Coadministration of Voriconazole and Rifabutin Can Increase the Risk of Adverse Drug Reactions in Patients with Multiple Infections.

BACKGROUND: Coinfection of tuberculosis or nontuberculous mycobacteria and Aspergillus presents a challenge in medication selection because of the pharmacokinetic interactions between rifampin and voriconazole. Some researchers have suggested the use of rifabutin as an alternative to rifampin because of its lower hepatic cytochrome P450 enzyme induction potency despite its contraindication to drug labels. This study presents clinical cases of voriconazole and rifabutin coadministration and their potential risks. METHODS: This retrospective study was conducted using clinical data from patients who met the following criteria: (1) admitted to Seoul National University Hospital between July 2014 and August 2023 and (2) concurrently administered rifabutin and voriconazole for more than 5 days. RESULTS: Among the 6 patients analyzed, 4 experienced adverse drug reactions (ADRs). Three patients experienced visual and auditory hallucinations, lower extremity numbness, or delirious behavior. Two patients had prolonged the time from the start of the Q wave to the end of the T wave intervals, and 1 had elevated aspartate aminotransferase and alanine aminotransferase levels. In addition, 2 patients experienced severe nausea, poor oral intake, and weight loss. Despite receiving 1.81-fold the recommended voriconazole dosage, a therapeutic concentration (1.0-5.5 mg/L) was not achieved because of cytochrome P450 induction by rifabutin. However, during septic shock, the voriconazole concentration increased by 13.7- to 36-fold. CONCLUSIONS: Concurrent use of rifabutin and voriconazole was associated with ADRs, including the time from the start of the Q wave to the end of the T wave prolongation, hallucinations, and severe nausea. Moreover, initially, there was a significant decrease in voriconazole concentrations; however, these concentrations substantially increased during septic shock. Therefore, it is essential to monitor drug concentrations and ADRs during concurrent use of voriconazole and rifabutin.

Diagnostic and Prognostic Values of Neutrophil Reactivity Intensity (NEUT-RI) in Pediatric Systemic Inflammatory Response Syndrome and Sepsis.

OBJECTIVE: Recent advances in hematology analyzers have generated cell population data (CPD), which quantify features of cells. The characteristics of CPD in pediatric systemic inflammatory response syndrome (SIRS) and sepsis were evaluated with 255 patients. METHODS: The ADVIA 2120i hematology analyzer was used for measurement of the delta neutrophil index (DN) including DNI and DNII. The XN-2000 was used for measurement of immature granulocytes (IG), neutrophil reactivity intensity (NEUT-RI), neutrophil granularity intensity (NEUT-GI), reactive lymphocytes (RE-LYMP), antibody synthesizing lymphocytes (AS-LYMP), RBC hemoglobin equivalent (RBC-He), and difference between RBC and reticulocyte hemoglobin equivalent (Delta-He). Measurement of high-sensitivity C-reactive protein (hsCRP) was performed using the Architect ci16200. RESULTS: The area under the receiver operating characteristic curve (AUC) values with confidence interval (CI) of IG (0.65, CI 0.58-0.72), DNI (0.70, CI 0.63-0.77), DNII (0.69, CI 0.62-0.76), and AS-LYMP (0.58, CI 0.51-0.65) were significant for diagnosis of sepsis. The levels of IG, NEUT-RI, DNI, DNII, RE-LYMP, and hsCRP exhibited gradual increasing trends from control to sepsis. In Cox regression analysis, the highest hazard ratio was observed for NEUT-RI (39.57, CI 4.87-321.75), higher than those for hsCRP (12.33, CI 2.49-61.12) and DNII (16.13, CI 1.98-131.08). IG (10.34, CI 2.47-43.26), DNI (11.60, CI 2.34-57.49), and RE-LYMP (8.20, CI 1.96-34.33) also showed high hazard ratios. CONCLUSION: NEUT-RI along with DNI and DNII can provide additional information regarding the diagnosis of sepsis and prediction of mortality in the pediatric ward.

Clinical and Genomic Profiles of Korean Patients with MECOM Rearrangement and the t(3;21)(q26.2;q22.1) Translocation.

The translocation (3;21)(q26.2;q22.1) is a unique cytogenetic aberration that characterizes acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) in patients with AML and myelodysplastic syndrome (MDS) or a therapy-related myeloid neoplasm. Using multigene target sequencing and FISH, we investigated the clinical and genomic profiles of patients with t(3;21) over the past 10 years. The frequency of t(3;21) among myeloid malignancies was very low (0.2%). Half of the patients had a history of cancer treatment and the remaining patients had de novo MDS. Twenty-one somatic variants were detected in patients with t(3;21), including in CBL, GATA2, and SF3B1. Recurrent variants in RUNX1 (c.1184A>C, p.Glu395Ala) at the same site were detected in two patients. None of the patients with t(3;21) harbored germline predisposition mutations for myeloid neoplasms. MECOM rearrangement was detected at a higher rate using FISH than using G-banding, suggesting that FISH is preferable for monitoring. Although survival of patients with t(3;21) is reportedly poor, the survival of patients with t(3;21) in this study was not poor when compared with that of other AML patients in Korea.