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Averbuch D, De Greef J, Duréault A, Wendel L, Tridello G, Lebeaux D, Mikulska M, Gil L, Knelange N, Zuckerman T, Roussel X, Robin C, Xhaard A, Aljurf M, Beguin Y, Le Bourgeois A, Botella-Garcia C, Khanna N, Van Praet J, Kröger N, Blijlevens N, Ducastelle Leprêtre S, Ho A, Roos-Weil D, Yeshurun M, Lortholary O, Fontanet A, de la Camara R, Coussement J, Maertens J, Styczynski J. Nocardia infections in hematopoietic cell transplant recipients: a multicenter international retrospective study of the Infectious Diseases Working Party (IDWP) of the European Society for Blood and Marrow Transplantation (EBMT). Clin Infect Dis 2021; 75:88-97. [PMID: 34596213 DOI: 10.1093/cid/ciab866] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nocardiosis is rare after hematopoietic cell transplantation (HCT). Little is known regarding its presentation, management, and outcome in this population. METHODS In this retrospective international study, we reviewed nocardiosis episodes in HCT recipients (01.01.2000-31.12.2018; 135 transplant centers; 33 countries) and described their clinical, microbiological, radiological, and outcome characteristics. RESULTS We identified 81 nocardiosis episodes in 74 allo- and 7 auto-HCT recipients. Nocardiosis occurred at a median of 8 (IQR 4-18) months post-HCT. The most frequently involved organs were lungs (70/81; 86%) and brain (30/81; 37%); 29 (36%) patients were afebrile; 46/81 (57%) had disseminated infections. The most common lung imaging findings were consolidations (33/68; 49%) or nodules (32/68; 47%); and brain imaging findings were multiple brain abscesses (19/30; 63%). 10/30 (33%) patients with brain involvement lacked neurological symptoms. 14/48 (29%) patients were bacteremic. N. farcinica was the most common among molecularly identified species (27%, 12/44). Highest susceptibility rates were reported to linezolid 45/45 (100%), amikacin 56/57 (98%), trimethoprim-sulfamethoxazole 57/63 (90%), and imipenem 49/57 (86%).One-year and last follow-up (IQR: 4-42.5 months) all-cause mortality were 40% (32/81) and 52% (42/81), respectively. In the multivariable analysis, underlying disease not in complete remission (HR 2.81, 95%CI 1.32-5.95), and prior bacterial infection (HR 3.42, 95%CI 1.62-7.22) were associated with higher one-year all-cause mortality. CONCLUSIONS Nocardiosis is a late post-HCT infection usually manifesting as a pulmonary disease with frequent dissemination, brain infection and bacteremia. Brain imaging should be performed in HCT recipients with nocardiosis regardless of neurological symptoms. Overall mortality is high.
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Affiliation(s)
- D Averbuch
- Pediatric Infectious Diseases Faculty of Medicine, Hebrew University of Jerusalem; Hadassah Medical Center, Jerusalem, Israel
| | - J De Greef
- Department of Internal Medicine and Infectious Diseases, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - A Duréault
- Centre d'Infectiologie Necker Pasteur, Hôpital Necker-Enfants Malades, APHP, Université Paris Descartes, Paris, France
| | - L Wendel
- EBMT Data Office, Leiden, Netherlands
| | - G Tridello
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - D Lebeaux
- Université de Paris, F-75006 Paris, France.,Service de Microbiologie, Unité Mobile d'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, Paris, France
| | - M Mikulska
- Division of Infectious Diseases, University of Genoa and Ospedale Policlinico San Martino, Genova, Italy
| | - L Gil
- University of Medical Sciences, Poznan, Poland
| | | | | | - X Roussel
- University hospital of Besançon, hematology department, Besançon, France
| | - C Robin
- Henri Mondor University Hospital, Creteil, France
| | - A Xhaard
- Hematology-transplantation, Hospital St-Louis, Paris Diderot University, Paris, France
| | - M Aljurf
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Y Beguin
- CHU of Liège and University of Liège, Liège, Belgium
| | | | | | - N Khanna
- Division of Infectious Diseases and Hospital Epidemiology. University and University Hospital of Basel, Basel, Switzerland
| | - J Van Praet
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - N Kröger
- Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany
| | - N Blijlevens
- Radboud university medical center, Nijmegen, The Netherlands
| | | | - A Ho
- Singapore General Hospital, Singapore, Singapore
| | - D Roos-Weil
- Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - M Yeshurun
- Institution of Hematology, Rabin medical Center, Petah Tikva, Israel and Sacker School of Medicine, Tel Aviv University, Israel
