Microbiological findings in febrile neutropenia.

BACKGROUND: This study was carried out to assess the isolation rate of bacterial and fungal causative agents in Mexican neutropenic adults with hematological neoplasia. METHODS: A prospective observational survey involving 120 consecutive episodes of febrile neutropenia during 1 year was carried out. These episodes were observed in 630 patients discharged with diagnoses of leukemia or lymphoma, or after bone-marrow transplantation. RESULTS: At least one pathogen was isolated in 42 of 120 episodes (35%), and was present in 39 patients with acute myeloid leukemia (AML) (43%), acute lymphoblastic leukemia (ALL) (23%), and in patients who underwent bone-marrow transplantation (20%). Primary bacteremia was the most frequent cause of fever (24 episodes, 57%), followed by intravascular device-related infections (5 episodes, 17%), and soft-tissue infections (5 episodes, 15%). Escherichia coli (33%) was the most frequently isolated agent of primary bacteremia, followed by coagulase-negative Staphylococcus (29%), and Klebsiella oxytoca (16%). Fungal infection was responsible for five events (4%): two episodes of pneumonia (Penicillium marneffei and Aspergillus fumigatus, one event each); two cases of fungemia, one due to Candida tropicalis and one to Rhodotorula gluttinis, and one cryptococcal meningitis event. CONCLUSIONS: The isolation rate, approximately 30%, was in accordance with previous reports; similar percentages of Gram-positive and Gram-negative isolates were found. A remarkably low rate of viridans group streptococci and fungal agents was observed, despite the fact that neutropenia is the main risk factor for infection due to these agents. Studies reporting local microbiological findings are necessary because they support an antibiotic choice for prophylaxis or therapy more accurately than reports from other areas.

[Comparison of 2 dyes in the detection of Pneumocystis carinii]. / Comparación de dos tinciones en la detección de Pneumocystis carinii.

OBJECTIVE: To evaluate two staining procedures used in the detection of P. carinii. MATERIAL AND METHODS: Bronchoalveolar lavage samples were obtained from 20 immunosupressed rats. The samples were stained by three procedures: o-toluidine blue (OTB), Diff Quik (DQ), and a silver stain as the gold standard. The microscopic search for P. carinii was made independently by two observers. RESULTS: Fifteen of the 20 samples were positive to P. carinii with the silver stain. The sensitivity with DQ was 27% and the specificity 100%. With OTB the sensitivity was 93% and the specificity was 80%. The inter-raters' agreement by kappa was 0.11 for DQ and 0.53 for OTB. CONCLUSION: Our results suggest that the silver stain should be used for an adequate diagnosis of pneumonia caused by P. carinii.

[Measles in the young adult. Clinical features of 201 cases]. / Sarampión en el adulto joven. Características clínicas en 201 casos.

The clinical and laboratory characteristics of 201 cases of measles and its associations with complications were analyzed during an outbreak of this disease in Mexico City. The complications were hepatitis (45%), bacterial pneumonia (17%), oral candidiasis (13%), upper gastrointestinal tract hemorrhage (13%), epistaxis (8%), encephalitis (4%), subcutaneous emphysema (2%), and hypocalcemic tetany (1%). In a subgroup of 20 consecutive patients hypocalcemia was found in 14 cases (70%), associated with high levels of calcitonin in three cases. An increased lactate dehydrogenase (LDH) was observed in 83% of the patients, showing a significant association with the occurrence of complications (p = 0.04) especially in the patients with values of LDH above 750 IU/mL (odds ratio of 6.4). Two patients died (1% mortality). The young patients with measles can develop serious complications, and an increased level of LDH may be a prognostic indicative of these complications.

[Histoplasma capsulatum in the peripheral blood of patients with AIDS. Report of 4 cases with an increase of lactate dehydrogenase]. / Histoplasma capsulatum en sangre periférica de pacientes con SIDA. Informe de cuatro casos con elevación de deshidrogenasa láctica.

This paper describes the clinical course of four patients with AIDS who were found to have H capsulatum in peripheral blood. The evolution of the infection was fulminant and all died within the first 96 hours following hospitalization. In every case the presence of the characteristic mycelium and "tuberculate" macroconidia of Histoplasma was established in cultures. All cases showed the hematological abnormalities common in other AIDS associated diseases. In addition, there was an increase in serum lactic dehydrogenase over ten times our normal level: the lowest LDM assay was 2137 IU/mL and the highest 4839 IU/mL. This clinical course resembling septicemia and the demonstration of H capsulatum in a peripheral blood smear has had a rate of 12% in our experience (four out of the 34 cases of AIDS with histoplasmosis seen in our institution from January 1984 to March 1991).

[Reticulocytopenia and neutropenia in 3 patients with idiopathic autoimmune hemolytic anemia]. / Reticulocitopenia y neutropenia en tres pacientes con anemia hemolítica autoimune idiopática.

Retyculocytopenia and neutropenia or both abnormalities are very infrequent findings during the evolution of patients with acquired autoimmune hemolytic anemia (AIHA). In this paper we describe the clinical cases of three patients with AIHA in whom six different periods of reticulocytopenia were identified; the first two patients also had neutropenia. At the moment of the diagnosis of the cytopenias, the patients did not have a systemic disease, a viral infection or received immunosuppression able to produce them. In every patient the bone marrow cellularity was increased mostly at the expense of normal and macroerythroblasts, containing significant amounts of the other hematopoietic cells. After the diagnosis of AIHA, the patients received supplementary treatment with folic acid which did not produce a remission. The remissions were related to steroids: the neutrophil counts increased importantly one to ten days after starting the steroid administration, whereas reticulocytes reappeared more slowly from 7 to 30 days post-initiation. In patients with AIHA the occurrence of reticulocytopenia and neutropenia have been related to several causes. The favorable responses to steroids in our cases suggests a relationship of steroid with the immunological changes in AHA. It should be pointed out that it is necessary to prolong the followup as done in our three cases. Although these cytopenias may be independent from the hemolytic anemia, we feel our cases suggest that they could be manifestations of a pathologic state not yet characterized.