Skin Infections

Abstract

Cutaneous infections are common in immunocompromised patients. Neutropenia predisposes patients to fungal, bacterial and viral infections. Antibacterial antifungal and antiviral prophylaxis have caused a significant reduction in some of these infections.There are two main types of cutaneous infections: primary cutaneous infections and cutaneous manifestations of a disseminated infection. In the latter, skin lesions may be the window to disseminated bloodstream infection and the first and only evidence of a disseminated life threatening infection.The diagnosis may be at your fingertips; therefore a thorough skin exam is the clue. However, it's also important to know the characteristic lesions associated with different infections. It will help expedite diagnosis so appropriate treatment is initiated promptly in neutropenic patients, which can be lifesaving.In a retrospective study of 43 neutropenic febrile patients with cutaneous lesions, fungal infections were the most frequent, and nodular lesions on the lower extremities were the most prevalent (Naorungroj and Aiempanakit, J Am Acad Dermatol 74:AB166, 2016).Skin biopsy for pathological study and culture remains the gold standard and should be obtained early to confirm the suspected diagnosis. In these immunocompromised patients the inflammatory response is altered by either the primary disease or its treatment. Therefore, routine pathogens may present in an atypical fashion, with diminished or absent induration, erythema, or pustulation in response to bacterial resulting cutaneous infection without typical cellulitis (Urabe, Clin Infect Dis 39:S53-S55, 2004). Skin lesions are evaluated not only by morphology, but also in the context of the clinical setting and biopsy result. The skin biopsy is inexpensive, relatively noninvasive and without contraindication, and may avoid the need for more invasive procedures such an open lung biopsy (Grossman, et al., Cutaneous manifestations of infection in the immunocompromised host. Springer Science+Business Media, LLC, New York, 2012).

Disseminated Corynebacterium jeikeium Infection in Cancer Patients

“…The presence of intravascular devices has also been described as a major risk factor for infection with C. jeikeium [ 8 ]. Skin lesions can also be an important marker of disseminated life-threatening infection, and early detection can play a key role in prompt management [ 13 ]. In case 1, skin biopsy demonstrated positive results for the presence of C. jeikeium and diphtheroids.…”

Recurrent Cellulitis: Who is at Risk and How Effective is Antibiotic Prophylaxis?

“… 57 Neutropenia also predisposes to infections from atypical fungal organisms, and more severe and invasive bacterial skin infections. 58 , 59 …”