannose-binding lectin status is associated with risk of major infection following myeloablative sibling allogeneic hematopoietic stem cell transplantation. Blood. 2008;112(5):2120–8.

    Article  PubMed  CAS  Google Scholar 

  20. Holler E, Rogler G, Herfarth H, Brenmoehl J, Wild PJ, Hahn J, et al. Both donor and recipient NOD2/CARD15 mutations associate with transplant-related mortality and GvHD following allogeneic stem cell transplantation. Blood. 2004;104(3):889–94.

    Article  PubMed  CAS  Google Scholar 

  21. Strober W, Murray PJ, Kitani A, Watanabe T. Signalling pathways and molecular interactions of NOD1 and NOD2. Nat Rev Immunol. 2006;6(1):9–20.

    Article  PubMed  CAS  Google Scholar 

  22. Hugot JP, Chamaillard M, Zouali H, Lesage S, Cezard JP, Belaiche J, et al. Association of NOD2 leucine-rich repeat variants with susceptibility to Crohn’s disease. Nature. 2001;411(6837):599–603.

    Article  PubMed  CAS  Google Scholar 

  23. Mullally A, Ritz J. Beyond HLA: the significance of genomic variation for allogeneic hematopoietic stem cell transplantation. Blood. 2007;109(4):1355–62.

    Article  PubMed  CAS  Google Scholar 

  24. Uehara A, Takada H. Synergism between TLRs and NOD1/2 in oral epithelial cells. J Dent Res. 2008;87(7):682–6.

    Article  PubMed  CAS  Google Scholar 

  25. Sonis ST. The pathobiology of mucositis. Nat Rev Cancer. 2004;4(4):277–84.

    Article  PubMed  CAS  Google Scholar 

  26. Beck PL, Wong JF, Li Y, Swaminathan S, Xavier RJ, Devaney KL, et al. Chemotherapy- and radiotherapy-induced intestinal damage is regulated by intestinal trefoil factor. Gastroenterology. 2004;126:796–808.

    Article  PubMed  CAS  Google Scholar 

  27. Parks WC, Wilson CL, Lopez-Boado YS. Matrix metalloproteinases as modulators of inflammation and innate immunity. Nat Rev Immunol. 2004;4:617–29.

    Article  PubMed  CAS  Google Scholar 

  28. Finch PW, Rubin JS. Keratinocyte growth factor/fibroblast growth factor 7, a homeostatic factor with therapeutic potential for epithelial protection and repair. Adv Cancer Res. 2004;91:69–136.

    Article  CAS  Google Scholar 

  29. Blijlevens N, Schwenkglenks M, Bacon P, D’Addio A, Einsele H, Maertens J, et al. Prospective oral mucositis audit: oral mucositis in patients receiving high-dose melphalan or BEAM conditioning chemotherapy – European Blood and Marrow Transplantation Mucositis Advisory Group. J Clin Oncol. 2008;26(9):1519–25.

    Article  PubMed  CAS  Google Scholar 

  30. Grazziutti ML, Dong L, Miceli MH, Krishna SG, Kiwan E, Syed N, et al. Oral mucositis in myeloma patients undergoing melphalan-based autologous stem cell transplantation: incidence, risk factors and a severity predictive model. Bone Marrow Transplant. 2006;38(7):501–6.

    Article  PubMed  CAS  Google Scholar 

  31. Costa LJ, Micallef IN, Inwards DJ, Johnston PB, Porrata LF, Litzow MR, et al. Effect of the dose per body weight of conditioning chemotherapy on severity of mucositis and risk of relapse after autologous haematopoietic stem cell transplantation in relapsed diffuse large B cell lymphoma. Br J Haematol. 2008;143(2):268–73.

    Article  PubMed  CAS  Google Scholar 

  32. Kuhne A, Sezer O, Heider U, Meineke I, Muhlke S, Niere W, et al. Population pharmacokinetics of melphalan and glutathione S-transferase polymorphisms in relation to side effects. Clin Pharmacol Ther. 2008;83(5):749–57.

    Article  PubMed  CAS  Google Scholar 

  33. McCann S, Schwenkglenks M, Bacon P, Einsele H, D’Addio A, Maertens J, et al. The Prospective Oral Mucositis Audit: relationship of severe oral mucositis with clinical and medical resource use outcomes in patients receiving high-dose melphalan or BEAM-conditioning chemotherapy and autologous SCT. Bone Marrow Transplant. 2009;43(2):141–7.

