Lymphoma treatment routinely impacts the immune system. Meaning that at different times in the treatment journey, a patient will be more likely to get an infection. Chemotherapy lowers the amount of white blood cells in the body. Neutrophils are a type of white blood cell that fight off infection. Low levels of these specific white blood cells is called neutropenia.
How infection happens
An infection happens when a very small pathogen enters the body and causes harm. In the medical world, these invading pathogens are also called micro-organisms. They can invade the body, use the body’s own resources to sustain themselves, reproduce and multiply quickly, causing illnesses.
These micro-organisms or pathogens, can be either:
These pathogens can invade the body and cause local or systemic infections. A local infection affects one single area of the body. A systemic infection impacts multiple areas or organs within the body.
These viral, bacterial or fungi pathogens can spread and be caught in many different ways, including:
- Skin to Skin contact
- The transfer of bodily fluids
- Contact with faeces
- Ingesting contaminated food or water
- Breathing in pathogens that are airborne particles or droplets
- Touching an object or surface that an infected person has also touched
What is Infection?
Infection is a broad term used to talk about any sickness that could be either viral, bacterial or the result of fungi. Infection is when outside organisms or “bugs” invade the body and cause illness.
An infection can be local (in one area) or systemic (widespread). A cut that gets bacteria in it, could start out as a local infection, without treatment the infection might grow, spread, and turn into a systemic infection. Systemic infections affect the entire body. This does not necessarily mean systemic infections are more severe than local infections, it means they impact more than one part of the body.
Some common local infections of bacterial, viral or fungi origin, might include:
- Urinary Tract Infection (UTI): bacteria in the urinary tract causes frequent urination and burning on urination
- Gastroenteritis: also known as a “stomach bug”, causes tummy cramps and diarrhoea/vomiting
- A cold: which is a viral infection in the upper airways causing sore throat and runny nose
- Herpes Simplex Virus (HSV-1): also called ‘kissing disease” is the leading cause of viral cold sores
- Bacterial food poisoning by E. Coli causes nausea, vomiting, sweating and stomach cramps
- Thrush: fungal infection in the mouth but can also be genital thrush too
- Athlete’s foot or Tinea Pedis is a fungal infection on the feet, causing itching, stinging and burning skin
Some common systemic (whole system) infections might include:
- Influenza: systemic viral infection causing fatigue, fever, muscle aches, sore throat and breathing difficulty
- Systemic Candidiasis: When the fungal organism ‘candida’ infects the bloodstream.
- Bacterial Sepsis: When bacteria travels into the bloodstream causing blood pressure drop, blotchy or discoloured skin, sweaty and clammy skin and fast heart rate.
Risk of Infection
A lymphoma diagnosis means that the patient will be at an increased risk of picking up infections. There are a few reasons a lymphoma diagnosis increases the infection risk:
Compromised Immune System
Lymphoma is a cancer of white blood cells called lymphocytes. Lymphocytes play a major role in fighting off bacteria, viruses and fungi. If part of the lymphocyte population is cancerous, then the chances are that these cancerous lymphocytes are NOT fighting off infections like they should be. This means that the immune system is compromised because of the lymphoma that has taken over.
Chemotherapy kills both good cells and bad cells. Some of the good cells that are damaged in the process of chemotherapy, are white blood cells. The damaged white blood cells are not able to do their job or fight infection, meaning that chemotherapy can also compromise the immune system.
Presence of long-term device
Lymphoma treatment can often mean the insertion of a long-term device such as a PICC (Peripherally Inserted Central Catheter), CVL (Central Venous Line) or Port-a-cath. These devices are inserted to allow chemotherapy and other lymphoma treatment to be administered, directly into large veins. They are used in the place of a peripheral cannula and stay in-place on a semi-permanent basis.
Not all lymphoma patients need to have one of these devices.
Having a long-term device in place increases your risk of getting an infection. The device itself is a place that pathogens and micro-organisms can harbour. The medical team at the hospital will be able to advise a patient how to care for their device and regularly assess the device for signs of infection.
