[Use of procalcitonin and C-reactive protein as infection markers in febrile neutropenic patients undergoing haematopoietic stem cell transplant]. / Utilización de procalcitonina y proteína C reactiva como marcadores de infección en la neutropenia febril de pacientes sometidos a trasplante de progenitores hematopoyéticos.

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.

[Fatal bacteremia related to Capnocytophaga sputigena in a hematological patient with type T non-Hodgkin lymphoma. Diagnosis by 16S rRNA gene sequencing]. / Bacteriemia fulminante asociada a Capnocytophaga sputigena en un paciente con linfoma no Hodgkin tipo T. Diagnóstico por secuenciación genética del ARNr 16S.

We described a case of fatal bacteremia related to Capnocytophaga sputigena in a hematological patient. The strain was identified by 16S rRNA gene sequencing.

[Diagnostic value of procalcitonin, interleukin 8, interleukin 6, and C-reactive protein for detecting bacteremia and fungemia in cancer patients]. / Valor diagnóstico de la procalcitonina, la interleucina 8, la interleucina 6 y la proteína C reactiva en la detección de bacteriemia y fungemia en pacientes con cáncer.

BACKGROUND AND OBJECTIVE: Bacteremia is one of the most important causes of morbidity and mortality in cancer patients. The aim of this study was to evaluate the diagnostic usefulness of procalcitonin (PCT), interleukin 8 (IL-8), interleukin 6 (IL-6), and C-reactive protein (CRP) in the detection of bacteremia in cancer patients. PATIENTS AND METHODS: PCT, IL-8, IL-6, and CPR levels were measured in 2 groups of cancer patients who had fever: one group with true bacteremia and another without bacteremia. RESULTS: Seventy-nine febrile episodes were analyzed in 79 patients, 43 men and 36 women. Forty-four patients were in the true bacteremia group. Significant differences in PCT (P<0.001), IL-8 (P<0.001), and IL-6 (P=0.002) values were found between patients with and without true bacteremia. CPR results were not significantly different between the groups (P=0.23). The cut-off point for PCT was 0.5 ng/mL and this parameter yielded the best specificity at 91.4%, with a sensitivity of 59.1%. CONCLUSIONS: Among the infection markers studied, PCT provided the most information for diagnosing bacteremia in cancer patients.

Utilización de procalcitonina y proteína C reactiva como marcadores de infección en la neutropenia febril de pacientes sometidos a trasplante de progenitores hematopoyéticos / Use of procalcitonin and C-reactive protein as infection markers in febrile neutropenic patients undergoing haematopoietic stem cell transplant

INTRODUCCIÓN Y OBJETIVO: La neutropenia es un signo frecuente en los pacientes que van a ser sometidos a trasplante de progenitores hematopoyéticos (TPH). Una complicación importante es la infección favorecida por la inmunodepresión y el grado de neutropenia. El objetivo del estudio es evaluar la utilidad diagnóstica de la procalcitonina (PCT) y de la proteína C reactiva (PCR) en pacientes onco-hematológicos sometidos a quimioterapia y TPH para discriminar la etiología de la fiebre. PACIENTES Y MÉTODOS: Se midieron los valores de PCT y PCR en 30 episodios de neutropenia febril antes del inicio de la quimioterapia, el día de la neutropenia, el día del inicio de la fiebre y los días 1, 2, 3 y 6 postinicio de la fiebre y al fin del episodio. Los episodios fueron clasificados como 5 bacteriemias, 3 infecciones documentadas microbiológicamente, 10 infecciones clínicas y 12 fiebres de origen desconocido. RESULTADOS: Los valores medios de PCT más elevados correspondieron al grupo de pacientes con bacteriemia. Hubo diferencias estadísticamente significativas (p = 0,04) el segundo día tras el inicio de la fiebre. El punto de corte de 0,5 ng/ml mostró una sensibilidad del 66% y una especificidad del 75%. La PCR mostró diferencias estadísticamente significativas los días 1, 2 y 3 postinicio de la fiebre (p = 0,01; p = 0,003 y p = 0,002). El punto de corte de 7,5 mg/dl mostró una sensibilidad del 88% y una especificidad del 58%. CONCLUSIONES: La combinación de PCT y PCR es un método insuficiente para la detección de infección bacteriana y no puede sustituir el correcto diagnóstico clínico y microbiológico

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 (AU)

Monoclonalidad T en paciente con linfoma de Hodgkin. ¿Linfoma compuesto o linfoma de Hodgkin con población T monoclonal reactiva? / T-cell monoclonality in Hodgkin's lymphoma. Composite lymphoma or Hodgkin's lymphoma with reactive T-cell monoclonal population

