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1.
A A Pract ; 15(4): e01432, 2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33783367

RESUMEN

The role of concurrent illness in coronavirus disease 2019 (COVID-19) is unknown. Patients with leukemia may display altered thromboinflammatory responses. We report a 53-year-old man presenting with acute leukemia and COVID-19 who developed thrombotic complications and acute respiratory distress syndrome. Multiple analyses, including rotational thromboelastometry and flow cytometry on blood and bronchoalveolar lavage, are reported to characterize coagulation and immune profiles. The patient developed chemotherapy-induced neutropenia that may have protected his lungs from granulocyte-driven hyperinflammatory acute lung injury. However, neutropenia also alters viral clearing, potentially enabling ongoing viral propagation. This case depicts a precarious equilibrium between leukemia and COVID-19.


Asunto(s)
Lesión Pulmonar Aguda/complicaciones , Trastornos de la Coagulación Sanguínea/complicaciones , Trastornos de la Coagulación Sanguínea/patología , /patología , Leucemia Mieloide Aguda/complicaciones , Lesión Pulmonar Aguda/diagnóstico , Lesión Pulmonar Aguda/patología , Trastornos de la Coagulación Sanguínea/diagnóstico , Lavado Broncoalveolar , Citometría de Flujo , Humanos , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/patología , Masculino , Persona de Mediana Edad , Neutropenia/complicaciones , Neutropenia/diagnóstico , Neutropenia/patología , Tromboelastografía , Factores de Virulencia
2.
J Clin Oncol ; 38(30): 3538-3546, 2020 10 20.
Artículo en Inglés | MEDLINE | ID: mdl-32795225

RESUMEN

PURPOSE: Coronavirus-2019 (COVID-19) mortality is higher in patients with cancer than in the general population, yet the cancer-associated risk factors for COVID-19 adverse outcomes are not fully characterized. PATIENTS AND METHODS: We reviewed clinical characteristics and outcomes from patients with cancer and concurrent COVID-19 at Memorial Sloan Kettering Cancer Center until March 31, 2020 (n = 309), and observed clinical end points until April 13, 2020. We hypothesized that cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis is associated with an increased hazard ratio (HR) of severe or critical COVID-19. In secondary analyses, we estimated associations between specific clinical and laboratory variables and the incidence of a severe or critical COVID-19 event. RESULTS: Cytotoxic chemotherapy administration was not significantly associated with a severe or critical COVID-19 event (HR, 1.10; 95% CI, 0.73 to 1.60). Hematologic malignancy was associated with increased COVID-19 severity (HR, 1.90; 95% CI, 1.30 to 2.80). Patients with lung cancer also demonstrated higher rates of severe or critical COVID-19 events (HR, 2.0; 95% CI, 1.20 to 3.30). Lymphopenia at COVID-19 diagnosis was associated with higher rates of severe or critical illness (HR, 2.10; 95% CI, 1.50 to 3.10). Patients with baseline neutropenia 14-90 days before COVID-19 diagnosis had worse outcomes (HR, 4.20; 95% CI, 1.70 to 11.00). Findings from these analyses remained consistent in a multivariable model and in multiple sensitivity analyses. The rate of adverse events was lower in a time-matched population of patients with cancer without COVID-19. CONCLUSION: Recent cytotoxic chemotherapy treatment was not associated with adverse COVID-19 outcomes. Patients with active hematologic or lung malignancies, peri-COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes. Interactions among antineoplastic therapy, cancer type, and COVID-19 are complex and warrant further investigation.


Asunto(s)
Antineoplásicos/efectos adversos , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Neoplasias/tratamiento farmacológico , Neumonía Viral/complicaciones , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neutropenia/complicaciones , Pandemias
3.
Rinsho Ketsueki ; 61(5): 455-461, 2020.
Artículo en Japonés | MEDLINE | ID: mdl-32507808

