Identifying factors that increase risk for IFI should be an important focus of the history in patients who have become febrile after antineoplastic therapy or HSCT. Review of systems should be thorough, yet focused on complaints that may indicate the presence of an undetected infection in the respiratory or gastrointestinal tracts (Table 4). The presence of cough, hemoptysis, and pleuritic chest pain should make one think of invasive pulmonary aspergillosis, but these complaints are neither sensitive nor specific. For instance, pleuritic pain is also reported in patients with hepatosplenic candidiasis.26 Although fever increases the index of suspicion for fungal infection in immunocompromised patients, it is not always present, especially in patients who are maintained on high doses of corticosteroids for prophylaxis or treatment of GVHD.
| Site of Involvement | Clinical Manifestation History | Physical Examination
|
Bronchopulmonary
| Nonproductive cough
Pleuritic chest pain
Hemoptysis
Dyspnea
| Pleural rub
Localized wheezing
|
|
Sinus
| Ear, orbital, or facial pain/pressure
Nasal congestion
Diminished smell, taste
Epistaxis
| Pallor of nasal mucosa
Nasal blockage, discharge, eschar
Absence of bleeding on light
abrasion of mucosa
Nasal hypesthesia to light touch
Palatal ischemia
|
|
Central nervous
| Headache
Nausea/vomiting
Visual blurring
Diplopia
Confusion
Lethargy
| Focal neurologic signs
Cranial nerve palsie
Hemiparesis
Seizures
Altered sensorium
|
|
Cutaneous
| Recent trauma
Pain
New skin lesions
| Maculopapular rash
Pustules
Subcutaneous nodules
Ulcerations
Necrosis
Eschar
Paronychia
Central venous catheter in place
Cellulitis
|
Course Number: V035D
This CME Expires on July 1, 2005; no tests will be accepted after this date.
This course is accredited by
The University of Pittsburgh School of Medicine, Center for Continuing Education and The International Immunocompromised Host Society
|
