Ehrlich Sabine, Spiekermann Karsten, Grothe Jan Hendrik, Stemler Jannik
Dtsch Med Wochenschr. 2023 Apr;148(8):467-473. doi: 10.1055/a-1873-4858. Epub 2023 Mar 29.
Infections represent one of the most frequent complications during therapy of acute myeloid leukemia (AML). In addition to associated prolonged phases of neutropenia, damage to the mucosal barrier by cytotoxic agents favors infections caused by endogenous pathogens. The source often remains unknown with bacteremia being the most common evidence of infection. Infections with gram-positive bacteria predominate, however, infections with gram-negative bacteria more often lead to sepsis and death. Due to prolonged neutropenia, patients with AML are furthermore at risk for invasive fungal infections. Viruses, on the other hand, are rarely the cause of neutropenic fever. Because of the limited inflammatory response in neutropenic patients, fever is often the only sign of infection and therefore always represents a hematologic emergency. Prompt diagnosis and initiation of an adequate anti-infective therapy are critical to avoid progression to sepsis and possibly death.
感染是急性髓系白血病(AML)治疗期间最常见的并发症之一。除了伴有长时间的中性粒细胞减少期外,细胞毒性药物对黏膜屏障的损害有利于内源性病原体引起的感染。感染源往往不明,菌血症是最常见的感染证据。革兰氏阳性菌感染占主导,但革兰氏阴性菌感染更常导致败血症和死亡。由于中性粒细胞减少持续时间长,AML患者还面临侵袭性真菌感染的风险。另一方面,病毒很少是中性粒细胞减少性发热的病因。由于中性粒细胞减少患者的炎症反应有限,发热往往是感染的唯一迹象,因此始终代表血液学急症。及时诊断并开始适当的抗感染治疗对于避免进展为败血症甚至可能死亡至关重要。