RESUMEN

An 81-year-old female was referred to our hospital with progressive neutropenia and anemia of unknown etiology. We performed a bone marrow biopsy which was notable for hypercellularity, multinucleated megakaryocytes and hypo-granular neutrophils with 2.6% blasts. A diagnosis of myelodysplastic syndrome with multilineage dysplasia (MDS-MLD) was made. Karyotype analysis revealed a t (9;22)(q34;q11.2) BCR-ABL1 fusion with no additional chromosomal abnormalities. BCR-ABL1 was also detected in transcripts from peripheral blood cells as well as in polynuclear leukocytes via FISH. Within one year, her peripheral blood neutrophil count had declined to 403/µl; further analysis was notable for increasing dysplasia including enlarged platelets and hypo-granular neutrophils. Platelet counts gradually increased over time and reached 100×104/µl. A second bone marrow examination revealed similar cell morphology and the BCR-ABL1 translocation. Her condition deteriorated and blood transfusions were required. Treatment with low doses of the tyrosine kinase inhibitor (TKI), imatinib mesylate (100 mg), was initiated. Thereafter, both the neutropenia and anemia resolved gradually, platelet counts returned to normal levels, and dysplasia eventually disappeared. Detection of the BCR-ABL fusion in mRNA decreased to < 0.0007% (IS%) after 16 months of treatment. Several cases of BCR-ABL1-positive myelodysplastic syndrome treated with TKIs have been reported. Our results suggest that complete hematologic recovery in response to imatinib mesylate suggests a critical role for the BCR-ABL1 fusion in the pathogenesis of this disease.


Asunto(s)
Anemia , Síndromes Mielodisplásicos , Neutropenia , Anciano de 80 o más Años , Anemia/complicaciones , Femenino , Proteínas de Fusión bcr-abl , Humanos , Mesilato de Imatinib , Síndromes Mielodisplásicos/complicaciones , Síndromes Mielodisplásicos/tratamiento farmacológico , Neutropenia/complicaciones , Inhibidores de Proteínas Quinasas
4.
Lung Cancer ; 145: 213-215, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32389426
5.
Br J Radiol ; 93(1113): 20190693, 2020 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-32462888

RESUMEN

OBJECTIVE: The aim of this study is to characterize chest CT findings of neutropenic patients with proven/probable invasive pulmonary aspergillosis (IPA). METHODS: Hematological cancer patients admitted to our institution (2007-2017) were retrospectively enrolled if the diagnostic criteria of proven/probable IPA during the neutropenia were met (EORTC/MSG). Galactomannan (GM) was routinely measured in serum and chest CT-scan was routinely performed in case of recurrent/persistent fever. Bronchoscopy was performed in case of chest CT-scan abnormalities. Chest CT-scan and GM dosage were analyzed at the time of IPA suspicion. Chest lesions were classified using a clinical report form by two expert radiologists. RESULTS: 35 patients were identified. Peribronchial focal lesions were observed in 29 IPA (82.9%) by the first radiologist and in 31 (88.5%) by the second (k = 0.768). 12 weeks mortality was 20%. CONCLUSION: Peribronchial focal lesions are a common finding in early-IPA whatever the GM value during neutropenia and our findings reinforce the efficiency of a preemptive approach. ADVANCES IN KNOWLEDGE;: Peribronchial focal lesions, which are classically described in airway invasive aspergillosis, are a common finding in early-IPA in hematological cancer patients with prolonged neutropenia regardless of the GM value, and such peribronchial lesions should reinforce the possibility of IPA.


Asunto(s)
Enfermedades Bronquiales/diagnóstico por imagen , Neoplasias Hematológicas/complicaciones , Aspergilosis Pulmonar Invasiva/diagnóstico por imagen , Neutropenia/complicaciones , Tomografía Computarizada por Rayos X , Adulto , Anciano , Biomarcadores/sangre , Broncoscopía , Femenino , Neoplasias Hematológicas/sangre , Humanos , Aspergilosis Pulmonar Invasiva/sangre , Masculino , Mananos/sangre , Persona de Mediana Edad , Neutropenia/sangre , Neutropenia/inducido químicamente , Prevalencia , Estudios Retrospectivos , Adulto Joven
10.
Sci Rep ; 10(1): 2894, 2020 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-32076032

RESUMEN

In this analysis, the levels of CRP and IL-8 were employed as a guide for designing the duration of antibiotics administration in the condition of febrile neutropenia. The importance of laboratory biomarkers is in the early diagnosis of critical illness and adjustment of further management. IL-8 is a useful biomarker for the early identification of critically ill patients, compared to CRP in FN.