A side effect of lymphoma treatment can also be loss of appetite, nausea, vomiting and indigestion. All of these side effects can contribute to a decrease in food intake and result in less nutrients being absorbed into the system. If the body is not getting the nutrients it needs, it can be harder for it to fight off invaders and infections.
Signs and Symptoms of Infection
Infections can develop at any point in the lymphoma journey, they can also develop in any part of the body. From an inner ear infection, to an in-grown toenail. All types of infection can occur, this is not to say that they will occur. It is good to know some of the key signs and symptoms of infections and when to get medical treatment. At Lymphoma Australia, we recommend that if you have any of the following signs or symptoms you should present to either your closet emergency department, phone an ambulance on 000 or speak to your health service.
Some signs of infection include:
- Fever (temperature above 38 degrees Celsius)
- Hypothermia (temperature below 35 degrees Celsius)
- Chills and sweating
- Chest pain
- Coughing or difficulty breathing
- Sore throat, runny nose, earache
- Redness, tenderness and swelling around your PICC, CVL or Port-a-Cath
- Diarrhoea and Vomiting
- Burning and stinging when urinating
- Unusual vaginal or penile discharge – burning or itching on vagina or penis
- Body aches and pains
Contact your medical team or present immediately to your nearest emergency department should you get a temperature of 38 degrees or above.
Keep a household thermometer handy, to check your temperature at home daily. If a temperature is recorded of 37.5 degrees Celsius or above, re-check it in 1 hour.
Shivering, chills and sweating can be signs of an infection even WITHOUT a fever. So do not ignore these symptoms.
What to do if there might be an infection
If any of the above symptoms are present or there are any additional signs of an infection contact the medical team immediately, even if the symptoms are minor. Do not wait for symptoms to become more severe before taking action, it is far better to treat these things sooner rather than later.
If there is uncertainty about any signs of infection, call the hospital’s cancer ward, the nursing staff on the ward should be able to provide the appropriate advice. Lymphoma Australia’s Nurse Support Line is open Monday – Friday within business hours. You can phone 1800 953 081 during this time and get advice from one of the Lymphoma Care Nurses. However, if there are signs of an infection present to the closest emergency department for medical treatment.
Low levels of white blood cells is an inevitable side effect of lymphoma treatment. Unfortunately, this means patients cannot prevent white cells from being low. Each lymphoma treatment is different and the medical team should be monitoring white cell count very closely. They will be able to tell when white cells are particularly low and the risk of getting an infection is particularly high.
Whilst it is impossible to prevent white cells from being low, and therefore minimise the risk of infection, there are some practical lifestyle changes to help reduce risk of an infection.
Some practical ways include:
- Stay away from family and friends or visitors who have cold and flu symptoms, diarrhoea, vomiting or have had the chickenpox.
- Avoid busy social events such as concerts, school fetes and busy times at the shopping centre or cinema.
- Practice regular and thorough hand hygiene: before eating, after going to the bathroom, after touching cats, dogs and other animals.
- Regularly clean and disinfect household surfaces such as the bench, refrigerator door, pantry door, microwave door. Regularly clean the toilet and bathrooms at your home.
- Avoid sharing food, cutlery and cups
- Wear protective gloves when gardening
- Shower or bath every day. If there is a CVL, PICC or Port-a-Cath in place, speak with the medical team about the precautions to take when bathing with a central venous access device.
- Keep good dental hygiene, brush teeth 2 – 3 times a day including before bed. Use a soft toothbrush and alcohol-free mouthwash. Do not share a toothbrush with someone else.
- Use hand sanitiser at all times, use it when on public transport or in public areas and avoid touching a communal hand-rail or elevator button. Sanitise before touching your face or eating and after blowing your nose.
- Keep hand-sanitiser at the front door, for guests to use when they visit
- Don’t eat out-of-date food.
- Ensure meat is cooked all the way through (especially chicken) before eating it.
- Do not reheat food more than once
- When eating out, choose freshly cooked food and ensure it is cooked all the way through and hot all the way through
- Avoid buffet, salad bars, and pre-prepared food or street vendors where the food is sitting out for an unknown length of time.