Infection in immunodepressed patients. The approach to diagnosis and treatment

Infectious episodes in severely granulocytopenic patients

In a prospective study, 40 episodes of granulocytopenia (granulocytes less than 500/mm3) in 34 patients were analyzed. During 52.5% of these episodes there was proven infection; these infections were present for only 24.4% of the 1,435 granulocytopenic days. The risk of infection and mortality were closely linked with extreme granulocytopenia (granulocytes less than 100/mm3). Of the episodes with severe granulocytopenia (granulocytes 100-500/mm3) only a small number were associated with infections, and mortality was virtually absent in this category. These results implicated a restricted use of supportive measures (e.g. granulocyte transfusions) especially when granulcotye counts are higher than 100 mm3.

Cervical-vaginal flora of immunosuppressed renal transplant patients

The purpose of this investigation was to determine the endocervical microflora present in 25 renal allograft recipients hwo were receiving therapeutic dosages of azathioprine or cyclophosphamide and prednisone. The aerobic flora was similar to that found in other populations. However, these immunosuppressed patients had more different anaerobic species per culture than were found in most other populations. This was reflected in the more frequent isolation of many species of anaerobic bacteria, especially the anaerobic gram-negative rods. The clinician should be aware of these differences since they may be significant in regard to gynecologic or obstetric postoperative infectious morbidity in women using immunosuppressive medications.