Signs and symptoms of infections and differential diagnosis from noninfectious conditions

  • Robert Hemmer
Part of the Cancer Treatment and Research book series (CTAR, volume 79)


Infection of the lung is one of the most frequent infections seen in cancer patients, or at least it is one of the most frequently diagnosed on radiography or computed tomography (CT) scan. Aspiration of oropharyngeal bacteria is the usual mechanism by which patients acquire lung infection, and the hematogenous route is more exceptional. Lung infection is favored by local obstruction, for example, a tumor mass caused by lung cancer or, less frequently, metastatic cancer.


Neutropenic Patient Adult Respiratory Distress Syndrome Cryptococcal Meningitis Pyoderma Gangrenosum Radiation Pneumonitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Haron E, Vartivarian S, Anaissie E, Dekmezian R, Bodey GP. 1993. Primary Candida pneumonia. Experience at a large cancer center and review of the literature. Medicine 72:137–142.PubMedGoogle Scholar
  2. 2.
    Armstrong D. 1989. Problems in management of opportunistic fungal diseases. Rev Infect Dis 11:S1591-S1599.PubMedCrossRefGoogle Scholar
  3. 3.
    Ognibene FP, Martin SE, Parker MM, et al. 1986. Adult respiratory distress syndrome in patients with severe neutropenia. N Engl J Med 315:547–551.PubMedCrossRefGoogle Scholar
  4. 4.
    Laufe MD, Simon RH, Flint A, Keller JB. 1986. Adult respiratory distress syndrome in neutropenic patients. Am J Med 80:1022–1026.PubMedCrossRefGoogle Scholar
  5. 5.
    Classen DC, Burke JP, Ford CD, Evershed S, Aloia MR, Wilfahrt JK, Elliot JA. 1990. Streptococcus mitis sepsis in bone marrow transplant patients receiving oral antimicrobial prophylaxis. Am J Med 89:441–446.PubMedCrossRefGoogle Scholar
  6. 6.
    Donowitz GR, Harman C, Pope T, Stewart M. 1991. The role of the chest roentgenogram in febrile neutropenic patients. Arch Intern Med 151:701–704.PubMedCrossRefGoogle Scholar
  7. 7.
    Curtis HM, Walker Smith GJ, Ravin CE. 1979. Air crescent sign of invasive aspergillosis. Radiology 133:17–21.PubMedGoogle Scholar
  8. 8.
    Funada H, Misawa T, Nakao S, Saga T, Hattori KI. 1984. The air crescent sign of invasive pulmonary mucormycosis in acute leukemia. Cancer 53:2721–2723.PubMedCrossRefGoogle Scholar
  9. 9.
    Gold W, Vellend H, Brunton J. 1992. The air crescent sign caused by Staphylococcus aureus lung infection in a neutropenic patient with leukemia. Ann Intern Med 116:910–911.PubMedGoogle Scholar
  10. 10.
    Barloon TJ, Galvin JR, Mori M, Stanford W, Gingrich RD. 1991. High-resolution ultrafast chest CT in the clinical management of febrile bone marrow transplant patients with normal or nonspecific chest roentgenograms. Chest 99:928–933.PubMedCrossRefGoogle Scholar
  11. 11.
    Yu VL, Muder RR, Poorsattar A. 1986. Significance of isolation of Aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergillosis. Am J Med 81:249–254.PubMedCrossRefGoogle Scholar
  12. 12.
    Wimberley NW, Bass JB, Boyd BW, Kirkpatrick MB, Serio RA, Pollock HM. 1982. Use of a bronchoscopic protected catheter brush for the diagnosis of pulmonary infections. Chest 82:556–562.CrossRefGoogle Scholar
  13. 13.
    Rouby JJ, Rossignon MD, Nicolas MH, Martin de Lassale E, Cristin S, Grosset G, Viars P. 1989. A prospective study of protected bronchoalveolar lavage in the diagnosis of nosocomial pneumonia. Anesthesiology 71:679–685.PubMedCrossRefGoogle Scholar
  14. 14.
