Bloodstream infection by Rhodococcus corynebacterioides in a pediatric patient diagnosed with high-risk retinoblastoma.

Rhodococcus is a pathogen that is known to cause infections in animals and humans, mainly in cases of immunocompromised patients. A case of a pediatric cancer patient suffering from a bloodstream infection caused by Rhodococcus corynebacterioides was described in this work. Gram positive rods were isolated from blood cultures. The target bacterium was identified using a combination of biochemical tests, the MALDI-TOF mass spectrometry technique, and the analysis of the 16S rRNA sequence. Moreover, an antimicrobial susceptibility test was performed using the E-test. The isolated bacterium was identified as R. corynebacterioides. The 3-year-old patient was successfully treated with vancomycin and meropenem. This is the first published report of R. corynebacterioides in a pediatric patient diagnosed with retinoblastoma that developed a bloodstream infection. R. corynebacterioides should be considered among the opportunistic infectious agents affecting pediatric cancer patients.

Securing access to a comprehensive diagnostic panel for children with suspected acute lymphoblastic leukemia: Results from the Mexico in Alliance with St. Jude "Bridge Project".

Background: The "Bridge Project" is a Mexico in Alliance with St. Jude (MAS) initiative developed in 2019 to improve access, accuracy, and timeliness of specialized diagnostic studies for patients with suspected acute lymphoblastic leukemia (ALL). The project strategy relies on service centralization to improve service delivery, biological characterization, risk-group classification, and support proper treatment allocation. Methods: This is an ongoing prospective multisite intersectoral quality improvement (QI) project available to all patients 0-18 years of age presenting with suspected ALL to the 14 actively participating institutions in 12 Mexican states. Institutions send specimens to one centralized laboratory. From a clinical standpoint, the project secures access to a consensus-derived comprehensive diagnostic panel. From a service delivery standpoint, we assess equity, timeliness, effectiveness, and patient-centeredness. From an implementation science standpoint, we document feasibility, utility, and appropriateness of the diagnostic panel and centralized approach. This analysis spans from July 2019 to June 2023. Results: 612 patients have accessed the project. The median age was 6 years (IQR 3-11), and 53% were males. 94% of the specimens arrived within 48 hours, which documents the feasibility of the centralized model, and 100% of the patients received precise and timely diagnostic results, which documents the effectiveness of the approach. Of 505 (82.5%) patients with confirmed ALL, 463/505 (91.6%) had B-cell ALL, and 42/505 (8.3%) had T-cell ALL. High-hyperdiploidy was detected by DNA index in 36.6% and hypodiploidy in 1.6%. 76.6% of the patients had conclusive karyotype results. FISH studies showed t(12;21) in 15%, iAMP21 in 8.5%, t(1;19) in 7.5%, t(4;11) in 4.2%, t(9;22) in 3.2%, del(9)(p21) in 1.8%, and TRA/D (14)(q11.2) rearrangement in 2.4%. Among B-cell ALL patients, 344/403 (85.1%) had Day 15 MRD<1% and 261/305 (85.6%) Day 84 MRD<0.01. For T-cell ALL patients 20/28 (71.4%) had Day 29 MRD<0.01% and 19/22 (86.4%) Day 84 MRD<0.01%. Conclusions: By securing access to a standardized consensus-derived diagnostic panel, the Bridge Project has allowed better characterization of childhood ALL in Mexico while producing unprecedented service improvements and documenting key implementation outcomes. We are using these results to inform iterative changes to the diagnostic panel and an associated treatment guideline (MAS-ALL18).

Trypanosoma cruzi: seroprevalence detected in the blood bank of the Instituto Nacional de Pediatría, Mexico City, in the period 2004 through 2009.

BACKGROUND: The second most common mode of Trypanosoma cruzi or Chagas disease transmission is via therapeutic blood transfusion. In Mexico, control of T. cruzi is still in its initial phase; in fact, there are only 14 studies published covering 10 states on T. cruzi seroprevalence in donated blood in Mexico. Here we present the results of 5 years of trypanosomiasis screening in the blood bank of the Instituto Nacional de Pediatría. STUDY DESIGN AND METHODS: Samples from all blood donated in the period from 2004 to 2009 were analyzed. We screened for T. cruzi using an enzyme-linked immunosorbent assay technique. Seropositive samples were then processed using the polymerase chain reaction (PCR) to detect a nuclear gene segment. RESULTS: A total of 37,333 samples were analyzed and a 0.17% (64 samples) T. cruzi seroprevalence was found. Donors were mostly from Mexico State and Mexico City, which is considered nonendemic for T. cruzi area. Of 64 seropositive samples, only two tested positive by PCR (3.12%), which amplified a 189-bp product from nuclear gene from the parasite. CONCLUSION: Although the seroprevalence of T. cruzi infection was low, this surveillance program prevented the infection of more than 100 children because each unit of blood provides 2.6 to 3.5 blood products. The majority of the donors were from Mexico State and Mexico City, which is a nonendemic area. The serodetection of T. cruzi in this region is evidence that is necessary to increase our understanding of its distribution in the Mexico City and surrounding places.