| | - O Lortholary
- Paris University, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, IHU Imagine, Necker Enfants malades University Hospital, Paris, France.,National Reference Center for Invasive Mycoses and Antifungals, Molecular Mycology Unit, CNRS UMR 2000, Institut Pasteur, Paris, France
| | - A Fontanet
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Global Health Department, Paris, France.,PACRI Unit, Conservatoire National des Arts et Métiers, Paris, France
| | | | - J Coussement
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.,National Centre for Infection in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Maertens
- Department of Haematology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - J Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
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Tatarelli P, Romani T, Santoro V, Spezia M, Gallo A, Ripamonti G, Carducci M, Trotti C, Parisini A, Nicolini LA, Mikulska M, Borrè S, Bassetti M. Debridement, antibiotics and implant retention (DAIR): An effective treatment option for early prosthetic joint infections. J Infect Chemother 2021; 27:1162-1168. [PMID: 33781690 DOI: 10.1016/j.jiac.2021.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/05/2021] [Accepted: 03/09/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Debridement, antibiotics and implant retention (DAIR) is an attractive treatment option for prosthetic joint infections (PJIs). However, reported success rates and predictors of DAIR failure vary widely. The primary aim of this study is to report the outcome of DAIR in patients with hip and knee PJIs receiving short course of antibiotic therapy. The secondary aim is to identify risk factors for DAIR failure. METHODS We performed a retrospective analysis of prospectively collected data of all hip and knee PJIs consecutively diagnosed at Quadrante Orthopedic Center, an Italian orthopedic hospital highly specialized in prosthetic surgery, from January 1, 2013 to January 1, 2019, and we analyzed those treated with DAIR. RESULTS Forty-seven PJIs occurred after 5102 arthroplasty procedures. Twenty-one patients (45%) aged 71 years were treated with DAIR for hip (62%) and knee (38%) PJIs. These were classified as early PJIs in 76% cases, delayed in 19% and late in 5%. Median time from PJI-related symptoms onset to implant revision surgery was 12 days (IQR, 7-20 days). The median duration of antibiotic treatment after surgery was 63 days (IQR, 53-84 days). Sixteen (76%) patients were cured after a median follow-up of 2197 days (IQR, 815-2342 days), while 5 (24%) experienced failure. At multivariate analysis, delayed/late PJIs were significantly associated with failure (OR = 12.51; 95% CI 1.21-129.63, p = 0.03). CONCLUSIONS DAIR represents an effective strategy for the treatment of early PJIs in spite of short course of antibiotic therapy.
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Affiliation(s)
- P Tatarelli
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Hospital and IRCCS, University of Genoa, Genoa, Italy.
| | - T Romani
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - V Santoro
- Public Health Department, Santa Maria Delle Croci Hospital, Ravenna, AUSL Romagna, Italy
| | - M Spezia
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - A Gallo
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - G Ripamonti
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - M Carducci
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - C Trotti
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - A Parisini
- Infectious Diseases SOC, A.S.O. SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - L A Nicolini
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Hospital and IRCCS, University of Genoa, Genoa, Italy
| | - M Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Hospital and IRCCS, University of Genoa, Genoa, Italy
| | - S Borrè
- Infectious Diseases Unit, Sant'Andrea Hospital, Vercelli, Italy
| | - M Bassetti
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Hospital and IRCCS, University of Genoa, Genoa, Italy
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3
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Taramasso L, Sepulcri C, Mikulska M, Magnasco L, Lai A, Bruzzone B, Dentone C, Bassetti M. Duration of isolation and precautions in immunocompromised patients with COVID-19. J Hosp Infect 2021; 111:202-204. [PMID: 33631234 PMCID: PMC7898969 DOI: 10.1016/j.jhin.2021.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- L Taramasso
- Infectious Diseases Unit, Department of Internal Medicine, IRCCS Policlinic San Martino Hospital, Genoa, Italy.