    Article  PubMed  CAS  Google Scholar 

  34. Elting LS, Cooksley C, Chambers M, Cantor SB, Manzullo E, Rubenstein EB. The burdens of cancer therapy: clinical and economic outcomes of chemotherapy-induced mucositis. Cancer. 2003;98:1531–9.

    Article  PubMed  Google Scholar 

  35. Sonis ST, Oster G, Fuchs H, Bellm L, Bradford WZ, Edelsberg J, et al. Oral mucositis and the clinical and economic outcomes of hematopoietic stem-cell transplantation. J Clin Oncol. 2001;19(8):2201–5.

    PubMed  CAS  Google Scholar 

  36. Fanning SR, Rybicki L, Kalaycio M, Andresen S, Kuczkowski E, Pohlman B, et al. Severe mucositis is associated with reduced survival after autologous stem cell transplantation for lymphoid malignancies. Br J Haematol. 2006;135(3):374–81.

    Article  PubMed  CAS  Google Scholar 

  37. Wardley AM, Jayson GC, Swindell R, Morgenstern GR, Chang J, Bloor R, et al. Prospective evaluation of oral mucositis in patients receiving myeloablative conditioning regimens and haematopoietic progenitor rescue. Br J Haematol. 2000;110(292):299.

    Google Scholar 

  38. van de Velden WJ, Blijlevens NM, Feuth T, Donnelly JP. Febrile mucositis in haematopoietic SCT recipients. Bone Marrow Transplant. 2009;43(1):55–60.

    Article  PubMed  Google Scholar 

  39. Blijlevens NM, Donnelly JP, DePauw BE. Inflammatory response to mucosal barrier injury after myeloablative therapy in allogeneic stem cell transplant recipients. Bone Marrow Transplant. 2005;36(8):703–7.

    Article  PubMed  CAS  Google Scholar 

  40. Wedlake L, McGough C, Hackett C, Thomas K, Blake P, Harrington K, et al. Can biological markers act as non-invasive, sensitive indicators of radiation-induced effects in the gastrointestinal mucosa? Aliment Pharmacol Ther. 2008;27(10):980–7.

    Article  PubMed  CAS  Google Scholar 

  41. Herbers AH, Blijlevens NM, Donnelly JP, de Witte TJ. Bacteraemia coincides with low citrulline concentrations after high-dose ­melphalan in autologous HSCT recipients. Bone Marrow Transplant. 2008;42(5):345–9.

    Article  PubMed  CAS  Google Scholar 

  42. Tsuji E, Hiki N, Nomura S, Fukushima R, Kojima J, Ogawa T, et al. Simultaneous onset of acute inflammatory response, sepsis-like symptoms and intestinal mucosal injury after cancer chemotherapy. Int J Cancer. 2003;107(2):303–8.

    Article  PubMed  CAS  Google Scholar 

  43. Costa SF, Miceli MH, Anaissie EJ. Mucosa or skin as source of coagulase-negative staphylococcal bacteraemia? Lancet Infect Dis. 2004;4(5):278–86.

    Article  PubMed  Google Scholar 

  44. Blijlevens NMA, van-’t Land B, Donnelly JP. Gram-positive bacteremia coincides with impaired gut integrity in HSCT recipients. Int J Infect Dis. 2002;6 Suppl 2:2S32–3.

    Google Scholar 

  45. Gassas A, Grant R, Richardson S, Dupuis LL, Doyle J, Allen U, et al. Predictors of viridans streptococcal shock syndrome in ­bacteremic children with cancer and stem-cell transplant recipients. J Clin Oncol. 2004;22(7):1222–7.

    Article  PubMed  Google Scholar 

  46. Vera-Llonch M, Oster G, Ford CM, Lu J, Sonis S. Oral mucositis and outcomes of allogeneic hematopoietic stem-cell transplantation in patients with hematologic malignancies. Support Care Cancer. 2007;15(5):491–6.

    Article  PubMed  Google Scholar 

  47. Ruescher TJ, Sodeifi A, Scrivani SJ, Kaban LB, Sonis ST. The impact of mucositis on alpha-hemolytic streptococcal infection in patients undergoing autologous bone marrow transplantation for hematologic malignancies. Cancer. 1998;82(11):2275–81.

