Predictive factors associated with induction-related death in acute myeloid leukemia in a resource-constrained setting.

Despite advances in supportive measures, acute myeloid leukemia (AML) remission induction still has a high mortality rate in real-world studies as compared to prospective reports. We analyzed data from 206 AML adult patients treated with conventional chemotherapy. The primary endpoint was the 60-day mortality rate, aiming to find risk factors and to examine the role of anti-infection prophylaxis. The 60-day mortality rate was 26%, raising to 41% among those older than 60 years. Complete response was documented at the end of induction in 49%. The final survival model showed that age > 60 years (HR 3.2), Gram-negative colonization (HR 3), monocytic AML (HR 1.8), C-reactive protein (CRP) > 15 mg/dL (HR 10), and an adverse risk in the genetic stratification (HR 3) were associated with induction death. Multidrug-resistant bacteria colonization, thrombosis, and AKI were documented in 71%, 12%, and 66% of the cohort, respectively. Antibacterial and antifungal prophylaxis did not improve outcomes in this study. Our report corroborated the higher mortality during AML induction compared to real-world data from the USA and Europe. In line with other publications, age and cytogenetic stratification influenced early death in this cohort. Noticeably, Gram-negative colonization, monocytic AML, and CRP were also significant to early mortality.

Acquired hemophagocytic lymphohistiocytosis as initial manifestation of multiple myeloma: A case report and literature review.

INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a condition characterized by a hyperinflammatory state and persistent macrophage activation, resulting in reactive phagocytosis of the hematopoietic elements. In children, it is usually a hereditary disorder, while in adults it is usually acquired secondary to viral infections, collagenoses, or tumors. Although accounting for 10% of hematologic malignancies, HLH is rarely associated with multiple myeloma (MM) and other plasmacytic dyscrasias. PATIENT CONCERNS: A 64-year-old Brazilian man seeked medical care with a 3-month history of intermittent fever, weight loss, night sweats, and progressive anemic symptoms. DIAGNOSIS: Total blood count showed severe bicytopenia (normocytic-normochromic anemia and thrombocytopenia), biochemical exams showed elevation of creatinine, as well as monoclonal peak in serum protein electrophoresis, high IgA dosage, and serum immunofixation with IgA kappa paraprotein. Bone marrow biopsy showed 30% of monoclonal and phenotypically anomalous plasmocytes, confirming the diagnosis of MM. Diagnosis of HLH was established by the presence of clinical and laboratory criteria: fever, splenomegaly, cytopenias, hypofibrinogenemia, hyperferritinemia, elevation of triglycerides, and several figures of erythrophagocytosis in bone marrow aspirate. INTERVENTIONS: The patient experienced pulse therapy with methylprednisolone for hemophagocytic lymphohistiocytosis, followed by initial therapy for multiple myeloma with cyclophosphamide and dexamethasone. OUTCOMES: Once the diagnosis of MM and secondary hemophagocytic syndrome was established, the patient had a rapid clinical deterioration despite the established therapeutic measures, evolving with cardiovascular failure, acute liver failure, acute disseminated intravascular coagulation, worsening renal dysfunction requiring dialysis support, respiratory dysfunction, and lowering of consciousness, characterizing rapid multiple organ dysfunction, ultimately leading to the death of the patient. INNOVATION: Here, we aimed to describe the sixth reported case of HLH associated with MM, according to cases cataloged in the PubMed database, and the first case evaluated by 18-fluordeoxyglucose positron emission tomography (18-FDG-PETCT). CONCLUSION: Our case report seeks to provide support for a better clinical and laboratory characterization of this rare paraneoplastic entity associated with MM, and aims to call the attention of hematologists and intensivists to this condition that falls within the scope of the differential diagnosis of rapid onset multiple organ failure in patients with plasmacytic neoplasms.

Capnocytophaga sputigena bloodstream infection in hematopoietic stem cell transplantations: two cases report and review of the literature.

Capnocytophaga is a group of facultative anaerobic gram-negative bacteria present in the oral cavity of humans, dogs and cats, as part of their normal oral flora. Here, we described two cases of bloodstream infections (BSI) caused by Capnocytophaga in neutropenic autologous hematopoietic stem cell transplantation (auto-HSCT) patients with mucositis (Grade I and Grade III) identified by Maldi-Tof. They were successfully treated with ß-lactam (meropenem and piperacillin-tazobactam). The species C. sputigena was confirmed by 16S rRNA gene sequencing in one patient. The review of literature showed that C. ochraceae was the most frequent species causing BSI in auto-HSCT patients and that the patients usually presented mucositis and were neutropenic at the onset of the infection.

