TERMINAL PULMONARY INFECTIONS IN PATIENTS WITH LUNG-CANCER

To determine the factors that predispose the patient with lung cancer to develop terminal pulmonary infections, we reviewed the case records and autopsy data of 304 patients who died of lung cancer in the Kyush u University Hospital between 1976 and 1990. The incidence of mycobact erial infection was significantly higher among those treated with anti neoplastic therapy and corticosteroids (group 3) than in those who rec eived antineoplastic therapy alone (group 2). The incidence of nonbact erial infection did not differ significantly between the two groups. I n some group 3 patients, the administration of corticosteroids for rel atively short periods (less than one month) led to fatal mycobacterial infection. Among those patients with lymphocytopenia, the incidence o f fatal mycobacterial infection was significantly higher in group 3 th an in group 2, whereas the incidence of fatal nonbacterial infection w as not. In group 3, the incidence of fatal mycobacterial and nonbacter ial infections did not differ significantly among those with and witho ut lymphocytopenia. Thus, in patients with lung cancer who were receiv ing antineoplastic treatment, corticosteroids were more closely associ ated with the development and exacerbation of mycobacterial infection than was lymphocytopenia. The influence of corticosteroids on the deve lopment of nonbacterial infection was not more marked than that of lym phocytopenia. The incidence of common bacterial infections was no high er among those patients who received no antineoplastic treatment or co rticosteroid (group 1), group 2, and group 3. Therefore, the local and systemic effects of the lung cancer itself are likely more important in predisposing the patient to bacterial infections than are either an tineoplastic agents or corticosteroids.