| | - C Sepulcri
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - M Mikulska
- Infectious Diseases Unit, Department of Internal Medicine, IRCCS Policlinic San Martino Hospital, Genoa, Italy; Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - L Magnasco
- Infectious Diseases Unit, Department of Internal Medicine, IRCCS Policlinic San Martino Hospital, Genoa, Italy
| | - A Lai
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - B Bruzzone
- Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - C Dentone
- Infectious Diseases Unit, Department of Internal Medicine, IRCCS Policlinic San Martino Hospital, Genoa, Italy
| | - M Bassetti
- Infectious Diseases Unit, Department of Internal Medicine, IRCCS Policlinic San Martino Hospital, Genoa, Italy; Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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4
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Furfaro E, Signori A, Di Grazia C, Dominietto A, Raiola AM, Aquino S, Ghiggi C, Ghiso A, Ungaro R, Angelucci E, Viscoli C, Mikulska M. Serial monitoring of isavuconazole blood levels during prolonged antifungal therapy. J Antimicrob Chemother 2020; 74:2341-2346. [PMID: 31119272 DOI: 10.1093/jac/dkz188] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/28/2019] [Accepted: 04/05/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Isavuconazole is the newest triazole antifungal approved for the treatment of invasive aspergillosis (IA) and invasive mucormycosis in adult patients. OBJECTIVES To characterize the assessment of the blood levels of isavuconazole and their association with efficacy and toxicity. METHODS From January 2017 to May 2018, blood samples obtained from patients receiving isavuconazole were analysed for therapeutic drug monitoring. Factors influencing the blood concentrations of isavuconazole, such as weight, length of treatment, route of administration and results of selected liver function tests, were analysed in univariate and multivariate models. The receiver operating characteristic (ROC) curve was analysed to detect the best cut-off for isavuconazole toxicity. RESULTS A total of 264 isavuconazole blood concentrations in 19 patients were analysed. The median value of isavuconazole concentration in all patients during the first 30 days of therapy was 3.69 mg/L (range 0.64-8.13 mg/L). A linear increase of 0.032 mg/L (range 0.023-0.041 mg/L) for each day of treatment (P = 0.002) was observed. In multivariate analysis the association between the length of treatment and higher levels of isavuconazole (P < 0.001) and higher serum GGT and lower isavuconazole levels (P = 0.001) was confirmed. Adverse events, mainly gastrointestinal, were reported in six patients (31.6%). Based on time-dependent and fixed-time ROC curve analysis, 4.87 mg/L and 5.13 mg/L, respectively, were the identified thresholds for toxicity. CONCLUSIONS Isavuconazole was efficacious and well tolerated. Side effects, mainly gastrointestinal, were associated with prolonged administration and high serum levels.
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Affiliation(s)
- E Furfaro
- Division of Infectious Diseases, Department of Health Science DISSAL, University of Genoa, Genoa, Italy
| | - A Signori
- Section of Biostatistics, Department of Health Science DISSAL, University of Genoa, Genoa, Italy
| | - C Di Grazia
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Dominietto
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A M Raiola
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - S Aquino
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - C Ghiggi
- Division of Hematology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Ghiso
- Division of Hematology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - R Ungaro
- Division of Infectious Diseases, Department of Health Science DISSAL, University of Genoa, Genoa, Italy.,Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - E Angelucci
- Division of Hematology and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - C Viscoli
- Division of Infectious Diseases, Department of Health Science DISSAL, University of Genoa, Genoa, Italy.,Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Mikulska
- Division of Infectious Diseases, Department of Health Science DISSAL, University of Genoa, Genoa, Italy.,Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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5
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Bassetti M, Giacobbe DR, Aliberti S, Barisione E, Centanni S, De Rosa FG, Di Marco F, Gori A, Granata G, Mikulska M, Petrosillo N, Richeldi L, Santus P, Tascini C, Vena A, Viale P, Blasi F. Balancing evidence and frontline experience in the early phases of the COVID-19 pandemic: current position of the Italian Society of Anti-infective Therapy (SITA) and the Italian Society of Pulmonology (SIP). Clin Microbiol Infect 2020; 26:880-894. [PMID: 32360444 PMCID: PMC7195088 DOI: 10.1016/j.cmi.2020.04.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19), which has rapidly become epidemic in Italy and other European countries. The disease spectrum ranges from asymptomatic/mildly symptomatic presentations to acute respiratory failure. At the present time the absolute number of severe cases requiring ventilator support is reaching or even surpassing the intensive care unit bed capacity in the most affected regions and countries. OBJECTIVES To narratively summarize the available literature on the management of COVID-19 in order to combine current evidence and frontline opinions and to provide balanced answers to pressing clinical questions. SOURCES Inductive PubMed search for publications relevant to the topic. CONTENT The available literature and the authors' frontline-based opinion are summarized in brief narrative answers to selected clinical questions, with a conclusive statement provided for each answer. IMPLICATIONS Many off-label antiviral and anti-inflammatory drugs are currently being administered to patients with COVID-19. Physicians must be aware that, as they are not supported by high-level evidence, these treatments may often be ethically justifiable only in those worsening patients unlikely to improve only with supportive care, and who cannot be enrolled onto randomized clinical trials. Access to well-designed randomized controlled trials should be expanded as much as possible because it is the most secure way to change for the better our approach to COVID-19 patients.
