Skin and Soft Tissue Infections Among Cancer Patients
Necrotizing soft tissue infections are characterized by a rapid and large-scale tissue destruction, usually accompanied by severe systemic toxicity. Necrotizing fasciitis (NF) affects the subcutaneous fat and the deep fascia. The infection can be polymicrobial (type I), associated with a breach of a mucosal barrier, or monomicrobial (type II), occurring after a skin penetration or spontaneously following blunt trauma. Given the lack of clinical suspicion, NF is frequently misdiagnosed as a simple cellulitis with devastating consequences. Early debridement and rapid onset of appropriate antibiotic therapy are essential to decrease its high morbidity and mortality.
Cellulitis, erysipelas, and skin abscess are common in patients who have undergone invasive surgery, lymphadenectomy, or recent bacteremia.
Perirectal infections are frequent in hematological cancer patients with prolonged and profound neutropenia. Treatment consists of broad-spectrum antibiotic therapy and, when possible, incision and drainage.
Ecthyma gangrenosum is frequently seen in patients with acute leukemia and neutropenia. Gram-negative rods, mainly Pseudomonas aeruginosa, are the most common etiology. Diagnosis is based on clinical suspicion and biopsy of the lesion. Treatment involves empiric antibiotic therapy until final identification of the causative organism. Surgical excision is often necessary.
Necrotic tumors involving the skin are at risk of secondary polymicrobial infection. Treatment is difficult as antimicrobials may not adequately reach the site of infection due to the impairment in blood supply.
KeywordsSoft tissue Gas gangrene Necrotizing fasciitis Cellulitis Erysipelas Skin abscess Perirectal infection Ecthyma gangrenosum Tumor infection
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