Asunto(s)
Proteína C-Reactiva/metabolismo , Fiebre/sangre , Fiebre/diagnóstico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Interleucina-8/sangre , Neutropenia/sangre , Neutropenia/diagnóstico , Medición de Riesgo , Niño , Fiebre/complicaciones , Humanos , Neutropenia/complicaciones , Sensibilidad y Especificidad
11.
BMC Med Genet ; 21(1): 35, 2020 02 17.
Artículo en Inglés | MEDLINE | ID: mdl-32066420

RESUMEN

BACKGROUND: We report a large family with four successive generations, presenting with a complex phenotype of severe congenital neutropenia (SCN), partially penetrant monocytosis, and hearing loss of varying severity. METHODS: We performed whole exome sequencing to identify the causative variants. Sanger sequencing was used to perform segregation analyses on remaining family members. RESULTS: We identified and classified a pathogenic GFI1 variant and a likely pathogenic variant in MYO6 which together explain the complex phenotypes seen in this family. CONCLUSIONS: We present a case illustrating the benefits of a broad screening approach that allows identification of oligogenic determinants of complex human phenotypes which may have been missed if the screening was limited to a targeted gene panel with the assumption of a syndromic disorder. This is important for correct genetic diagnosis of families and disentangling the range and severity of phenotypes associated with high impact variants.


Asunto(s)
Síndromes Congénitos de Insuficiencia de la Médula Ósea/genética , Proteínas de Unión al ADN/genética , Pérdida Auditiva Sensorineural/genética , Cadenas Pesadas de Miosina/genética , Neutropenia/congénito , Factores de Transcripción/genética , Adulto , Anciano , Síndromes Congénitos de Insuficiencia de la Médula Ósea/complicaciones , Síndromes Congénitos de Insuficiencia de la Médula Ósea/diagnóstico , Síndromes Congénitos de Insuficiencia de la Médula Ósea/fisiopatología , Exoma/genética , Femenino , Enfermedades Genéticas Congénitas/complicaciones , Enfermedades Genéticas Congénitas/diagnóstico , Enfermedades Genéticas Congénitas/genética , Enfermedades Genéticas Congénitas/fisiopatología , Pérdida Auditiva Sensorineural/complicaciones , Pérdida Auditiva Sensorineural/diagnóstico , Pérdida Auditiva Sensorineural/patología , Humanos , Masculino , Persona de Mediana Edad , Mutación/genética , Neutropenia/complicaciones , Neutropenia/diagnóstico , Neutropenia/genética , Neutropenia/fisiopatología , Linaje , Fenotipo , Secuenciación del Exoma Completo
12.
Am J Hematol ; 95(5): 521-528, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32052479

RESUMEN

Neutropenia (NP), that is, an absolute blood neutrophil count (ANC) <1.5 g/L, accompanies various diseases. However, the clinical significance of NP, detected in routine complete blood cell counts (CBC) in primary care, is poorly characterized. Here, from a primary care resource with ANCs from >370 000 individuals, we identified and followed neutropenic subjects for the next 4 years for novel ICD-10 based diagnoses of viral infections and hematological malignancies (ie, previously identified major outcomes in NP individuals) in Danish nationwide health registers. Risk estimates were assessed for children/adolescents (1-18 years) and adults (19-90 years) in relation to NP severity, and for isolated NP, bi- or pancytopenias. We found that NP was observed in 4.9% of children and in 1.9% of adults. The lower the ANC, the likelier was a diagnosis of viral infections or hematological malignancies established during the ensuing 4 years. Among neutropenic children, unspecified viral infections predominated, followed by mononucleosis (with other cytopenias in only 7% and 25% of the cases, respectively). All NP children with acute leukemia presented with bi- or pancytopenia from start of follow-up. In NP adults, hepatitis, followed by HIV, were the most common infections, and acute myelogenous leukemia (AML) and myelodysplastic syndromes (MDSs) the predominating hematological malignancies. Adult NP patients, subsequently diagnosed with hepatitis, HIV or AML, MDS, were bi- or pancytopenic in 42%, 47%, 90% and 91% of cases, respectively. Thus, presence of NP in even one CBC may be the first sign of a latent viral or hematological disorder requiring careful follow-up.