    Fagon JY, Chastre J, Hance AJ, Guiguet M, Trouillet JL, Domart Y. 1988. Detection of nosocomial lung infection in ventilated patients: Use of a protected specimen brush and quantitative culture techniques in 147 patients. Am Rev Respir Dis 138:110–116.PubMedGoogle Scholar
  15. 15.
    Masse M, Andreu G, Angue M, et al. 1991. A multicenter study on the efficiency of white cell reduction by filtration of red cells. Transfusion 31:792–797.PubMedCrossRefGoogle Scholar
  16. 16.
    Lew D, Southwick FS, Montgomery WW, Weber Al, Baker AS. 1983. Sphenoid sinusitis. A review of 30 cases. N Engl J Med 309:1149–1154.PubMedCrossRefGoogle Scholar
  17. 17.
    Morrison VA, Weisdorf DJ. 1993. Alternia: A sinonasal pathogen of immunocompromised hosts. Clin Infect Dis 16:265–270.PubMedCrossRefGoogle Scholar
  18. 18.
    Goering P, Berlinger NT, Weisdorf DJ. 1988. Aggressive combined modality treatment of progressive sinonasal fungal infections in immunocompromised patients. Am J Med 85:619–623.PubMedCrossRefGoogle Scholar
  19. 19.
    Wolfson JS, Sober AJ, Rubin RH. 1985. Dermatologic manifestations of infections in immunocompromised patients. Medicine 64:115–133.PubMedCrossRefGoogle Scholar
  20. 20.
    Harris RL, Fainstein V, Elting L, Hopfer RL, Bodey GP. 1985. Bacteremia caused by Aeromonas species in hospitalized cancer patients. Rev Infect Dis 7:314–320.PubMedCrossRefGoogle Scholar
  21. 21.
    Tacket CO, Brenner F, Blake PA. 1984. Clinical features and an epidemiologic study of Vibrio vulnificus infection. J Infect Dis 149:558–561.PubMedCrossRefGoogle Scholar
  22. 22.
    Meyer RD, Kaplan MH, Ong M, et al. 1973. Cutaneous lesions in disseminated mucormycosis. JAMA 225:737–738.PubMedCrossRefGoogle Scholar
  23. 23.
    Edwards JE, Lehrer RI, Stiehm ER, et al. 1978. Severe candidal infections. Ann Intern Med 89:91–106.PubMedGoogle Scholar
  24. 24.
    Gander JP. 1977. Cryptococcal cellulitis. JAMA 237:672–673.CrossRefGoogle Scholar
  25. 25.
    Hay CRM, Messenger AG, Cotton DWK, et al. 1987. Atypical bullous pyoderma gangrenosum associated with myeloid malignancies. J Clin Pathol 40:387–392.PubMedCrossRefGoogle Scholar
  26. 26.
    Cohen PR, Kurzrock R. 1987. Sweet’s syndrome and malignancy. Am J Med 82:1220–1226.PubMedCrossRefGoogle Scholar
  27. 27.
    Kristjansson M, Bieluch VM, Byeff PD. 1991. Mycobacterium haemophilum infection in immuno-compromised patients: Case report and review of the literature. Rev Infect Dis 13:906–910.PubMedCrossRefGoogle Scholar
  28. 28.
    Kiehn TE. 1992. Mycobacterium haemophilum: A new opportunistic pathogen. Clin Microbiol Newslett 14:81–84.CrossRefGoogle Scholar
  29. 29.
    Press OW, Ramsey PG, Larson EB, Fefer A, Hickman RO. 1984. Hickman catheter infections in patients with malignancies. Medicine 63:619–623.CrossRefGoogle Scholar
  30. 30.
    Groeger JS, Lucas AB, Thaler HT, Friedlander-Klar H, Brown AE, Kiehn TE, Armstrong D. 1993. Infectious morbidity associated with long-term use of venous access devices in patients with cancer. Ann Intern Med 119:1168–1174.PubMedGoogle Scholar
  31. 31.