Introducción. El diagnóstico de los linfomas precisa la integración de hallazgos clínicos, morfológicos, inmunohistoquímicos (IHQ) y moleculares. En algunos casos en los que existe solapamiento en la morfología y/o la IHQ, los estudios de clonalidad B y/o T ofrecen pistas importantes que ayudan al diagnóstico definitivo. Material y métodos. Se describe el caso de un paciente masculino de 72 años de edad con micosis fungoide, pancitopenia y hepatoesplenomegalia sin adenopatías. Se realiza biopsia hepática y de médula ósea con estudio morfológico, IHQ y molecular. Se discute el diagnóstico diferencial entre procesos reactivos y neoplásicos. Resultados. La biopsia de médula ósea y hepática mostró una infiltración por dos poblaciones tumorales diferentes. Una de ellas estaba compuesta de células grandes tipo Reed-Sternberg y sus variantes con expresión IHQ de CD30, CD15, MUM1 y EBV. El otro componente, más extenso, estaba constituido por un infiltrado polimorfo de linfocitos de mediano/pequeño tamaño con núcleos irregulares y fenotipo CD3+, CD4+, CD7+ y CD2+. El estudio por biología molecular en la muestra procedente de médula ósea mostró reordenamiento clonal del receptor de células T así como reordenamiento clonal de IGH. Conclusión. La interpretación de los resultados moleculares en el diagnóstico de los linfomas debe correlacionarse estrictamente con la evolución clínica y los hallazgos morfológicos e IHQ(AU)

Introduction. The diagnosis and management of malignant lymphoma should be based on clinical, morphological, immunohistochemical and molecular information. Particularly in cases with morphological and/or immunohistochemistry overlapping, molecular biology provides important diagnostic clues. Material and methods. A 72 year-old male with mycosis fungoides, pancitopenia and hepatosplenomagly without lymph node enlargement, underwent both hepatic and bone marrow biopsies and histopathological, immunohistochemical and molecular studies were performed. Results. The bone marrow and hepatic biopsies showed two different populations, one composed of large cells including typical Reed-Sternberg cells and their variant, with expression of CD30, CD15, MUM1 and EBV. The other was more extensive and revealed polymorphic medium to small cells with convoluted nuclei positive for CD3, CD4, CD2, CD7. Clonal T cell receptor gamma and monoclonal immunoglobulin H gene were detected in the bone marrow infiltration. Conclusion. The interpretation of the molecular results in the diagnosis of lymphoma should be strictly correlated with the clinical evolution and the morphological and immunohistochemical findings(AU)

Valor diagnóstico de la procalcitonina, la interleucina 8, la interleucina 6 y la proteína C reactiva en la detección de bacteriemia y fungemia en pacientes con cáncer / Diagnostic value of procalcitonin, interleukin 8, interleukin 6, and c-reactive protein for detecting bacteremia and fungemia in cancer patients

Introducción y objetivo La bacteriemia es una de las causas más importantes de morbimortalidad en los pacientes con cáncer. El objetivo del presente estudio es evaluar la utilidad diagnóstica de la procalcitonina (PCT), la interleucina 8 (IL-8), la interleucina 6 (IL-6) y la proteína C reactiva (PCR) en la detección de bacteriemia en pacientes con cáncer. Pacientes y métodos Se midieron los valores de PCT, IL-8, IL-6 y PCR en 2 grupos de pacientes con cáncer que presentaron fiebre: el grupo con bacteriemia verdadera y el grupo sin bacteriemia. Resultados Se estudiaron 79 síndromes febriles en 79 pacientes, 43 hombres y 36 mujeres. Cuarenta y cuatro pacientes pertenecían al grupo de bacteriemia verdadera. Se encontraron diferencias significativas al comparar los valores de PCT, IL-8 e IL-6 (p<0,001, p<0,001, p=0,002, respectivamente) entre los pacientes con bacteriemia verdadera y sin bacteriemia. Los resultados de la PCR no mostraron diferencias significativas entre los 2 grupos estudiados (p=0,23). El punto de corte para la PCT fue de 0,5ng/ml y mostró la mejor especificidad (91,4%), con una sensibilidad del 59,1%.ConclusionesEl marcador de infección que puede aportar más información en el diagnóstico de bacteriemia en pacientes con cáncer es la PCT (AU)

Background and Objective Bacteremia is one of the most important causes of morbidity and mortality in cancer patients. The aim of this study was to evaluate the diagnostic usefulness of procalcitonin (PCT), interleukin 8 (IL-8), interleukin 6 (IL-6), and C-reactive protein (CRP) in the detection of bacteremia in cancer patients. Patients and methods PCT, IL-8, IL-6, and CPR levels were measured in 2 groups of cancer patients who had fever: one group with true bacteremia and another without bacteremia. Results Seventy-nine febrile episodes were analyzed in 79 patients, 43 men and 36 women. Forty-four patients were in the true bacteremia group. Significant differences in PCT (P<0.001), IL-8 (P<0.001), and IL-6 (P=0.002) values were found between patients with and without true bacteremia. CPR results were not significantly different between the groups (P=0.23). The cut-off point for PCT was 0.5ng/mL and this parameter yielded the best specificity at 91.4%, with a sensitivity of 59.1%.ConclusionsAmong the infection markers studied, PCT provided the most information for diagnosing bacteremia in cancer patients (AU)