Asunto(s)
Neutropenia/diagnóstico por imagen , Atención Primaria de Salud/métodos , Adolescente , Análisis de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neutropenia/complicaciones , Prevalencia
13.
Cytogenet Genome Res ; 160(1): 11-17, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31982875

RESUMEN

Small supernumerary marker chromosomes (sSMCs) are characterized as additional centric chromosome fragments which are too small to be classified by cytogenetic banding alone and smaller than or equal to the size of chromosome 20 of the same metaphase spread. Here, we report a patient who presented with slight neutropenia and oral aphthous ulcers. A mosaic de novo sSMC, which originated from 5 discontinuous regions of chromosome 8, was detected in the patient. Formation of the sSMC(8) can probably be explained by a multi-step process beginning with maternal meiotic nondisjunction, followed by post-zygotic anaphase lag, and resulting in chromothripsis. Chromothripsis is a chromosomal rearrangement which occurs by breakage of one or more chromosomes leading to a fusion of surviving chromosome pieces. This case is a good example for emphasizing the importance of conventional karyotyping from PHA-induced peripheral blood lymphocytes and examining tissues other than bone marrow in patients with inconsistent genotype and phenotype.


Asunto(s)
Cromosomas Humanos Par 8/genética , Cromosomas Humanos Par 8/ultraestructura , Neutropenia/genética , Úlceras Bucales/genética , Estomatitis Aftosa/genética , Preescolar , Aberraciones Cromosómicas , Trastornos de los Cromosomas/genética , Citogenética , Femenino , Marcadores Genéticos , Genotipo , Humanos , Cariotipificación , Linfocitos/metabolismo , Metafase , Mosaicismo , Neutropenia/complicaciones , Neutropenia/diagnóstico , Análisis de Secuencia por Matrices de Oligonucleótidos , Úlceras Bucales/complicaciones , Úlceras Bucales/diagnóstico , Fenotipo , Estomatitis Aftosa/complicaciones , Estomatitis Aftosa/diagnóstico
14.
Pediatr Blood Cancer ; 67(4): e28146, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31886613

RESUMEN

BACKGROUND: Autoimmune neutropenia (AIN) is a common cause of chronic neutropenia in childhood. Despite an expected benign clinical course, many patients undergo extensive evaluation. Data on healthcare utilization and rates of bloodstream infections in young patients with AIN are limited. METHODS: All patients with a diagnosis code of leukopenia, neutropenia, or AIN followed within the outpatient hematology clinic of a single institution from 2014 to 2016 were identified. Patients aged ≤5 years with absolute neutrophil count (ANC) ≤500/µL persisting for ≥3 months, a clinical diagnosis of AIN, and documented resolution of neutropenia were included. Data on clinical management, including infectious outcomes and emergency center (EC) encounters, were collected. RESULTS: Forty-three patients with AIN (18 male [42%], median age at diagnosis 12 months) met eligibility criteria. Children were followed by hematology for a median duration of 18 (range, 2-85) months. Diagnostic evaluations were variable. Thirty patients (70%) had ≥ 1 EC encounters for evaluation of isolated fever with a total of 113 EC encounters for the overall cohort. Patients with ANC < 500/µL and isolated fever were admitted for observation, which resulted in 24 hospitalizations in 16 patients. Of 138 blood cultures drawn, two were positive, both later determined to be contaminants. CONCLUSION: At a large tertiary care center, no bloodstream infections were identified in a cohort of 43 children with AIN presenting to the EC for assessment of fever. A less-intensive, more cost-effective management paradigm, which continues to prioritize patient safety, among young children with AIN is needed.


