ABSTRACT

Neutropenia is well known as a risk factor for infectious complications of patients treated for hematological malignancies. Less is known about the impact of intensive chemotherapy on the epithelial innate immunity that protects us from infections due to opportunistic pathogens that reside on the mucosal surfaces. Injury to the mucosal barrier leads to barrier dysfunction, perturbed microbial signaling and inadequate host responses all of which increase the risk for life-threatening clinically- and microbiologically-defined infections. Greater awareness of mucosal barrier injury should help the physician to know better when and how to act when fever occurs during neutropenia innate immune system (e.g. complement, lysozyme, lectins), especially epithelial cells of the digestive tract and skin for protection against potentially lethal infectious complications. These epithelia form an anatomical and immunological barrier often referred to as the integument that serves as the front line against microbial invasion. Although these epithelia are highly organized and sophisticated structures, the barrier they create is not invincible to microorganisms, certainly not after it is damaged by anti-cancer therapy. Adequate supportive care is predicated by recognition of the disintegration of the primary host defense mechanisms aimed at early recognition and treatment of infection to improve survival.