RESUMEN
We reported the case with infected abdominal aortic aneurysm (AAA) caused by Streptococcus (S.) pyogenes. A seventy-seven-year-old man, who had the history of uncontrolled diabetes mellitus (DM), complained fever and abdominal pain. Abdominal computed tomography scan revealed the aneurysm above common iliac artery with false lumen. On admission, laboratory tests found marked elevation of inflammatory biomarkers. Thereby the infected AAA was suspected and blood culture was taken. The administration of meropenem (MEPM) and daptomycin (DAP) was started. Next day he underwent abdominal aortic replacement with prosthetic graft and debridement because of persistent abdominal pain and the enlargement of aneurysm. S. pyogenes in blood culture samples was identified by Matrix Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry. Same result was obtained from the tissue samples of the resected AAA. Then the diagnosis of infected AAA caused by S. pyogenes was made. Since isolated S. pyogenes showed the susceptibility to antibiotics tested including penicillin, antibiotics were changed to ampicillin (ABPC) for the de-escalation of antibiotics. He had kept the administration of ABPC for 4 weeks and transferred to another hospital for the further treatment of DM. The aneurysms by S. pyogenes are extremely rare, but we should note that S. pyogenes could induce the aneurysms.
Asunto(s)
Aneurisma Infectado , Aneurisma de la Aorta Abdominal , Anciano , Aorta Abdominal , Aneurisma de la Aorta Abdominal/tratamiento farmacológico , Humanos , Masculino , Streptococcus pyogenes , Tomografía Computarizada por Rayos XRESUMEN
A 74-year-old man was admitted to hospital due to suspected acute leukemia. He had a history of thymic carcinoma, which had been treated with carboplatin in combination with either paclitaxel or amrubicin. However, the tumor remained unresponsive to these treatments. Administration of tegafur/gimeracil/oteracil (TS-1) was initiated, which resulted in tumor size reduction and a partial response. However, leukopenia persisted after the last TS-1 treatment, and four years after the initial treatment, increased blast cell counts were found in a blood film . Bone marrow analysis showed blasts with Auer rods, faggot cells, and dysplastic promyelocytes. Flow cytometry was positive for CD13, CD33, CD34, CD117, and myeloperoxidase, but negative for HLA-DR. PML-RARA fluorescence in situ hybridization was positive. Cytogenetic analysis revealed 47,XY,t (15;17) (q22;q21),+21. Thus, therapy-related acute promyelocytic leukemia (tAPL) was diagnosed. The patient achieved and maintained complete remission for more than 20 months by a de novo APL-treatment regimen including all-trans retinoic acid, arsenic trioxide and tamibarotene. Moreover, the thymic carcinoma has remained stable. Although secondary malignancies of thymic carcinoma have been previously reported, therapy-related leukemia, especially tAPL, is very rare.
Asunto(s)
Leucemia Promielocítica Aguda , Timoma , Neoplasias del Timo , Anciano , Humanos , Hibridación Fluorescente in Situ , Masculino , Translocación GenéticaRESUMEN
We reported the case of a patient with leukemia who developed febrile neutropenia after hematopoietic stem cell transplantation. Blood culture results revealed the presence of Streptococcus oralis, while antimicrobial susceptibility testing showed the resistance to penicillin and cephem. Furthermore, isolates were not susceptible to either meropenem or daptomycin but not to vancomycin. S oralis is known to belong to Streptococcus mitis group and be a causative agent of bacteremia in the neutropenic patients, but multidrug resistance of S oralis is rare. Our findings suggest that we might pay attention to the emergence of the microorganisms acquiring multidrug resistance in neutropenic patients.
Asunto(s)
Antibacterianos/uso terapéutico , Bacteriemia/diagnóstico , Farmacorresistencia Bacteriana Múltiple , Neutropenia Febril/complicaciones , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Infecciones Estreptocócicas/diagnóstico , Adulto , Bacteriemia/tratamiento farmacológico , Neutropenia Febril/microbiología , Femenino , Humanos , Leucemia/terapia , Pruebas de Sensibilidad Microbiana , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus oralis/efectos de los fármacos , Resultado del TratamientoAsunto(s)
Biomarcadores de Tumor/metabolismo , Antígeno CD56/metabolismo , Leucemia-Linfoma Linfoblástico de Células Precursoras B/metabolismo , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Niño , Femenino , Humanos , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamiento farmacológico , Pronóstico , Resultado del TratamientoRESUMEN
We report the case of a patient with advanced gastric cancer and multiple liver metastases, who presented with bacteremia and hepatic gas gangrene caused by Clostridium novyi (C. novyi). The gas gangrene caused abscesses to form within metastatic lesions. This case highlights the antitumor effects of C. novyi in human.
