Savage D G, Lindenbaum J, Garrett T J
Ann Intern Med. 1982 Jan;96(1):47-50. doi: 10.7326/0003-4819-96-1-47.
Since the 1960s, gram-negative bacilli have become commoner pathogens than Streptococcus pneumoniae in multiple myeloma. To investigate this trend, we analyzed 75 bacterial infections in 57 patients with myeloma. Episodes of infection with Streptococcus pneumoniae and Haemophilus influenzae occurred at presentation, early in the disease, and in patients responding to chemotherapy. Gram-negative bacilli and Staphylococcus aureus caused 80% of infections seen after diagnosis and 92% of deaths from infection. Episodes of infection with gram-negative bacteria occurred in patients with active and advancing disease and in those responding to chemotherapy when neutropenia. Impaired antibody production may be the major immune defect leading to S. pneumoniae and H. influenzae infections whereas some additional factor or factors related to disease activity appear to predispose to gram-negative infection in myeloma.
自20世纪60年代以来，在多发性骨髓瘤中，革兰氏阴性杆菌已成为比肺炎链球菌更常见的病原体。为了研究这一趋势，我们分析了57例骨髓瘤患者的75次细菌感染情况。肺炎链球菌和流感嗜血杆菌感染发作发生在疾病初发、疾病早期以及对化疗有反应的患者中。革兰氏阴性杆菌和金黄色葡萄球菌导致了诊断后80%的感染以及92%的感染相关死亡。革兰氏阴性菌感染发作发生在疾病活动进展期患者以及化疗后出现中性粒细胞减少的患者中。抗体产生受损可能是导致肺炎链球菌和流感嗜血杆菌感染的主要免疫缺陷，而一些与疾病活动相关的其他因素似乎易使骨髓瘤患者发生革兰氏阴性菌感染。
