RESUMO
Invasive fusariosis (IF) is associated with severe neutropenia in patients with concurrent hematologic conditions. We conducted a retrospective observational study to characterize the epidemiology of IF in 18 Spanish hospitals during 2000-2015. In that time, the frequency of IF in nonneutropenic patients increased from 0.08 cases per 100,000 admissions in 2000-2009 to 0.22 cases per 100,000 admissions in 2010-2015. Nonneutropenic IF patients often had nonhematologic conditions, such as chronic cardiac or lung disease, rheumatoid arthritis, history of solid organ transplantation, or localized fusariosis. The 90-day death rate among nonneutropenic patients (28.6%) and patients with resolved neutropenia (38.1%) was similar. However, the death rate among patients with persistent neutropenia (91.3%) was significantly higher. We used a multivariate Cox regression analysis to characterize risk factors for death: persistent neutropenia was the only risk factor for death, regardless of antifungal therapy.
Assuntos
Fusariose , Fusarium , Neutropenia , Antifúngicos/uso terapêutico , Fusariose/tratamento farmacológico , Fusariose/epidemiologia , Humanos , Neutropenia/tratamento farmacológico , Neutropenia/epidemiologia , Estudos Observacionais como Assunto , Espanha/epidemiologiaRESUMO
The aim of this study is to evaluate the diagnostic performance of human epididymis protein 4 (HE4), cancer antigen 125 (Ca125) and the risk of ovarian malignancy algorithm (ROMA) in discriminating ovarian cancer from other benign gynaecological diseases. Serum levels of HE4 and Ca125 were measured in 119 women with benign gynaecological diseases, 29 patients with primary ovarian cancer, 32 patients with ovarian cancer on chemotherapy treatment (18 of them with progressive disease), 6 patients treated and free of disease and 32 healthy women. Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios (LR ±) were calculated. Receiver operator characteristic (ROC) curves were constructed, and the areas under the curve (AUC) were calculated. High serum levels for HE4, Ca125 and ROMA were observed in cancer patients. HE4 was elevated in 12.6 %, Ca125 in 21 % and ROMA in 9.2 % in the benign group, but HE4 was not elevated in endometriosis. The AUC values for HE4, Ca125 and ROMA were 0.92, 0.911 and 0.945 respectively. The sensitivity for discriminating ovarian cancer from benign gynaecological diseases was 86.2 % for HE4 and Ca125 and 93.1 % for ROMA. The specificity was 87.4, 78.9 and 90.7 % for HE4, Ca125 and ROMA. The overall positive likelihood ratio (LR+) was 6.84 for HE4, 4.1 for Ca125 and 10.01 for ROMA. In premenopausal women, LR + was 11.86 for HE4, 5.11 for ROMA and 2.02 for Ca125. HE4 might be significant in the differential diagnosis of ovarian cancer. HE4 seems to be superior to Ca125 in terms of diagnostic performance of all premenopausal women. ROMA could help to discriminate in cases with any doubt with a high diagnostic accuracy.
Assuntos
Antígeno Ca-125/sangue , Diagnóstico Diferencial , Doenças dos Genitais Femininos/sangue , Proteínas de Membrana/sangue , Neoplasias Ovarianas/sangue , Proteínas/metabolismo , Idoso , Algoritmos , Biomarcadores Tumorais/sangue , Feminino , Doenças dos Genitais Femininos/patologia , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Fatores de Risco , Proteína 2 do Domínio Central WAP de Quatro DissulfetosRESUMO
INTRODUCTION AND OBJECTIVE: Neutropenia is a frequent sign in patients who are going to have a haematopoietic stem cell transplant (HSCT). Infection is an important complication in these patients, which is favoured by immunosuppression and the degree of neutropenia. This study aims to evaluate the diagnostic usefulness of procalcitonin (PCT) and C-reactive protein (CRP) in onco-haematological patients undergoing chemotherapy and HSCT to determine the origin of the fever. PATIENTS AND METHODS: PCT and CRP values were measured in 30 episodes of febrile neutropenia: before starting chemotherapy, appearance of neutropenia, onset of fever, days 1, 2, 3 and 6 after the onset of fever, and when the febrile episode ended. The episodes were classified as 5 bacteraemia, 3 microbiologically documented infections, 10 clinical infections, and 12 fevers of unknown origin. RESULTS: The highest PCT mean values corresponded to the group of patients with bacteraemia. Statistically significant differences (P=.04) were found on the second day after the onset of fever. The cut-off point of 0.5ng/ml showed a sensitivity of 66% and a specificity of 75%. PCR results showed statistically significant differences on days 1, 2 and 3 after the onset of fever (P=.01, P=.003, and P=.002, respectively). The cut-off point of 7.5mg/L had a sensitivity of 88% and a specificity of 58%. CONCLUSIONS: The combination of PCT and CRP is an insufficient method to detect bacterial infections and may not replace the proper clinical and microbiological diagnosis.