    Flynn PM, Van Hooser B, Gigliotti F. 1988. Atypical mycobacterial infections of Hickman catheter exit sites. Pediatr Infect Dis J 7:510–513.PubMedCrossRefGoogle Scholar
  32. 32.
    Raad II, Vartivarian S, Khan A, Bodey GP. 1991. Catheter-related infections caused by the Mycobacterium fortuitum complex: 15 cases and review. Rev Infect Dis 13:1120–1125.PubMedCrossRefGoogle Scholar
  33. 33.
    Flynn PM, Shenep JL, Stokes DC, Barrett FF. 1987. In situ management of confirmed central venous catheter-related bacteremia. Pediatr Infect Dis 6:729–734.CrossRefGoogle Scholar
  34. 34.
    Benezra D, Kiehn TE, Gold JW, Brown AE, Turnbull AD, Armstrong D. 1988. Prospective study of infections in indwelling central venous catheters using quantitative blood cultures. Am J Med 85: 495–498.PubMedCrossRefGoogle Scholar
  35. 35.
    Wheeler RR, Peacock JE Jr, Cruz JM, Richter JE. 1987. Esophagitis in the immunocompromised host: Role of esophagoscopy in diagnosis. Rev Infect Dis 9:88–96.PubMedCrossRefGoogle Scholar
  36. 36.
    Goodgame RW. 1993. Gastrointestinal cytomegalovirus disease. Ann Intern Med 119:924–935.PubMedGoogle Scholar
  37. 37.
    Crowan J, Burrell M, Trepata R. 1980. Aphthoid ulcerations in gastric candidiasis. Radiology 134:607.Google Scholar
  38. 38.
    Pugh TF, Fitch SJ. 1986. Invasive gastric candidiasis. Pediatr Radiol 16:67–68.PubMedCrossRefGoogle Scholar
  39. 39.
    Samuels BI, Pagani JJ, Libschitz HI. 1993. Radiologic features of Candida infections. In: Bodey GP, ed Candidiasis: Pathogenesis, Diagnosis and Treatment, New York: Raven Press, pp 137–157.Google Scholar
  40. 40.
    Lewis JI, Hart CA, Baxby D. 1985. Diarrhoea due to cryptosporidium in acute lymphoblastic leukaemia. Arch Dis Child 60:60–62.PubMedCrossRefGoogle Scholar
  41. 41.
    Heard SR, O’Farrell S, Holland D, Crook S, Barnett MJ, Tabaqchali S. 1986. The epidemiology of Clostridium difficile with use of a typing scheme: Nosocomial acquisition and cross-infection among immunocompromised patients. J Infect Dis 153:159–162.PubMedCrossRefGoogle Scholar
  42. 42.
    Gérard M, Defresne N, Daneau D, Van der Auwera P, Delmée M, Bourguignon AM, Meunier F. 1988. Incidence and significance of Clostridium difficile in hospitalized cancer patients. Eur J Clin Microbiol Infect Dis 7:274–278.PubMedCrossRefGoogle Scholar
  43. 43.
    McFarland LV, Mulligan ME, Kwok RYY, Stamm WE. 1989. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 320:204–210.PubMedCrossRefGoogle Scholar
  44. 44.
    Scowden EB, Schaffner W, Stone WJ. 1978. Overwhelming strongyloidiasis. Medicine 57:527–544.PubMedCrossRefGoogle Scholar
  45. 45.
    Powell RW, Moss JP, Nagar D, Melo JC, Boram LH, Anderson WH, Cheng SH. 1980. Strongyloidiasis in immunosuppressed hosts. Presentation as massive lower gastrointestinal bleeding. Arch Intern Med 140:1061–1063.PubMedCrossRefGoogle Scholar
  46. 46.
