Alison Freifeld, MD

Current guidelines recommend antimicrobial prophylaxis with fluoroquinolones in patients at high risk for infection-related morbidity and mortality, but this practice provides a short-term benefit to individual patients.

Review of the pathophysiology of foodborne illness and pertinent studies about the neutropenic diet lead to the conclusion that there is no clear benefit from the longstanding dietary restrictions that may be imposed during neutropenia. Instead, we propose adoption of standard safe food handling methods to allow for a more liberalized diet in the neutropenic patient.

The article by Dr. Seo providesa comprehensive review of theepidemiology, presentation, andtreatment of infection in lung cancerpatients. Infection is a significant causeof morbidity and mortality in cancerpatients, as a consequence of immunologicabnormalities that result from thecancer itself as well as from cytotoxiccancer therapies. Granulocytopenia andlymphocyte dysfunction commonlyoccur following intensive therapy formany solid tumors such as lung cancer,and these cellular deficiencies particularlypredispose patients to certain infections.Respiratory infections arecommon during the course of lung cancer,often as a result of direct effects onthe lung including radiation therapy andtumor burden causing obstruction, especiallywith bronchogenic carcinomasor carcinoid tumors. Postsurgical infections,following biopsy or thoracotomyfor resection, are also common.Infectious complications are problematicfor both patient and oncologistsbecause they may delay treatment andimpair quality of life.

The incidence of invasive aspergillosis is increasing parallel to the intensity of immunosuppressive and myelosuppressive anticancer treatments. Successful management is linked to an understanding of the

Treatment of fever and neutropenia in cancer patients has been recognized for 30 years as a medical emergency, requiring prompt in-hospital evaluation and institution of broad-spectrum intravenous (IV) antibiotics. This action