Qualidade bacteriológica de ovos contaminados com Pseudomonas aeruginosa e armazenados em temperatura ambiente ou refrigerados / Bacteriological quality of washed and unwashed eggs stored under room temperature and refrigeration and contaminated with Pseudomonas aeruginosa

The aim of this study was to evaluate the effect of sanitization and storage temperature on the quality of commercial eggs inoculated with Pseudomonas aeruginosa. We used 240 large eggs, without cracks, from Dekalb White laying hens at 30 to 40 weeks of age. The experimental design used was two blocks in a 2 x 2 factorial arrange (washed/non-washed and refrigerated/non-refrigerated) with twelve replicates. The eggs were contaminated by handling, with 1.5 x 105 colony-forming units (CFU) of Pseudomonas aeruginosa and stored at 5 C and 25 C for 30 days. Each ten days the eggshell and contents were submitted to bacteriological analyses. Variance analyses were performed and the data were compared by Tukey test. The results showed that Pseudomonas aeruginosa were isolated from the shells and contents of all eggs. Therefore, when the eggs were sanitized and stored at 5 ºC the contamination was less intense. The correlation between the presences of Pseudomonas aeruginosa in the shell and contents was high, when the eggs were not sanitized nor refrigerated. The conclusion of this study was that the egg must be sanitized and refrigerated when the stored for more than 30 days.

Objetivou-se verificar o efeito da sanitização e da temperatura de armazenamento sobre a qualidade bacteriológica de ovos contaminados experimentalmente com Pseudomonas aeruginosa. Foram utilizados 240 ovos brancos em esquema fatorial 2 x 2  (lavados ou não e refrigerados ou não).  Os ovos foram sanitizados com água quente contendo clorhexidina 20% e teor ativo 8% de cloro. Após a sanitização, foram contaminados com 1,5 x 105 unidades formadoras de colônia (UFCs) de Pseudomonas aeruginosa/mL de solução e armazenados a 5 oC ou 25 oC por 30 dias. A cada dez dias foram realizadas análises bacteriológicas e contagens de Pseudomonas aeruginosa na casca e conteúdo. Foi realizada análise de variância e as médias comparadas pelo teste de Tukey. Pseudomonas aeruginosa foi isolada da casca e do conteúdo em todos os ovos, independentemente dos tratamentos. No entanto, quando os ovos foram sanitizados e armazenados a 5 ºC apresentaram menor contagem bacteriana na casca e no conteúdo. Houve alta correlação entre Pseudomonas aeruginosa presente na casca com a presença no conteúdo do ovo quando os ovos não foram sanitizados e resfriados. Concluiu-se que para reduzir o crescimento bacteriano de Pseudomonas aeruginosa, os ovos devem ser sanitizados e mantidos a 5 ºC durante o armazenamento de 30 dias.

Qualidade bacteriológica de ovos contaminados com Pseudomonas aeruginosa e armazenados em temperatura ambiente ou refrigerados

The aim of this study was to evaluate the effect of sanitization and storage temperature on the quality of commercial eggs inoculated with Pseudomonas aeruginosa. We used 240 large eggs, without cracks, from Dekalb White laying hens at 30 to 40 weeks of age. The experimental design used was two blocks in a 2 x 2 factorial arrange (washed/non-washed and refrigerated/non-refrigerated) with twelve replicates. The eggs were contaminated by handling, with 1.5 x 10(5) colony-forming units (CFU) of Pseudomonas aeruginosa and stored at 5 ºC and 25 ºC for 30 days. Each ten days the eggshell and contents were submitted to bacteriological analyses. Variance analyses were performed and the data were compared by Tukey test. The results showed that Pseudomonas aeruginosa were isolated from the shells and contents of all eggs. Therefore, when the eggs were sanitized and stored at 5 ºC the contamination was less intense. The correlation between the presences of Pseudomonas aeruginosa in the shell and contents was high, when the eggs were not sanitized nor refrigerated. The conclusion of this study was that the egg must be sanitized and refrigerated when the stored for more than 30 days.