Asunto(s)
Clostridium/aislamiento & purificación , Gangrena Gaseosa/diagnóstico , Gangrena Gaseosa/patología , Absceso Hepático/diagnóstico , Absceso Hepático/patología , Neoplasias Hepáticas/complicaciones , Neoplasias Gástricas/complicaciones , Anciano de 80 o más Años , Clostridium/clasificación , Gangrena Gaseosa/microbiología , Humanos , Absceso Hepático/microbiología , Neoplasias Hepáticas/diagnóstico , Masculino , Neoplasias Gástricas/secundarioRESUMEN
BACKGROUND: Eosinophilic pneumonia (EP) is characterized by massive pulmonary infiltration by eosinophils. Although serum periostin is a novel marker for eosinophil-dominant asthma, the upregulation of periostin in the airway of asthmatics is controversial. In this study, we examined whether periostin concentrations are elevated in the bronchoalveolar lavage fluid (BALF) of patients with EP. METHODS: BAL was performed in healthy volunteers and in patients with acute eosinophilic pneumonia (AEP), chronic eosinophilic pneumonia (CEP), and sarcoidosis. The periostin concentrations in the BALF were measured. RESULTS: The periostin concentration in the BALF increased significantly with pulmonary eosinophil ia and was higher in AEP and CEP patients than in healthy volunteers and sarcoidosis patients, even after adjusting the albumin concentration. In pulmonary eosinophilia, the periostin concentration correlated with the eosinophil and lymphocyte counts, the concentration of albumin, and the concentration of cytokines such as IL-5, IL-13, and transforming growth factor ß1. CONCLUSIONS: Although some blood leakage may be involved in the elevation of periostin in the BALF of EP, periostin can be induced locally, at least in part. Therefore, periostin may play a role in the development of EP.
Asunto(s)
Líquido del Lavado Bronquioalveolar/química , Moléculas de Adhesión Celular/análisis , Eosinofilia Pulmonar/inmunología , Adulto , Moléculas de Adhesión Celular/fisiología , Citocinas/análisis , Eosinófilos/fisiología , Femenino , Humanos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Eosinofilia Pulmonar/etiología , Albúmina Sérica/análisisRESUMEN
Blood cultures are the most valuable tool when bacteremia is clinically suspected. Technical advances have led to the development of automated blood culture systems to detect bacterial infections. Usually positive signals in automated blood culture systems result from the proliferation of microorganisms. Cases are classified as false-positive when the automated blood culture system produces a positive signal but no microorganisms are detected on Gram-stained smears and no microorganism growth is observed in blood subcultures. False-positive blood culture results are very rare in patients with hematologic malignancies. Recently, we encountered four patients who had false-positive blood culture results. Two of the patients were diagnosed with acute leukemia, involving hyperleukocytosis and an excess of blasts. The other two patients were diagnosed with acute leukemia and diffuse large B cell lymphoma with leukocytopenia. Although hypercapnia or acidosis, apart from hyperleukocytosis, might also cause false-positive results, our cases clearly did not have these conditions. We should be aware of the possibility that false-positive blood culture results can occur in patients with leukocytopenia, as well as hyperleukocytosis. To understand the mechanisms responsible for the observed false-positive results, additional studies are needed after the accumulation of similar cases.
