Infection in the Immunocompromised Patient
For patients who are immunocompromised, daily tasks can become frightening forums of infection. Public transportation, grocery store carts, and doctors’ offices can present immune system insults that these patients cannot readily fight.
Patients can become immunocompromised as a result of an acquired or hereditary immune disease, medical treatments that result in immunosuppression like chemotherapy and radiation treatment for cancer, or immunosuppressive drugs related to autoimmune diseases or organ transplants.
Pathology and Etiology
Leukocyte activity, or the normal white blood cell response to foreign agents, in the immunocompromised patient is decreased as a function of the suppressed immune system, which results in altered presentation of infection in some immunocompromised patients. Normal inflammatory responses like edema, pus or redness at an infection site may therefore not be present; it may be more likely that these patients would present with fever and/or pain at the site of the infection instead. The lack of these typical immune responses demonstrates the body’s inability to fight off infections normally, while also making infections much more difficult for physicians to detect and treat. Differences in symptoms make it all the more important for patients and their healthcare providers to be extra vigilant regarding signs of infection.1
Hospitals tend to be home to more antibiotic-resistant bacteria than other clinical or non-clinical settings. This is potentially more problematic for immunocompromised patients who spend time in hospital settings than for other patients. In order to mitigate some of these risks, special air filtration systems are employed by many hospitals to cut down on bacterial and fungal colonization and infection.1
For the immunocompromised patient, hospitalization itself can increase the risk of infection. Units that tend to house higher rates of immunocompromised patients include oncology, intensive care, and respiratory care units.
Chemotherapies aimed at tumor reduction and cancer treatment are toxic to healthy cells as well, including bone marrow. The reduction of marrow components drastically reduces the efficacy of the immune system to fight pathogens, leading to compromised immune systems in the cancer patient, with complications not unlike patients with primary immunodeficiency.3
Those with acquired or primary immunodeficiencies, such as AIDS or SCIDS patients, have increased chances of developing respiratory infections from various pathogenic sources including bacteria, viruses, and fungi. Such infections are often dangerous due to the impervious nature of respiratory infections and the immunodeficient patient’s inability to fight infection.
Awareness and Infection Prevention
Outside of hospital settings, immunocompromised patients are advised to avoid situations in which many opportunistic infectious agents typically cause infection, including avoiding contact with animals that bite/scratch or animal excrement, other people with skin infections, undercooked foods and unpasteurized dairy products, and observing diligent bathroom hygiene.
In the hospital setting, proper and adequate hand-washing and use of personal protective equipment (PPE) by healthcare practitioners is more important than with the average patient. Avoidance of patient fluid contact through improper hygiene or improperly disinfected surfaces is necessary, as well is the disinfection of all high contact surfaces including bed rails, re-usable equipment and portable medical devices.4
Mobile healthcare devices in these units represent another point of entry for infection, particularly when used across patients. Interestingly, early concerns regarding the use of mobile technology in critical care and intensive care units focused not on the possibility of infectious transmission through mobile device surfaces, but rather on the potential for electromagnetic interferences with medical equipment2 though such concerns have proven largely invalid.
Prophylactic antibiotic or antifungal treatment can be utilized, though such long-term treatments carry their own set of risks including secondary yeast infections/thrush, GI complications, and risks of side effects. Ideally, minimizing patient risk through optimized anti-microbial techniques would be preferred over preventative antibiotics. Specialized air filtration systems, ensuring patient safety practices amongst providers, and continued evolution of relevant disinfectant techniques such as mobile device cleaning stations, all represent important interventions at the facility and provider level which can reduce the risk of healthcare acquired infections in immunocompromised patients. Thoughtful care must be taken to ensure as germ-free an environment as possible for all patients, but especially for these patients.
About the Author
Dana Carter, PhD is an academically trained, experimental neuroscientist. Currently, Dana is a science writer who focuses on different aspects of psychology, physiology, and overall health and wellness. Prior to her current role, she spent a combined seven years researching the genetic components of mental illnesses, and the effects of drugs and alcohol on fetal brain development. She received her PhD in Neuroscience from the Texas A&M Institute for Neuroscience and her B.Sc. in Psychology from Texas A&M University. She enjoys traveling, writing, and promoting learning about healthy, active minds and lifestyles.
References
Infectious Diseases: Infections in Immunocompromised Patient (2013). St. Jude Children’s Research Hospital: Disease Information. http://www.stjude.org
Yeolekar ME, and Sharma A. Use of Mobile Phones in ICU – Why Not Ban? (2004) JAPI 52:313. http://www.japi.org/april2004
Steele, RW. Managing infection in cancer patients and other immunocompromised children (2012). Ochner J 12(3):202-210.
Kaplan JE, Benson C, Holmes KH, Brooks JT, Pau A, Masur H. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents (2009). MMWR Recomm Rep. 58:1-207.