Although no specific
infection is limited entirely to hosts with T-lymphocyte defects, certain microbial organisms have an affinity for such individuals. Effective, safe, and feasible methods are available for the prevention of two of the major life-threatening
infections in patients with T-lymphocyte defects, although none of these methods is ideal.
Trimethoprim-sulfamethoxazole administered orally daily or thrice weekly is highly effective for the prevention of
Pneumocystis carinii pneumonia. For patients who cannot tolerate this
drug combination, monthly inhalation of aerosolized
pentamidine is an alternative prophylactic approach. Additional drugs in clinical or preclinical trials offer promise for use in preventing this
pneumonitis.
Varicella is one of the most frequent serious
viral infections in patients with
cancer, especially children.
Varicella-zoster immune globulin (
VZIG) has proven effective in reducing the frequency of
infection in exposed susceptible individuals; however,
breakthrough infections are not uncommon. Of 358 children with
acute lymphoblastic leukemia, 62 received
VZIG following exposure to
varicella, and 16 (26%) of these had breakthrough
varicella. A live attenuated varicella-zoster virus
vaccine offers promise, especially for the universal immunization of individuals before immunocompromise occurs.