RESUMENLos pacientes oncohematológicos presentan elevada incidencia de infecciones siendo éstas una de las principales causas de morbimortalidad. Existen distintos tipos de inmunodepresión relacionados con la enfermedad, el momento evolutivo y el tratamiento recibido. A efectos prácticos vamos a distinguir los pacientes con neutropenia severa, los que tienen alguna alteración de la inmunidad humoral y por último las inmunodeficiencias celulares. No existen inmunodeficiencias asociadas a cada enfermedad, sino que en una misma entidad clínica se pueden asociar varias deficiencias inmunitarias. Los pacientes neutropénicos, generalmente con leucemias agudas y tras quimioterapia intensiva, tienen infecciones bacterianas y fúngicas condicionadas por la intensidad y la duración de la neutropenia. En el caso de los pacientes con inmunodeficiencia humoral (mieloma múltiple, leucemia linfá-tica crónica, esplenectomizados) son frecuentes las infecciones por gérmenes encapsulados. Cuando hay inmunodepresión celular (enfermedad de Hodgkin, sín-dromes linfoproliferativos crónicos avanzados, tratamiento con glucocorticoides, análogos de las purinas y tratamientos con anticuerpos monoclonales) el riesgo de infecciones por gérmenes oportunistas viene condicionado por la reducción de la cifra de linfocitos CD4. Revisaremos las distintas estrategias de profilaxis y tratamiento en cada una de las situaciones.Palabras clave. Infección. Inmunodeficiencia celular. Neutropenia. Hipogammaglobulinemia. ABSTRACTOncohaematological patients present a high incidence of infections, which are one of the principle causes of morbility and mortality. There are different types of immunodepression related to the disease, the moment of its evolution and the treatment received. For practical purposes we will distinguish between patients with severe neutropenia, those with some alteration to humoral immunity and, finally, cellular immunodeficiencies. There are no immunodeficiencies associated to each disease, instead several immunitarian deficiencies can be associated in a single clinical entity. Neutropenic patients, generally with acute leukaemias and following intensive chemotherapy, have bacterial and fungal infections conditioned by the intensity and duration of the neutropenia. In the case of patients with humoural immunodeficiency (multiple mieloma, chronic lymphatic leukaemia, splenectomised) there are frequent infections by encapsulated germs. When there is cellular immunodepression (Hodgkin's disease, advanced chronic lymphoproliferative symdromes, treatment with glucocorticoids, analogues of the purines and treatment with monoclonal antibodies) the risk of infection by opportunist germs is conditioned by the reduction of the figure of CD4 lymphocytes. We review the different strategies of prophylaxis and treatment in each of the situations.
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