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Biphasic Pattern of Bacterial Infection in Multiple Myeloma

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Grant support: in part by grant AM-07373 from the National Institute of Arthritis, Metabolism, and Digestive Diseases, to Dr. Savage.

▸ Requests for reprints should be addressed to John Lindenbaum, M.D.; Department of Medicine, Harlem Hospital Center, New York, NY 10037.

New York, New York

© 1982 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1982;96(1):47-50. doi:10.7326/0003-4819-96-1-47
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Since the 1960s, gram-negative bacilli have become commoner pathogens than Streptococcus pneumoniae in multiple myeloma. To investigate this trend, we analyzed 75 bacterial infections in 57 patients with myeloma. Episodes of infection with Streptococcus pneumoniae and Haemophilus influenzae occurred at presentation, early in the disease, and in patients responding to chemotherapy. Gram-negative bacilli and Staphylococcus aureus caused 80% of infections seen after diagnosis and 92% of deaths from infection. Episodes of infection with gram-negative bacteria occurred in patients with active and advancing disease and in those responding to chemotherapy when neutropenic. Impaired antibody production may be the major immune defect leading to S. pneumoniae and H. influenzae infections whereas some additional factor or factors related to disease activity appear to predispose to gram-negative infection inmyeloma.





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