Asunto(s)
Enfermedades Autoinmunes/complicaciones , Bacteriemia/prevención & control , Infecciones/diagnóstico , Neutropenia/complicaciones , Aceptación de la Atención de Salud/estadística & datos numéricos , Bacteriemia/diagnóstico , Bacteriemia/etiología , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Infecciones/economía , Infecciones/etiología , Masculino , Pronóstico , Estudios Retrospectivos
15.
J Mycol Med ; 30(1): 100916, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31843296

RESUMEN

Here, we describe an invasive infection due to Trichosporon coremiiforme in an HIV positive patient with neutropenia. The strain was first erroneously identified as Trichosporon asahii by conventional methods, but correctly identified by mass spectrometry using matrix-assisted laser desorption/ionization time-of-flight technology (MALDI-TOF MS) and ribosomal DNA sequencing. The infection was successfully resolved after antifungal treatment with amphotericin B and fluconazole. This case report is a contribution to the study of T. coremiiforme infections and reinforces its relevance as a species capable of causing invasive human infection in immunocompromised patients and also contributes to the study of its susceptibility profile against antifungal drugs.


Asunto(s)
Infecciones Relacionadas con Catéteres/diagnóstico , Infecciones por VIH/complicaciones , Neutropenia/complicaciones , Tricosporonosis/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/sangre , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Anfotericina B/administración & dosificación , Antituberculosos/administración & dosificación , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Infecciones Relacionadas con Catéteres/complicaciones , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/microbiología , Catéteres Venosos Centrales/efectos adversos , Catéteres Venosos Centrales/microbiología , Quimioterapia Combinada , Femenino , Fluconazol/administración & dosificación , VIH , Infecciones por VIH/diagnóstico , Infecciones por VIH/microbiología , Humanos , Huésped Inmunocomprometido , Persona de Mediana Edad , Neutropenia/diagnóstico , Neutropenia/microbiología , Neutropenia/virología , Trichosporon/aislamiento & purificación , Tricosporonosis/tratamiento farmacológico , Tricosporonosis/etiología , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiología
16.
Int J Hematol ; 111(2): 293-302, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31709502

RESUMEN

The D-index assesses neutropenia dynamics. Prolonged neutropenia is a major risk for invasive fungal infection (IFI); we hypothesized that D-index is predictive of IFI risk. We retrospectively reviewed 789 adults who underwent allogeneic hematopoietic transplant (HSCT) from 1/1/2005 to 9/30/2015. Medical records were reviewed from transplant (D0) through Day 100. The D-index was calculated as area over the neutrophil curve until engraftment. 714 patients were included for analysis. Sixteen (2%) developed probable (11) or proven (5) IFI. Median time to IFI was 40 days (range 8-98) after HSCT. Groups with and without IFI did not differ significantly in duration of mild or profound neutropenia. Median D-index of those with IFI was 4293 days neutrophil/µl compared to 3590 days neutrophil/µl for those without IFI (P = 0.17). Patients who were neutropenic on D0 showed higher rates of IFI than those who were not (10/123 [8%] vs 6/591 [1%]; P < 0.001). Only 2% developed IFI, likely due to mold-active antifungal prophylaxis. The D-index was not significantly higher in those with IFI. Duration of profound neutropenia and neutropenia at D0 may be better markers for IFI among HSCT recipients during the first 30 and 100 days after transplant.


Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Infecciones Fúngicas Invasoras/etiología , Neutropenia/complicaciones , Neutropenia/diagnóstico , Aloinjertos , Humanos , Infecciones Fúngicas Invasoras/diagnóstico , Periodo Posoperatorio , Estudios Retrospectivos , Riesgo , Factores de Tiempo
17.
J Infect Chemother ; 26(2): 292-295, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31570321

RESUMEN

Fusariosis is a critical infectious complication that can develop in immunocompromised hosts, mainly under conditions of prolonged neutropenia, and is often disseminated and associated with a high mortality rate. Disseminated fusariosis developing during the course of hematopoietic stem cell transplantation (HSCT) is a critical condition, and there have been few reports of successful treatment of cases complicated with fusariosis before HSCT. Here, we present a case of acute myeloid leukemia (AML) with the development of fungal endophthalmitis during chemotherapy. Vitrectomy was performed and Fusarium solani infection was confirmed by vitreal culture. The infection was also disseminated to the lung, triceps, and spleen. The splenic lesions disappeared with the administration of antifungal agents, and residual lesions in the lung and triceps were surgically resected. After two courses of consolidation chemotherapy, the patient received cord blood transplantation (CBT) twice because of graft failure in the first transplantation. Antifungal agents were administered continuously during chemotherapy and transplantation. Although Fusarium sinusitis developed after neutrophil engraftment, it was well controlled by surgical resection. Thereafter, the patient has been well without recurrence of fusariosis for more than 2 years since transplantation. A combination of continuous administration of antifungal agents and vigorous surgical intervention may be important for management of disseminated fusariosis in the setting of HSCT.


