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Borregón M, Sánchez D, Martínez E. Screening and treatment of latent tuberculosis in patients with solid tumors and systemic cancer therapy. Clin Transl Oncol 2024:10.1007/s12094-024-03433-4. [PMID: 38514601 DOI: 10.1007/s12094-024-03433-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Tuberculosis is one of the infectious diseases with greater morbidity and mortality worldwide. Cancer causes an important immunosuppression with increased risk of infections. There is an enlarged bidirectional incidence between tuberculosis and cancer, mainly due to latent tuberculosis. GUIDELINES REVIEW There is great discrepancy between recommendations for screening and prophylaxis of latent tuberculosis in patients with solid tumors and systemic cancer therapy among different medical societies and guidelines. Most infectious diseases guidelines recommend it, while most oncology guidelines do not. DISCUSSION Patients with solid tumours generally have a limited life expectancy and a state of intermittent immunosuppression, resulting in a lower risk of tuberculosis reactivation than other risky populations. There is a lack of prospective and retrospective studies analysing the benefit of screening and prophylaxis in this population. The first step is to study the incidence of active tuberculosis in this population to estimate the real magnitude of the problem.
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Affiliation(s)
- Miguel Borregón
- Servicio de Oncología Médica del Hospital General Universitario de Elche, Carrer Almazara, 11, 03203, Elche, Alicante, Spain.
| | - David Sánchez
- Servicio de Oncología Médica del Hospital General Universitario de Elche, Carrer Almazara, 11, 03203, Elche, Alicante, Spain
| | - Elia Martínez
- Servicio de Oncología Médica del Hospital Universitario de Fuenlabrada, Madrid, Spain
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Schonardie AP, Beck E, Rigatto MH. Prevalence of bloodstream infection pathogens in hemato-oncological patients and predictors of carbapenem-resistant gram-negative bacterial infections during febrile neutropenia. Braz J Infect Dis 2023; 27:102758. [PMID: 36809849 PMCID: PMC10024133 DOI: 10.1016/j.bjid.2023.102758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/13/2023] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Carbapenem-Resistant Gram-Negative (CRGN) Bloodstream Infections (BSI) represent a therapeutic challenge, especially in the context of Febrile Neutropenia (FN) in cancer patients. METHODS We characterized pathogens causing BSI in patients aged ≥18 years who had undergone systemic chemotherapy for solid or hematological cancers between 2012 and 2021 in Porto Alegre, Brazil. Predictors of CRGN were evaluated through a case-control analysis. Each case was matched to two controls from whom CRGN were not isolated and had the same sex and year of inclusion in the study. RESULTS From 6094 blood cultures evaluated, 1512 (24.8%) showed positive results. Gram-negative bacteria accounted for 537 (35.5%) of the isolated bacteria, of which 93 (17.3%) were carbapenem-resistant. From 105 patients included in the case-control analysis, all cases had baseline hematological malignancies (60% acute myeloid leukemia). Variables related to CRGN BSI in Cox regression analysis were the first chemotherapy session (p<0.01), chemotherapy performed in the hospital setting (p = 0.03), intensive care unit admission (p<0.01), and CRGN isolation in the previous year (p<0.01). Patients with CRGN BSI received 75% less empirical active antibiotics and had 27.2% higher 30-day mortality rates than controls. CONCLUSIONS A CRGN risk-guided approach should be considered for empirical antibiotic therapy in patients with FN.
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Affiliation(s)
- Ana Paula Schonardie
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil
| | - Eduarda Beck
- Pontifícia Universidade Católica do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Maria Helena Rigatto
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Médicas, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Medicina Interna, Porto Alegre, RS, Brazil; Programa de Liderança Médica Jovem da Academia Nacional de Medicina, Rio de Janeiro, RJ, Brazil; Infectious Disease Service, Hospital de Clínicas de Porto Alegre, RS, Brazil.