Assuntos
Proteína C-Reativa/análise , Calcitonina/sangue , Febre/sangue , Transplante de Células-Tronco Hematopoéticas , Neutropenia/sangue , Precursores de Proteínas/sangue , Adulto , Idoso , Biomarcadores/sangue , Peptídeo Relacionado com Gene de Calcitonina , Feminino , Febre/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/complicações , Valor Preditivo dos TestesRESUMO
We described a case of fatal bacteremia related to Capnocytophaga sputigena in a hematological patient. The strain was identified by 16S rRNA gene sequencing.
Assuntos
Bacteriemia/microbiologia , Capnocytophaga/isolamento & purificação , DNA Bacteriano/análise , DNA Ribossômico/análise , Infecções por Bactérias Gram-Negativas/microbiologia , Linfoma de Células T/complicações , Infecções Oportunistas/microbiologia , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , Ribotipagem , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bacteriemia/complicações , Bacteriemia/diagnóstico , Capnocytophaga/genética , Carboplatina/administração & dosagem , Carboplatina/efeitos adversos , Coinfecção , Terapia Combinada , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , DNA Bacteriano/genética , DNA Ribossômico/genética , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Evolução Fatal , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/diagnóstico , Humanos , Ifosfamida/administração & dosagem , Ifosfamida/efeitos adversos , Hospedeiro Imunocomprometido , Linfoma de Células T/tratamento farmacológico , Linfoma de Células T/radioterapia , Masculino , Insuficiência de Múltiplos Órgãos/etiologia , Infecções Oportunistas/complicações , Infecções Oportunistas/diagnóstico , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Vincristina/administração & dosagem , Vincristina/efeitos adversosAssuntos
Bancos de Espécimes Biológicos , Pesquisa Biomédica , Institutos de Câncer , Microbiologia , Bancos de Espécimes Biológicos/ética , Bancos de Espécimes Biológicos/legislação & jurisprudência , Bancos de Espécimes Biológicos/organização & administração , Bancos de Espécimes Biológicos/normas , Infecção Hospitalar/complicações , Infecção Hospitalar/microbiologia , Infecção Hospitalar/parasitologia , Infecção Hospitalar/virologia , Comitês de Ética Clínica , Humanos , Consentimento Livre e Esclarecido , Neoplasias/complicações , Espanha , Manejo de Espécimes/métodos , Manejo de Espécimes/normasAssuntos
Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Bacilos e Cocos Aeróbios Gram-Negativos/isolamento & purificação , Mieloma Múltiplo/complicações , Idoso , Bacteriemia/complicações , Técnicas Bacteriológicas , Proteína de Bence Jones/urina , Infecções Relacionadas a Cateter/complicações , Exposição Ambiental , Feminino , Bacilos e Cocos Aeróbios Gram-Negativos/classificação , Bacilos e Cocos Aeróbios Gram-Negativos/enzimologia , Bacilos e Cocos Aeróbios Gram-Negativos/crescimento & desenvolvimento , Humanos , Mieloma Múltiplo/urina , Espanha/epidemiologia , Microbiologia da ÁguaAssuntos
Aeromonas hydrophila/isolamento & purificação , Infecções por Bactérias Gram-Negativas/diagnóstico , Mastite/microbiologia , Dermatopatias Vesiculobolhosas/diagnóstico , Vasculite/microbiologia , Aeromonas hydrophila/efeitos dos fármacos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Feminino , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/patologia , Humanos , Hospedeiro Imunocomprometido , Leiomiossarcoma/complicações , Leiomiossarcoma/tratamento farmacológico , Mastite/etiologia , Mastite/patologia , Pessoa de Meia-Idade , Dermatopatias Vesiculobolhosas/etiologia , Dermatopatias Vesiculobolhosas/microbiologia , Dermatopatias Vesiculobolhosas/patologia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/tratamento farmacológico , Vasculite/etiologia , Vasculite/patologiaRESUMO
Our objective was to determine the prevalence of methicillin-resistant Staphylococcus aureus in workers who had direct contact with oncologic patients infected with MRSA and admitted to the intensive care unit of the Valencian Institute of Oncology. A study of prevalence of MRSA colonization of 62 workers was performed. Samples were taken from nose and pharynx in each of the workers. After 24 hours of incubation in Amies transport medium Viscose (Eurotubo®), 124 samples were seeded (N = 124) in chocolate agar agar, MRSA II and BHI broth (Brain Heart Infusion). Those colonies that were identified by Gram stain gram-positive cocci in clusters available, catalase positive and coagulase positive were processed for study of sensitivity by Kirby-Bauer method and screening test for methicillin (10µg of Oxoid®) on Mueller-Hinton (Becton-Dickinson®, BD), supplemented with NaCl (2%). Those confirmed MRSA isolates, he returned to perform sensitivity study by microdilution (MicroScan®, Siemens) to determine the MIC (mg/L). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 1.61% (1) and 12.90% (8) for methicillin-sensitive Staphylococcus aureus (MSSA), from nostrils. The measures implemented were: nasal application of mupirocin to the worker colonized control isolation measures in infected patients and indoctrination of the personnel involved.