Asunto(s)
Antifúngicos/uso terapéutico , Trasplante de Células Madre de Sangre del Cordón Umbilical/métodos , Fusariosis/complicaciones , Fusariosis/tratamiento farmacológico , Leucemia Mieloide Aguda/terapia , Adolescente , Antibacterianos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Supervivientes de Cáncer , Endoftalmitis/complicaciones , Endoftalmitis/tratamiento farmacológico , Fusarium/aislamiento & purificación , Humanos , Huésped Inmunocomprometido , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/tratamiento farmacológico , Masculino , Neutropenia/complicaciones , Neutropenia/tratamiento farmacológico , Resultado del Tratamiento , Vitrectomía/métodos , Voriconazol/uso terapéutico
18.
Infect Dis Health ; 25(1): 22-29, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31586572

RESUMEN

BACKGROUND: Patients with haematological malignancies have higher risk of acquiring bloodstream infection (BSI). Neutropenia resulting from cytotoxic chemotherapy is the most common risk factor. Infections can progress rapidly with poor outcomes. Understanding the epidemiology may enable prevention and effective management. We investigated and compared the incidence of BSI amongst patients with haematological malignancies and neutropenia and examined the changing spectrum of organisms, and their antimicrobial profiles. METHODS: BSI data between July 1st 2009 and June 30th 2015 was reviewed. RESULTS: Three hundred and fifty five BSI were identified in 255 neutropenic patients. Acute myeloid leukaemia (AML) accounted for 40%, Non-Hodgkin's lymphoma for 22% and Acute lymphocytic leukaemia (ALL) for 11.8%. A neutrophil count of <500 cells/µL was present in 93.2%. The overall incidence was 5.40 BSI per 1000 Haematology Occupied Bed days (OBD). Viridans streptococci and Enterococcus species were the most predominant Gram-positives. Vancomycin resistant Enterococcus faecium (VRE) emerged as the predominant Enterococcus species during the study period. Escherichia coli was the most predominant Gram-negative and Extended-spectrum beta-lactamases (ESBL) were detected in 7.1% of isolates. Amongst the Enterobacteriaceae and Pseudomonas aeruginosa dual resistance to Piperacillin-tazobactam and Gentamicin was detected in 5.4%. CONCLUSION: Our incidence of BSI was 5.40 per 1000 OBD, however variability in reporting of rates in neutropenic patients with haematological malignancies makes comparison between studies difficult, highlighting the need for rate reporting standardization. The epidemiology of organisms causing BSI has changed over time. There is a trend towards an increasing incidence of VRE and multidrug resistant Gram-negatives.


Asunto(s)
Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/epidemiología , Neutropenia/complicaciones , Neutropenia/epidemiología , Neutropenia/etiología , Sepsis/epidemiología , Sepsis/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiinfecciosos/farmacología , Antiinfecciosos/uso terapéutico , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Bacteriemia/epidemiología , Bacteriemia/etiología , Farmacorresistencia Microbiana , Femenino , Fungemia/diagnóstico , Fungemia/tratamiento farmacológico , Fungemia/epidemiología , Fungemia/etiología , Humanos , Incidencia , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Sepsis/diagnóstico , Sepsis/tratamiento farmacológico , Factores de Tiempo , Adulto Joven
19.
Scand J Rheumatol ; 49(2): 122-130, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31612777