    Article  PubMed  CAS  Google Scholar 

  48. Elting LS, Bodey GP, Keefe BH. Septicemia and shock syndrome due to viridans streptococci: a case-control study of predisposing factors. Clin Infect Dis. 1992;14(6):1201–7.

    Article  PubMed  CAS  Google Scholar 

  49. Deenik W, van der Holt B, Verhoef GE, Smit WM, Kersten MJ, Kluin-Nelemans HC, et al. Dose-finding study of imatinib in combination with intravenous cytarabine: feasibility in newly diagnosed patients with chronic myeloid leukemia. Blood. 2008;111(5):2581–8.

    Article  PubMed  CAS  Google Scholar 

  50. Cordonnier C, Buzyn A, Leverger G, Herbrecht R, Hunault M, Leclercq R, et al. Epidemiology and risk factors for Gram-Positive coccal infections in neutropenia: toward a more targeted antibiotic strategy. Clin Infect Dis. 2003;36:149–58.

    Article  PubMed  Google Scholar 

  51. de Souza V, Serufo JC, da Costa Rocha MO, Costa RN, Duarte RC. Performance of a modified MASCC index score for identifying low-risk febrile neutropenic cancer patients. Support Care Cancer. 2008;16(7):841–6.

    Article  Google Scholar 

  52. Zollner-Schwetz I, Auner HW, Paulitsch A, Buzina W, Staber PB, Ofner-Kopeinig P, et al. Oral and intestinal Candida colonization in patients undergoing hematopoietic stem-cell transplantation. J Infect Dis. 2008;198(1):150–3.

    Article  PubMed  Google Scholar 

  53. Bow EJ, Loewen R, Cheang MS, Shore TB, Rubinger M, Schacter B. Cytotoxic therapy-induced D-xylose malabsorption and invasive infection during remission-induction therapy for acute myeloid leukemia in adults. J Clin Oncol. 1997;15(6):2254–61.

    PubMed  CAS  Google Scholar 

  54. Gorschluter M, Marklein G, Hofling K, Clarenbach R, Baumgartner S, Hah C, et al. Abdominal infections in patients with acute leukaemia: a prospective study applying ultrasonography and microbiology. Br J Haematol. 2002;117:351–8.

    Article  PubMed  Google Scholar 

  55. Gomez L, Martino R, Rolston KV. Neutropenic enterocolitis: spectrum of the disease and comparison of definite and possible cases. Clin Infect Dis. 1998;27:695–9.

    Article  PubMed  CAS  Google Scholar 

  56. Gorschluter M, Mey U, Strehl J, Ziske C, Schepke M, Schmidt-Wolf IG, et al. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol. 2005;75(1):1–13.

    Article  PubMed  Google Scholar 

  57. Cardona AF, Ramos PL, Casasbuenas A. From case reports to systematic reviews in neutropenic enterocolitis. Eur J Haematol. 2005;75(5):445–6.

    Article  PubMed  Google Scholar 

  58. Sloas MM, Flynn PM, Kaste SC, Patrick CC. Typhlitis in children with cancer: a 30-year experience. Clin Infect Dis. 1993;17(3):484–90.

    Article  PubMed  CAS  Google Scholar 

  59. Dietrich CF, Hermann S, Klein S, Braden B. Sonographic signs of neutropenic enterocolitis. World J Gastroenterol. 2006;12(9):1397–402.

    PubMed  Google Scholar 

  60. McCarville MB. Evaluation of typhlitis in children: CT versus US. Pediatr Radiol. 2006;36(8):890–1.

    Article  PubMed  Google Scholar 

  61. Ellis M, Zwaan F, Hedstrom U, Poynton CH, Kristensen J, Jumaa P, et al. Recombinant human interleukin 11 and bacterial infection in patients with haemological malignant disease undergoing chemotherapy: a double-blind placebo-controlled randomised trial. Lancet. 2003;361:275–80.

    Article  PubMed  CAS  Google Scholar 

  62. Spielberger R, Stiff P, Bensinger W, Gentile T, Weisdorf D, Kewalramani T, et al. Palifermin for oral mucositis after intensive therapy for hematologic cancers. N Engl J Med. 2004;351(25):2590–8.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Nicole M. A. Blijlevens .

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Blijlevens, N.M.A., Donnelly, J.P. (2011). Mucosal Barrier Injury and Infections. In: Safdar, A. (eds) Principles and Practice of Cancer Infectious Diseases. Current Clinical Oncology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-644-3_14

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