Spectrum of cutaneous infections in patients of leukemia

Abstract

Background Cutaneous infections are common in patients of leukemia due toimmunosuppression caused by the disease itself and its therapy.Objectives This study was aimed to analyze the incidence, types and clinical presentations ofvarious cutaneous infections in different types of leukemias in this part of the world.Patients and methods This observational, descriptive and cross sectional study was carriedout in department of dermatology, King Edward Medical College & Mayo Hospital, Lahore.Two hundred and fifty diagnosed patients of leukemia were enrolled from pediatrics,oncology, dermatology and medical units of Mayo Hospital, Lahore. Detailed dermatologicalexamination was performed and the cases having any skin infection were further investigated.The incidence and morphological patterns of various cutaneous infections in leukemia wereanalyzed.Results Out of the 250 enrolled patients, cutaneous infections were present in 177 (71%)patients. Out of these 177 patients, 101(57%) were male while 76(43%) were female. The ageranged from 2-76 years. Infections of skin were more common in acute as compared tochronic leukemias (p< 0.01). Candidiasis was the commonest infection (72%) seen, whilebacterial, viral and dermatophytic infections were present in 31%, 35% and 12% of thepatients, respectively. Scabies was found in 12%. More than half of the patients (54%) hadtwo or three types of concomitant infections. Bacterial infections were more frequent inmyelogenous leukemias (p < 0.001), while candidal and dermatophytic infections were morecommon in lymphocytic leukemias (p<0.001 and < 0.05, respectively). Dissemination, highergrade of severity and atypical morphology was frequently seen with these infections.Conclusions The incidence of cutaneous infections in leukemic patients is very high andthese are more common in acute as compared to chronic leukemia. Candidiasis is thecommonest infection. Bacterial infections are more frequent in myelogenous leukemias,whereas superficial fungal infections are more in lymphocytic leukemias. Infections withhigher degree of severity, dissemination and atypical morphology are common.