RESUMEN

Objective: The aim of this study was to investigate whether incident proteinuria in patients with systemic lupus erythematosus (SLE) was preceded by changes in blood lymphocytes and neutrophil counts and/or neutrophil-lymphocyte ratio (NLR).Method: SLE patients with no proteinuria before or at the time of classification were included. Longitudinal data on SLE manifestations, vital status, and SLE-associated medications were collected during clinical visits and chart review. Laboratory data were collected through a nationwide database. Lymphopenia, severe lymphopenia, and neutropenia were defined as values below 0.8 × 109, 0.5 × 109, and 2.0 × 109 cells/L, respectively. High NLR was defined as values above the median. Proteinuria was defined by at least two measurements of elevated urine protein excretion (> 0.5 g/day). Hazard ratios (HRs) were calculated by Cox modelling using time-dependent continuous and binary covariates based on multiple laboratory measurements adjusted for use of immunosuppressants.Results: In total, 260 SLE patients were available for the analysis, of whom 30 (12%) developed incident proteinuria following the diagnosis of SLE. Median follow-up time was 73.5 months. Lymphocyte and neutrophil counts, but not NLR, were associated with incident proteinuria. HRs for incident proteinuria were 2.71 for lymphopenia [95% confidence interval (CI) 1.20-6.11], 4.73 for severe lymphopenia (95% CI 1.93-11.59), and 2.54 for neutropenia (95% CI 1.14-5.65).Conclusion: Lymphopenia and neutropenia predicted the risk of first-time proteinuria independently of immunosuppressants.


Asunto(s)
Lupus Eritematoso Sistémico/complicaciones , Linfopenia/complicaciones , Neutropenia/complicaciones , Proteinuria/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Inmunosupresores/uso terapéutico , Interferón-alfa/fisiología , Estudios Longitudinales , Nefritis Lúpica/etiología , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Adulto Joven
20.
Mycoses ; 63(1): 30-37, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31514231

RESUMEN

Hepatosplenic fungal infection (HSFI) is a severe invasive fungal infection observed during neutrophil recovery in patients with acute leukaemia treated with intensive chemotherapy. Retrospective analysis including all paediatric haematological malignancies patients with HSC treated in Children Cancer Hospital Egypt (2013-2018). Twenty-five patients with acute leukaemia developed HSFI (19 patients diagnosed as hepatosplenic candidiasis). Most of the cases (92%) occurred during the induction phase. Organs affected were as follows: liver in 18 patients, renal in 13 patients, spleen in 12 patients, skin in four patients and retina in one patient. Five (20%) patients had proven HSC, 14 (56%) probable and six (24%) possible HSFI. Ten patients had a PET-CT for response assessment. Candida tropicalis was the most common isolated spp. from blood/tissue culture. Six (24%) patients developed HSFI on top of antifungal prophylaxis. Steroids were given in 12 (52%) patients with HSFI as immune reconstitution syndrome (IRS). Caspofungin was the first line of treatment in 14 (56%) patients, liposomal amphotericin B in six (24%) patients and azoles in five (20%) patients. HSFI was associated with delayed of intensification phase of chemotherapy (median 42 days). The success rate was reported in 24 patients with complete response (68%) and partial response in (28%) patients, while failure (death) seen in 1(4%) patient. HSC is still a major challenge in paediatric leukaemias patients with impact on treatment delay and survival outcome. PET scan, non-culture diagnostics and steroid role evidence in IRS are growing. Antifungal stewardship for screening, early detection for high-risk patients and better response assessment is challenging.


Asunto(s)
Antifúngicos/uso terapéutico , Candidiasis , Neoplasias Hematológicas/complicaciones , Neoplasias Hematológicas/microbiología , Adolescente , Candidiasis/diagnóstico , Candidiasis/tratamiento farmacológico , Candidiasis/microbiología , Candidiasis/patología , Niño , Preescolar , Egipto , Femenino , Humanos , Riñón/microbiología , Riñón/patología , Leucemia/complicaciones , Leucemia/microbiología , Hígado/microbiología , Hígado/patología , Masculino , Neutropenia/complicaciones , Neutropenia/microbiología , Retina/microbiología , Retina/patología , Estudios Retrospectivos , Piel/microbiología , Piel/patología , Bazo/microbiología , Bazo/patología , Resultado del Tratamiento
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