    Koransky JR, Stargel MD, Dowell VR. 1979. Clostridium septicum bacteremia. Its clinical significance. Am J Med 66:63–66.PubMedCrossRefGoogle Scholar
  47. 47.
    Tashjian LS, Abramson JS, Peacock JE. 1984. Focal hepatic candidiasis: A distinct clinical variant of candidiasis in immunocompromised patients. Rev Infect Dis 6:689–703.PubMedCrossRefGoogle Scholar
  48. 48.
    Thaler M, Pastakia B, Shawker TH, O’Leary T, Pizzo PA. 1988. Hepatic candidiasis in cancer patients: The evolving picture of the syndrome. Ann Intern Med 108:88–100.PubMedGoogle Scholar
  49. 49.
    Kaplan MH, Armstrong D, Rosen P. 1974. Tuberculosis complicating neoplastic disease. A review of 201 cases. Cancer 33:850–858.PubMedCrossRefGoogle Scholar
  50. 50.
    Schoenbaum SC, Gardner P, Shillito J. 1975. Infections of cerebrospinal fluid shunts: Epidemiology, clinical manifestations, and therapy. J Infect Dis 131:543–552.PubMedCrossRefGoogle Scholar
  51. 51.
    Rekate HL, Ruch T, Nulsen FE. 1980. Diphteroid infections of cerebrospinal fluid shunts. The changing pattern of shunt infection in Cleveland. J Neurosurg 52:553–556.PubMedCrossRefGoogle Scholar
  52. 52.
    Chernik NL, Armtrong D, Posner JB. 1977. Central nervous system infections in patients with cancer: Changing patterns. Cancer 40:268–274.PubMedCrossRefGoogle Scholar
  53. 53.
    Louria DB, Hensle T, Armstrong D, et al. 1967. Listeriosis complicating malignant disease, a new association. Ann Intern Med 67:261–281.Google Scholar
  54. 54.
    Diamond RD, Bennett JE. 1974. Prognostic factors in cryptococcal meningitis: A study in 111 cases. Ann Intern Med 80:176–181.PubMedGoogle Scholar
  55. 55.
    Dismukes WE, Cloud G, Gallis HA, et al. 1987. Treatment of cryptococcal meningitis with combination amphotericin B and flucytosine for four as compared with six weeks. N Engl J Med 317:334–341.PubMedCrossRefGoogle Scholar
  56. 56.
    Salaki JS, Louria DB, Chmel H. 1984. Fungal and yeast infections of the central nervous system. A clinical review. Medicine 63:108–132.PubMedCrossRefGoogle Scholar
  57. 57.
    Ruskin J. 1989. Parasitic diseases in the compromised host. In: Rubin RH, Young LS, eds Clinical Approach to Infection in the Compromised Host, 2nd ed New York: Plenum Medical, pp 253–304.Google Scholar
  58. 58.
    Porter SB, Sande MA. 1992. Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. N Engl J Med 327:1643–1648.PubMedCrossRefGoogle Scholar
  59. 59.
    Luft BJ, Remington JS. 1992. Toxoplasmic encephalitis in AIDS. Clin Infect Dis 15:211–222.PubMedCrossRefGoogle Scholar
  60. 60.
    Auerbach M, Haubenstock A, Soloman G. 1986. Systemic babesiosis. Another cause of the hemophagocytic syndrome. Am J Med 80:301–303.PubMedCrossRefGoogle Scholar
  61. 61.
    Klastersky J. 1993. Febrile neutropenia. Curr Opin Oncol 5:625–632.PubMedCrossRefGoogle Scholar
  62. 62.
    The International Antimicrobial Therapy Cooperative Group of the European Organization for Research and Treatment of Cancer. 1993. Efficacy and toxicity of single daily doses of amikacin and ceftriaxone versus multiple daily doses of amikacin and ceftazidime for infection in patients with cancer and granulocytopenia. Ann Intern Med 119:584–593.Google Scholar
  63. 63.