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Li W, Zhu H, Wen L, Quan M, Wang L. Application Value of Metagenomics Next-Generation Sequencing (mNGS) in Detection of Mucormycosis after Chemotherapy in Childhood Acute Leukemia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:7366432. [PMID: 36034963 PMCID: PMC9417758 DOI: 10.1155/2022/7366432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022]
Abstract
Objective To analyze the application of macrogenomics next-generation sequencing (mNGS) in the detection of postchemotherapy trichomoniasis cases in children with acute leukemia. Methods To retrospectively analyze the clinical data of 7 patients with acute leukemia combined with trichomoniasis after chemotherapy in the department of hematology and oncology of Hebei Children's Hospital, and to summarize the characteristics of their postchemotherapy clinical data, diagnostic and therapeutic processes, and outcomes. Results Among the 7 children, 6 cases had acute lymphoblastic leukemia and 1 case had acute myeloid leukemia. mNGS detected trichoderma infection, including 1 case of pulmonary cerebral type and 6 cases of pulmonary type. After treatment, 1 case died, 2 cases were cured, and 4 cases improved. Conclusion The clinical manifestations of trichomoniasis after combined chemotherapy in pediatric acute leukemia lack specificity. Early application of the mNGS assay is of great value.
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Affiliation(s)
- Wenzi Li
- Department of Hematology and Oncology, Hebei Province Children's Hospital, Shijiazhuang City 050031, Hebei Province, China
| | - Hua Zhu
- Hebei Province Children's Hospital Orthopedics Department, Shijiazhuang City 050031, Hebei Province, China
| | - Li Wen
- Department of Hematology and Oncology, Hebei Province Children's Hospital, Shijiazhuang City 050031, Hebei Province, China
| | - Meijie Quan
- Department of Hematology and Oncology, Hebei Province Children's Hospital, Shijiazhuang City 050031, Hebei Province, China
| | - Li Wang
- Department of Hematology and Oncology, Hebei Province Children's Hospital, Shijiazhuang City 050031, Hebei Province, China
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Coyne CJ, Castillo EM, Shatsky RA, Chan TC. Procalcitonin as a Predictive Tool for Death and ICU Admission among Febrile Neutropenic Patients Visiting the Emergency Department. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:985. [PMID: 35893100 PMCID: PMC9329824 DOI: 10.3390/medicina58080985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Risk stratification tools for febrile neutropenia exist but are infrequently utilized by emergency physicians. Procalcitonin may provide emergency physicians with a more objective tool to identify patients at risk of decompensation. Materials and Methods: We conducted a retrospective cohort study evaluating the use of procalcitonin in cases of febrile neutropenia among adult patients presenting to the Emergency Department compared to a non-neutropenic, febrile control group. Our primary outcome measure was in-hospital mortality with a secondary outcome of ICU admission. Results: Among febrile neutropenic patients, a positive initial procalcitonin value was associated with significantly increased odds of inpatient mortality after adjusting for age, sex, race, and ethnicity (AOR 9.912, p < 0.001), which was similar, though greater than, our non-neutropenic cohort (AOR 2.18, p < 0.001). All febrile neutropenic patients with a positive procalcitonin were admitted to the ICU. Procalcitonin had a higher sensitivity and negative predictive value (NPV) in regard to mortality and ICU admission for our neutropenic group versus our non-neutropenic control. Conclusions: Procalcitonin appears to be a valuable tool when attempting to risk stratify patients with febrile neutropenia presenting to the emergency department. Procalcitonin performed better in the prediction of death and ICU admission among patients with febrile neutropenia than a similar febrile, non-neutropenic control group.
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Affiliation(s)
- Christopher J. Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, CA 92103, USA; (E.M.C.); (T.C.C.)
| | - Edward M. Castillo
- Department of Emergency Medicine, University of California San Diego, San Diego, CA 92103, USA; (E.M.C.); (T.C.C.)
| | - Rebecca A. Shatsky
- Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, CA 92037, USA;
| | - Theodore C. Chan
- Department of Emergency Medicine, University of California San Diego, San Diego, CA 92103, USA; (E.M.C.); (T.C.C.)