Objetivou-se verificar o efeito da sanitização e da temperatura de armazenamento sobre a qualidade bacteriológica de ovos contaminados experimentalmente com Pseudomonas aeruginosa. Foram utilizados 240 ovos brancos em esquema fatorial 2 x 2 (lavados ou não e refrigerados ou não). Os ovos foram sanitizados com água quente contendo clorhexidina 20% e teor ativo 8% de cloro. Após a sanitização, foram contaminados com 1,5 x 10(5) unidades formadoras de colônia (UFCs) de Pseudomonas aeruginosa/mL de solução e armazenados a 5 ºC ou 25 ºC por 30 dias. A cada dez dias foram realizadas análises bacteriológicas e contagens de Pseudomonas aeruginosa na casca e conteúdo. Foi realizada análise de variância e as médias comparadas pelo teste de Tukey. Pseudomonas aeruginosa foi isolada da casca e do conteúdo em todos os ovos, independentemente dos tratamentos. No entanto, quando os ovos foram sanitizados e armazenados a 5 ºC apresentaram menor contagem bacteriana na casca e no conteúdo. Houve alta correlação entre Pseudomonas aeruginosa presente na casca com a presença no conteúdo do ovo quando os ovos não foram sanitizados e resfriados. Concluiu-se que para reduzir o crescimento bacteriano de Pseudomonas aeruginosa, os ovos devem ser sanitizados e mantidos a 5 ºC durante o armazenamento de 30 dias.

Qualidade bacteriológica de ovos contaminados com Pseudomonas aeruginosa e armazenados em temperatura ambiente ou refrigerados / Bacteriological quality of washed and unwashed eggs stored under room temperature and refrigeration and contaminated with Pseudomonas aeruginosa

The aim of this study was to evaluate the effect of sanitization and storage temperature on the quality of commercial eggs inoculated with Pseudomonas aeruginosa. We used 240 large eggs, without cracks, from Dekalb White laying hens at 30 to 40 weeks of age. The experimental design used was two blocks in a 2 x 2 factorial arrange (washed/non-washed and refrigerated/non-refrigerated) with twelve replicates. The eggs were contaminated by handling, with 1.5 x 105 colony-forming units (CFU) of Pseudomonas aeruginosa and stored at 5 C and 25 C for 30 days. Each ten days the eggshell and contents were submitted to bacteriological analyses. Variance analyses were performed and the data were compared by Tukey test. The results showed that Pseudomonas aeruginosa were isolated from the shells and contents of all eggs. Therefore, when the eggs were sanitized and stored at 5 ºC the contamination was less intense. The correlation between the presences of Pseudomonas aeruginosa in the shell and contents was high, when the eggs were not sanitized nor refrigerated. The conclusion of this study was that the egg must be sanitized and refrigerated when the stored for more than 30 days.(AU)

Objetivou-se verificar o efeito da sanitização e da temperatura de armazenamento sobre a qualidade bacteriológica de ovos contaminados experimentalmente com Pseudomonas aeruginosa. Foram utilizados 240 ovos brancos em esquema fatorial 2 x 2  (lavados ou não e refrigerados ou não).  Os ovos foram sanitizados com água quente contendo clorhexidina 20% e teor ativo 8% de cloro. Após a sanitização, foram contaminados com 1,5 x 105 unidades formadoras de colônia (UFCs) de Pseudomonas aeruginosa/mL de solução e armazenados a 5 oC ou 25 oC por 30 dias. A cada dez dias foram realizadas análises bacteriológicas e contagens de Pseudomonas aeruginosa na casca e conteúdo. Foi realizada análise de variância e as médias comparadas pelo teste de Tukey. Pseudomonas aeruginosa foi isolada da casca e do conteúdo em todos os ovos, independentemente dos tratamentos. No entanto, quando os ovos foram sanitizados e armazenados a 5 ºC apresentaram menor contagem bacteriana na casca e no conteúdo. Houve alta correlação entre Pseudomonas aeruginosa presente na casca com a presença no conteúdo do ovo quando os ovos não foram sanitizados e resfriados. Concluiu-se que para reduzir o crescimento bacteriano de Pseudomonas aeruginosa, os ovos devem ser sanitizados e mantidos a 5 ºC durante o armazenamento de 30 dias.(AU)