    Kiehn TE, Wong B, Edward FF, Armstrong D. 1983. Comparative recovery of bacteria and yeasts from lysis-centrifugation and a conventional blood culture system. J Clin Microbiol 18:300–304.PubMedGoogle Scholar
  64. 64.
    Buller RS, Bailey TC, Ettinger NA, Keener M, Langlois T, Miller JP, Storch GA. 1992. Use of a modified shell vial technique to quantitate cytomegalovirus viremia in a population of solid-organ transplant recipients. J Clin Microbiol 30:2620–2624.PubMedGoogle Scholar
  65. 65.
    Zipeto D, Revello MG, Silini E, Parea M, et al. 1992. Development and clinical significance of a diagnostic assay based on the polymerase chain reaction for detection of human cytomegalovirus DNA in blood samples from immunocompromised patients. J Clin Microbiol 30:527–530.PubMedGoogle Scholar
  66. 66.
    Delgado R, Lumbreras C, Alba C, et al. 1992. Low predictive value of polymerase chain reaction for diagnosis of cytomegalovirus disease in liver transplant recipients. J Clin Microbiol 30:1876–1878.PubMedGoogle Scholar
  67. 67.
    Drew WL. 1992. Nonpulmonary manifestations of cytomegalovirus infection in immunocompromised patients. Clin Microbiol Rev 5:204–210.PubMedGoogle Scholar
  68. 68.
    Riikonen P, Saarinen UM, Teppo AM, Metsärinne K, Fyhrquist F, Jalanko H. 1992. Cytokine and acute-phase reactant levels in serum of children with cancer admitted for fever and neutropenia. J Infect Dis 166:432–436.PubMedCrossRefGoogle Scholar
  69. 69.
    Riikonen P, Jalanko H, Hovi L, Saarinen UM. 1993. Fever and neutropenia in children with cancer: Diagnostic parameters at presentation. Acta Paediatr 82:271–275.PubMedCrossRefGoogle Scholar
  70. 70.
    Ligtenberg PC, Hoepelman IM, Oude Sogtoen GAC, Dekker AW, Van der Tweel I, Rozenberg-Arska M, Verhoef J. 1991. C-reactive protein in the diagnosis and management of infections in granulocytopenic and non-granulocytopenic patients. Eur J Clin Microbiol Infect Dis 10:25–31.PubMedCrossRefGoogle Scholar
  71. 71.
    Riikonen P, Leinonen M, Jalanko H, Hovi L, Saarinen UM. 1993. Fever and neutropenia: Bacterial etiology revealed by serological methods. Acta Paediatr 82:355–359.PubMedCrossRefGoogle Scholar
  72. 72.
    Walsh TJ, Hathorn JW, Sobel JD, et al. 1991. Detection of circulating Candida enolase by immunoassay in patients with cancer and invasive candidiasis. N Engl J Med 324:1026–1031.PubMedCrossRefGoogle Scholar
  73. 73.
    Peter JB. 1991. The polymerase chain reaction: Amplifying our options. Rev Infect Dis 13: 166–171.PubMedCrossRefGoogle Scholar
  74. 74.
    Meunier-Carpentier F, Kiehn TE, Armstrong D. 1981. Fungemia in the immunocompromised host. Am J Med 71:363–370.PubMedCrossRefGoogle Scholar
  75. 75.
    Maksymiuk AW, Thongprasert S, Hopfer R, Luna M, Fainstein V, Bodey GP. 1984. Systemic candidiasis in cancer patients. Am J Med 77:20–27.PubMedGoogle Scholar
  76. 76.
    Ellis CA, Spivack ML. 1967. The significance of Candidemia. Ann Intern Med 67:511–521.PubMedGoogle Scholar
  77. 77.
    Lecciones JA, Lee JW, Navarro EE, et al. 1992. Vascular catheter-associated fungemia in patients with cancer: Analysis of 155 episodes Clin Infect Dis 14:875–883.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1995

Authors and Affiliations

  • Robert Hemmer

There are no affiliations available

Personalised recommendations