Acute infection in elderly cancer patients
Introduction
Introduction to acute infection in elderly cancer patients Cellular and humoral immunity in cancer patients has obvious defects. After chemotherapy and radiotherapy, organ damage, granulocyte reduction, and skin mucosal damage undoubtedly increase the chance of infection and increase the risk. Infection is the main cause of complications or death in cancer patients, especially in advanced tumors. In practice, the incidence and severity of infection are strongly related to the degree of neutropenia, which is the biggest obstacle to chemotherapy and radiotherapy. Special site infections and opportunistic infections in cancer patients are also more common acute infections. basic knowledge The proportion of illness: 0.001% Susceptible people: the elderly Mode of infection: contagious Complications: pneumonia sepsis
Cause
The cause of acute infection in elderly cancer patients
(1) Causes of the disease
The neutropenia after chemotherapy and radiotherapy is the main cause of acute infection in cancer patients. Bodey et al reported 410 cases of Pseudomonas aeruginosa sepsis, and the neutrophilic patients with fever did not use antibiotics within 48 hours to achieve a mortality rate of 70%. The use of antibiotics in patients with neutropenia with fever can be significantly reduced. Now, as the dose of chemotherapy and radiotherapy increases, it can enhance the anti-tumor effect. However, the widespread adoption of these methods will lead to more serious problems. And longer-term neutropenia, as well as organ damage, the elderly are more prominent, therefore, granulocytopenia should be highly valued.
(two) pathogenesis
The pathogenesis has not yet been elucidated and may be related to low immunity.
Prevention
Acute infection prevention in elderly cancer patients
Actively treat primary diseases, give immune boosters, and improve immunity.
Complication
Acute infection complications in elderly cancer patients Complications pneumonia
Complications include fever, infection, pneumonia, sepsis, etc.
Symptom
Acute infection symptoms in elderly cancer patients Common symptoms Immunodeficiency response, urinary tract infection, frequent sputum, sputum neutropenia
Patients with neutropenia and fever after chemotherapy and radiotherapy should have a detailed understanding of medical history and physical examination. This patient is unresponsive, and the signs of clinical infection are often not strong and difficult to be detected. Locally only red, swollen, painful, chest X Line examination of pulmonary invasive lesions can be delayed, and the voice may be an early sign of pneumonia. It has been reported that 25% of patients with neutropenia and leukemia patients have normal physical examinations, and more than one third of patients have no cough, cough, urinary tract. When infected, the urinary frequency may not be accompanied by dysuria. There may be hidden infections in the mouth, nose and teeth. It must be carefully examined. Patients with first or repeated fever must pay attention to the area around the rectum, sometimes with severe perianal infection, any part of the body. There can be recessive infections, and the clinical manifestations of infections are often atypical.
Diagnosis of infection in immunodeficiency patients: fever is the main symptom of infection, but the primary disease itself (such as cancer, leukemia) may also have fever, blood transfusion, drug reaction, local bleeding, thrombophlebitis, etc. can cause fever, Such patients should be asked in detail about the medical history and detailed physical examination, especially pay attention to the parts that are prone to infection.
Before starting the application of antibiotics, the following laboratory tests should be carried out: blood culture (including anaerobic culture at least 2 times), sputum, urine, nasopharynx secretion, feces, cerebrospinal fluid, wound secretion according to the site where infection may occur. Wait for bacterial culture and drug sensitivity test, take serum for serological test (preferably take acute phase, recovery period two specimens), in order to prevent pollution, it is best to use tracheal puncture or fiberoptic bronchoscopy to take sputum, suprapubic puncture Urine is taken for culture.
Examine
Examination of acute infections in elderly cancer patients
Neutrophil reduction, especially when the total number of white blood cells <1 × 109 / L (neutrophils 0.5 × 109 / L) should be noted.
X-ray examination, biopsy and other pathological examinations help to confirm the diagnosis in time.
Diagnosis
Diagnosis and diagnosis of acute infection in elderly cancer patients
Diagnostic criteria
If necessary, X-ray examination, endoscopy, immunological examination, biopsy and other pathological examinations are needed to help confirm the diagnosis in time.
Special attention should be paid to the infection of immunodeficiency patients in the following situations:
1 suffering from cancer or blood disease;
2 use of immunosuppressive agents after organ transplantation;
3 neutrophil count <0.5 × 109 / L;
4 application of broad-spectrum antibiotics;
5 long-term use of adrenocortical hormone.
Differential diagnosis
Clinical cancer is differentiated from leukemia.