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SEOM clinical guidelines for the prophylaxis of infectious diseases in cancer patients (2021). Clin Transl Oncol 2022; 24:724-732. [PMID: 35230619 PMCID: PMC8886704 DOI: 10.1007/s12094-022-02800-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/14/2022]
Abstract
Infections are still a major cause of morbi-mortality in patients with cancer. Some of these infections are preventable through specific measures, such as vaccination or prophylaxis. This guideline aims to summarize the evidence and recommendations for the prevention of infections in cancer patients, devoting special attention to the most prevalent preventable infectious disease. All the evidences will be graded according to The Infectious Diseases Society of America grading system.
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Zhu Q, Li H, Zheng S, Wang B, Li M, Zeng W, Zhou L, Guan Z, Wang H, Liu Y, Gao Y, Qiu S, Chen C, Yang S, Yuan Y, Zhang H, Ruan G, Pan X. IL-6 and IL-10 Are Associated With Gram-Negative and Gram-Positive Bacteria Infection in Lymphoma. Front Immunol 2022; 13:856039. [PMID: 35432366 PMCID: PMC9011156 DOI: 10.3389/fimmu.2022.856039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/09/2022] [Indexed: 11/24/2022] Open
Abstract
To investigate the Th1/Th2 cytokine profile in patients with lymphoma during the myelosuppression stage of infection. 52 patients with gram-negative bacterial infection (G- group), 49 patients with gram-positive bacterial infection (G+ group), 51 uninfected patients with lymphoma (uninfected group) and 20 healthy controls (healthy group) were enrolled in this study. We evaluated the quantification of Th1/Th2 cytokines with flow cytometry bead assay (CBA) in the sera to explore a rapid diagnostic method to determine the type of infection and anti-infective effect. The levels of procalcitonin (PCT) were also detected simultaneously. The four groups did not differ with regard to IL-2 and IL-4 (P>0.05). The IFN-γ and TNF-α levels of patients with lymphoma were higher than those of healthy controls (P<0.05). There was significantly upregulated IL-6 and IL-10 expression in the G- group (P<0.001). A similar trend was reflected in the IL-6 of the G+ group, which was significantly increased (P<0.001). However, no significant upregulation was observed for IL-10 in the G+ group. According to the different degrees of increased IL-6 and IL-10 levels, We proposed to use the G- Bacterial Infection Cytokine Profile (G- BICP) and the G+ Bacterial Infection Cytokine Profile (G+ BICP) for the first time to differentiate between Gram-negative and Gram-positive (G-/G+) bacterial infection in adults with lymphoma in the myelosuppression stage after chemotherapy. The IL-6, IL-10 and PCT in the G- group and the IL-6, PCT in the G+ group were significantly decreased at day 4 and day 8 compared with those at day 1. IL-6 and IL-10 are closely associated with the severity and treatment efficacy in adults with lymphomas who develop infections after chemotherapy and can help distinguish between G- and G+ bacterial infections at an early stage.
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Affiliation(s)
- Qiuhua Zhu
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Huan Li
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Shanshan Zheng
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Bin Wang
- Department of Organ Transplantation, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- *Correspondence: Xueyi Pan, ; Bin Wang,
| | - Mingjie Li
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Wenbin Zeng
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Lanlan Zhou
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Zebing Guan
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Hong Wang
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Yanan Liu
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Yanmin Gao
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Shiqiu Qiu
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Chaolun Chen
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Shimei Yang
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Yuemei Yuan
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Hanling Zhang
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Guanqiao Ruan
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Xueyi Pan
- Department of Hematology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
- *Correspondence: Xueyi Pan, ; Bin Wang,
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