Asunto(s)
Bacteriemia/diagnóstico , Técnicas Bacteriológicas/métodos , Cultivo de Sangre/métodos , Leucemia Mieloide Aguda/sangre , Linfoma de Células B Grandes Difuso/sangre , Adulto , Anciano , Automatización de Laboratorios , Bacteriemia/microbiología , Cultivo de Sangre/instrumentación , Reacciones Falso Positivas , Femenino , Humanos , Leucemia Mieloide Aguda/complicaciones , Linfoma de Células B Grandes Difuso/complicaciones , MasculinoRESUMEN
BACKGROUND: Recent evidence has suggested that the innate immune response may play a role in the development of eosinophilic airway inflammation. We previously reported that uric acid (UA) and adenosine triphosphate (ATP), two important damage-associated molecular pattern molecules (DAMPs), activate eosinophil functions, suggesting that these molecules may be involved in the development of eosinophilic airway inflammation. The objective of this study was to measure the concentrations of DAMPs including UA and ATP in the bronchoalveolar lavage fluid (BALF) of patients with eosinophilic pneumonia (EP). METHODS: BAL was performed in patients with EP including acute and chronic eosinophilic pneumonia, and in patients with hypersensitivity pneumonia, and sarcoidosis. UA, ATP, and cytokine concentrations in the BALF were then measured. RESULTS: The UA concentration was increased in the BALF of EP patients. UA concentrations correlated with eosinophil numbers, and with eosinophil-derived neurotoxin and interleukin (IL)-5 concentrations. Furthermore, the ATP concentration was increased in the BALF of EP patients and ATP concentrations correlated with UA concentrations. Moreover, IL-33 was increased in EP patients and IL-33 concentrations correlated with UA and ATP concentrations. CONCLUSIONS: The UA and ATP concentration was increased in the BALF of EP patients. UA concentrations correlated with eosinophil numbers, and with ATP and IL-33 concentrations. Our findings suggest that DAMPs such as UA and ATP play a role in the pathogenesis of EP.
Asunto(s)
Adenosina Trifosfato/metabolismo , Líquido del Lavado Bronquioalveolar/inmunología , Eosinofilia Pulmonar/inmunología , Eosinofilia Pulmonar/metabolismo , Ácido Úrico/metabolismo , Adolescente , Adulto , Anciano , Alarminas/metabolismo , Biomarcadores , Líquido del Lavado Bronquioalveolar/citología , Citocinas/metabolismo , Eosinófilos/inmunología , Eosinófilos/metabolismo , Eosinófilos/patología , Femenino , Humanos , Mediadores de Inflamación/metabolismo , L-Lactato Deshidrogenasa/metabolismo , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Eosinofilia Pulmonar/patología , Adulto JovenRESUMEN
INTRODUCTION: Infections represent a major complication of hematological malignancies. C-reactive protein (CRP) and procalcitonin (PCT) have been used as diagnostic biomarkers of infections, but do not produce definitive findings. Recently, a new biomarker, presepsin, has been used as a diagnostic tool for detecting infections in the fields of emergency and neonatal medicine. However, the usefulness of presepsin for identifying infections in patients with hematological malignancies, including those who develop febrile neutropenia, remains unclear. METHODS: In this study, we retrospectively analyzed the utility of PCT, presepsin, and CRP as biomarkers of infections during 49 febrile episodes that occurred in 28 patients with hematological malignancies. RESULTS: The levels of PCT, but not those of CRP or presepsin, were significantly higher in the infection group than in the uninfected group (P<.03), indicating that PCT might be a more sensitive biomarker of infections. No differences in presepsin levels were detected between the patients with and without neutropenia, or between the infected and uninfected patients with neutropenia, indicating that presepsin might have less diagnostic value in patients with neutropenia. CONCLUSIONS: We conclude that PCT might provide additional information and could be used in combination with other biomarkers to detect infections in patients with hematological malignancies.
Asunto(s)
Proteína C-Reactiva/análisis , Calcitonina/sangre , Neutropenia Febril Inducida por Quimioterapia/diagnóstico , Neoplasias Hematológicas , Infecciones/diagnóstico , Receptores de Lipopolisacáridos/sangre , Fragmentos de Péptidos/sangre , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Neutropenia Febril Inducida por Quimioterapia/sangre , Neutropenia Febril Inducida por Quimioterapia/epidemiología , Femenino , Neoplasias Hematológicas/sangre , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/epidemiología , Humanos , Infecciones/sangre , Infecciones/epidemiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC , Estudios Retrospectivos , Adulto JovenRESUMEN
The present study aimed to measure the levels of coagulation factors in stored whole blood of pregnant women and to determine their usefulness in treating pregnant women who developed coagulopathy. A prospective study to measure coagulation factors in stored donated whole blood from pregnant and non-pregnant women was conducted. Fibrinogen, FV, FVII, FVIII, FXIII, and von Willebrand factor were measured in blood stored at 4°C for 0, 1, 3, and 5 weeks. All coagulation factors except for factor XIII decreased during storage. Fibrinogen and factor VII in the blood collected from pregnant women gradually decreased over time and their levels were significantly higher after 5 weeks of storage than those of non-pregnant women at week 0. Whole blood donated by pregnant women for autologous blood transfusion and stored at 4°C may be expected being effectively for the prevention of coagulopathy and the treatment of circulatory blood volume loss.