RESUMO
PET/CT is useful for investigation of neutropenic fever (NF) and potential invasive fungal infection (IFI) in those with hematological malignancies (HM). An online survey evaluating the utility and current practices regarding PET/CT scanning for investigation of NF was distributed to infectious diseases (ID) clinicians and hematologists via email lists hosted by key professional bodies. One-hundred and forty-five clinicians responded (120 ID; 25 hematologists). Access to PET/CT was fair but timeliness of investigation was limited (within 3 days in 35% and 46% of ID and hematology respondents, respectively). Among those with experience with PET/CT for infection (n = 109), 40% had utilized PET/CT for prolonged NF and 20% for diagnosing IFI. The majority of respondents indicated the desire to utilize PET/CT more frequently for infection indications. There is a strong desire among surveyed Australian clinicians to use PET/CT for prolonged NF and potential IFI. However, access to PET/CT is a current barrier to uptake.
Assuntos
Fluordesoxiglucose F18 , Neoplasias Hematológicas/complicações , Infecções/diagnóstico por imagem , Infecções/etiologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Austrália/epidemiologia , Competência Clínica , Gerenciamento Clínico , Feminino , Neoplasias Hematológicas/epidemiologia , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Infecções/epidemiologia , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodosAssuntos
Neurite do Plexo Braquial/diagnóstico , Doença Enxerto-Hospedeiro/diagnóstico , Melfalan/administração & dosagem , Transplante de Células-Tronco de Sangue Periférico , Neurite do Plexo Braquial/etiologia , Terapia Combinada/efeitos adversos , Relação Dose-Resposta a Droga , Doença Enxerto-Hospedeiro/etiologia , Humanos , Masculino , Melfalan/efeitos adversos , Pessoa de Meia-Idade , Mieloma Múltiplo , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Transplante AutólogoRESUMO
We describe laboratory-confirmed influenza A pandemic (H1N1) 2009 in 17 hospitalized recipients of a hematopoietic stem cell transplant (HSCT) (8 allogeneic) and in 15 patients with malignancy treated at 6 Australian tertiary centers during winter 2009. Ten (31.3%) patients were admitted to intensive care, and 9 of them were HSCT recipients. All recipients of allogeneic HSCT with infection <100 days posttransplantation or severe graft-versus-host disease were admitted to an intensive care unit. In-hospital mortality rate was 21.9% (7/32). The H275Y neuraminidase mutation, which confers oseltamivir resistance developed in 4 of 7 patients with PCR positive for influenza after > or = 4 days of oseltamivir therapy. Three of these 4 patients were critically ill. Oseltamivir resistance in 4 (13.3%) of 30 patients who were administered oseltamivir highlights the need for ongoing surveillance of such resistance and further research on optimal antiviral therapy in the immunocompromised.