Invasive fungal infection occurring in low birthweight infants.

A national surveillance study has been launched to look at the rate of invasive fungal infection in low birthweight infants. The survey has been prompted by the rise in morbidity and mortality in pre-term infants caused by candida. The rate of fungal infection is estimated to be about 2 in 100 babies who are born at a weight below 1,500 g (Saiman et al, 2000; Stoll et al, 1996). It is likely that the increasing incidence is due to the improved survival rates of these very young babies. Fifteen years ago very premature babies would have been of 29-30 weeks' gestation--currently they are more likely to be aged 25-26 weeks. But their extreme prematurity means that they need more invasive and intensive care.

Preventing fungal infections in immunocompromised patients.

The incidence of systemic fungal infections in immunosuppressed patients has increased in the past two decades (Fridkin and Jarvis, 1996). Bone marrow transplant recipients and patients with prolonged neutropenia are most at risk, particularly when environmental factors increase the presence of fungi and fungal spores. Preventive measures include air filtration, handwashing, exclusion of flowers and some foodstuffs and use of chemoprophylaxis. In April 1999, a meeting was held under the auspices of the European Group for Blood and Marrow Transplantation (UK) Nurses and Allied Professionals Group to discuss the role of nurses in the management of patients at risk of systemic fungal infection. Issues discussed included: the need for nurses to recognize risk factors for systemic fungal infection; the role of nurses in giving feedback to patients; and the use of antifungal agents and associated problems, such as non-compliance and side-effects.

Treatment of fungal infections with ABLC in the home-care setting.

Invasive fungal infections are an important cause of morbidity and mortality in HIV-infected individuals. The management of opportunistic infections in a home-care setting offers many psychological and economic advantages over hospitalization. Amphotericin B, the gold standard treatment for invasive fungal infections, is associated with significant adverse reactions, particularly nephrotoxicity, that make it difficult to administer as home infusion therapy. Lipid formulations of amphotericin B offer therapeutic alternatives to the parent compound with comparable efficacy, significantly lower rates of nephrotoxicity, and decreased infusion times versus the conventional form. Clinical experience with amphotericin B lipid complex injection in the treatment of fungal infections demonstrates its usefulness as an effective alternative to conventional amphotericin B in home infusion therapy.

Micosis sistémica en niños

Debido a que las micosis sistémicas son entidades particularmente severas en los niños y que no hay información sobre la magnitud del problema en Colombia, se llevó a cabo un estudio retrospectivo en un período de 10 años (1983-1994) en dos centros de referencia para las enfermedades micóticas del país. Se diagnosticaron 57 casos de micosis sitémicas en este grupo de pacientes, distribuidos así: 39 de histoplasmosis, 14 de criptococosis y cuatro de paracoccidioidomicosis. La edad de los pacientes osciló entre uno y 14 años. La histoplasmosis se presentó en niños menores (promedio 6.1 años), la criptococosis y la paracoccidioidomicosis, en mayores (promedio 8 y 11 años, respectivamente). La evolución de los síntomas antes del diagnóstico inicial fue de 4.3 meses en la histoplasmosis, de 2.3 en la criptococosis y de 12 en la paracoccidioidomicosis. Los síntomas y signos predominantes en la histoplasmosis pulmonar y la paracoccidioidomicosis fueron fiebre (51.5 por ciento), tos (42.2 por ciento), adenopatías (33.3 por ciento), pérdida de peso (30.3 por ciento), anorexia (24.2 por ciento) y hepatoesplenomegalia (18.1 por ciento). En las formas meníngeas de histoplasmosis y de criptococosis predominaron cefalea (62 por ciento), fiebre (41.3 por ciento), papiledema bilateral (34.4 por ciento), anorexia (27.5 por ciento) y astenia (13.8 por ciento). Las radiografías de tórax mostraron infiltrados sólo en 14 casos (25 por ciento). Los métodos que permitieron el diagnóstico etiológico fueron los procedimientos inmunológicos para determinar anticuerpos y antígeno, los cultivos, los exámenes directos y la biopsia. Las primeras fueron indispensables para el pronto diagnóstico de estos pacientes. En la criptococosis se encontraron patologías asociadas tales como leucemia, VIH, lupus, desnutrición e involución del timo. Diez de los pacientes con histoplasmosis y los cuatro con paracoccidioidomicosis estaban desnutridos.

Use of amphotericin B in immunosuppressed patients with cancer. Part One: Pharmacology and toxicities.

Potentially fatal fungal infections account for most of the prolonged fevers found in immunosuppressed patients with cancer. Amphotericin B (AmB) is the most effective drug available to treat these infections. This article, Part One of two parts, reviews the biochemical properties of AmB and its dosage and administration. Major toxicities and common side effects are discussed. Part Two uses the pharmacodynamics addressed in Part One as a basis for planning nursing interventions to prevent or suppress adverse reactions.

Use of amphotericin B in immunosuppressed patients with cancer. Part Two: Pharmacodynamics and nursing implications.

Nursing care of patients receiving amphotericin B (AmB) must address the underlying condition of the immunosuppressed patient with cancer and the iatrogenic responses induced by the drug. This review, the companion to "Part One: Pharmacology and Toxicities," focuses on nursing actions that consider both the drug's specific pharmacodynamics and the altered human responses caused by disease and therapy. Maximization of drug effectiveness and minimization of drug toxicity are key care goals.

Critical infections in the pediatric oncologic patient.

Over the past three decades, significant progress has been made in the treatment of childhood cancers. These advances derive not only from the effectiveness of the multimodal approach but also because of advances in supportive measures during the critical induction phase of therapy. The impact of disease and therapy on the immune system significantly compromises the child to a critical state. Astute application of the nursing process in assessing, planning, implementing, and evaluating measures to prevent, detect, and treat infectious processes in the granulocytopenic child is one of the critical challenges of nursing the child with cancer.