LWBK1006-43 LWW-Govindan-Review December 14, 2011 15:38
Chapter 43•Infections in the Cancer Patient 549Answer 43.20. The answer is B.
Oropharyngeal HSV is commonly seen in patients with prolonged
chemotherapy-induced neutropenia and may lead to significant morbid-
ity in these patients. Oral acyclovir (400 mg given five times daily) or
valacyclovir for 7 to 10 days may be considered in some patients, but
intravenous acyclovir (5 mg/kg every 8 hours) is preferred for patients
with significant mucosal disease causing impaired oral intake. Dissemi-
nated HSV should be treated with intravenous acyclovir (10 mg/kg every
8 hours).Answer 43.21. The answer is A.
Solid-organ and HSCT recipients are at risk for PTLD, which is an
abnormal proliferation of EBV-infected B cells. There are varied clin-
ical manifestations, including a mononucleosis-like syndrome, general-
ized adenopathy, and extranodal organ involvement. Treatment strate-
gies include reduction in immune suppression, rituximab, and adoptive
transfer of EBV-specific cytotoxic T lymphocytes. For those with a more
aggressive clinical course, combination chemotherapy may also be war-
ranted.Answer 43.22. The answer is B.
Alemtuzumab is a humanized monoclonal antibody against CD52 and is
approved for the treatment of CLL. Treatment with alemtuzumab results
in prolonged lymphopenia and patients are at increased risk forP. jiroveci
infection. There is also increased risk for CMV reactivation but CMV dis-
ease is rare. Herpes virus prophylaxis is recommended in patients receiv-
ing alemtuzumab.Answer 43.23. The answer is A.
Persistent fever despite count recovery should trigger a careful search for
occult infections such as line infections, abscesses, and fungal infections.
Elevated alkaline phosphatase and the characteristic findings on the liver
by imaging are consistent with hepatosplenic candidiasis.Answer 43.24. The answer is D.
Fluoroquinolones are the only class of oral antibiotics with activity against
pseudomonas species. As a result fluoroquinolones are the preferred
agents for antibacterial prophylaxis to prevent febrile neutropenia as well
as for outpatient management of febrile neutropenia.Answer 43.25. The answer is A.
Patients with acute and chronic leukemias, myelodysplastic syndrome,
undergoing highly myelosuppressive chemotherapy and prolonged treat-
ment with steroids are at increased risk for parvovirus B19 infection.
Parvovirus B19 infection can result in prolonged cytopenias in immuno-
compromised patients. Intravenous immunoglobulin is the treatment of
choice for parvovirus B19 infection.