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Affiliation(s)
- M Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - D R Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - S Aliberti
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
| | - E Barisione
- Interventional Pulmonology, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - S Centanni
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - F G De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - F Di Marco
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A Gori
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - G Granata
- Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - M Mikulska
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - N Petrosillo
- Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - L Richeldi
- Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, UOC Pneumologia, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Santus
- Department of Biomedical and Clinical Sciences (DIBIC), University of Milan, Division of Respiratory Diseases, Luigi Sacco University Hospital, Milan, Italy
| | - C Tascini
- Infectious Diseases Clinic, Santa Maria Misericordia Hospital, Udine, Italy
| | - A Vena
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - P Viale
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - F Blasi
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
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6
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Boffa G, Lapucci C, Sbragia E, Varaldo R, Raiola AM, Currò D, Roccatagliata L, Capello E, Laroni A, Mikulska M, Gualandi F, Uccelli A, Angelucci E, Mancardi GL, Inglese M. Aggressive multiple sclerosis: a single-centre, real-world treatment experience with autologous haematopoietic stem cell transplantation and alemtuzumab. Eur J Neurol 2020; 27:2047-2055. [PMID: 32418281 DOI: 10.1111/ene.14324] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/06/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE The best therapeutic approach for aggressive relapsing-remitting multiple sclerosis remains unknown. The objective was to compare the efficacy and safety of autologous haematopoietic stem cell transplantation (aHSCT) and alemtuzumab in aggressive relapsing-remitting multiple sclerosis. METHODS The time to first relapse, time to confirmed disability worsening, time to first evidence of magnetic resonance imaging (MRI) activity and time to first evidence of disease activity were compared between the two treatment groups. Secondary outcomes included the 12, 24 and 36 month annualized relapse rate (ARR) and the 6-month confirmed Expanded Disability Status Scale (EDSS) changes at months 12 and 24. RESULTS Fifty-seven patients treated with aHSCT (n = 25) or alemtuzumab (n = 32) were included. At baseline, aHSCT patients had a higher EDSS (median score 6 vs. 3; P < 0.001), higher ARR (mean ARR 3.2 vs. 1.7; P = 0.001) and a higher number of baseline T1 gadolinium-enhancing lesions on MRI (mean number 15.5 vs. 1.6; P < 0.001). NEDA-3 (no evidence of disease activity) status was more frequently achieved in aHSCT-treated patients than in alemtuzumab-treated patients [75% vs. 56% of patients at the end of the observation period; hazard ratio (HR) 0.27, 95% confidence interval (CI) 0.08-0.84; P = 0.023]. aHSCT significantly reduced the risk of relapse (relapse-free survival 84% vs. 69%; HR 0.13, 95% CI 0.02-0.63; P = 0.012) and MRI activity (MRI-activity-free survival 85% vs. 59%; HR 0.13, 95% CI 0.03-0.59; P = 0.009). The ARR at 36 months was significantly lower in the aHSCT group (0.05 vs. 0.35, P = 0.02). A significant effect of aHSCT in promoting EDSS improvement compared with alemtuzumab was noted (P = 0.035). CONCLUSIONS Alemtuzumab and aHSCT are effective treatment choices for aggressive multiple sclerosis. aHSCT seems to be superior to alemtuzumab in inducing complete disease control and in promoting short-term disability improvement.
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Affiliation(s)
- G Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - C Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - E Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - R Varaldo
- Hematology and Transplant Center, Ospedale Policlinico San Martino, IRCSS, Genoa, Italy
| | - A M Raiola
- Hematology and Transplant Center, Ospedale Policlinico San Martino, IRCSS, Genoa, Italy
| | - D Currò
- Department of Neurology, San Paolo Hospital, Savona, Italy
| | - L Roccatagliata
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - E Capello
- Department of Neurology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - A Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Department of Neurology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - M Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Division of Infectious Diseases, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - F Gualandi
- Hematology and Transplant Center, Ospedale Policlinico San Martino, IRCSS, Genoa, Italy
| | - A Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Department of Neurology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - E Angelucci
- Hematology and Transplant Center, Ospedale Policlinico San Martino, IRCSS, Genoa, Italy
| | - G L Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Scientific Clinical Institutes Maugeri IRCCS, Pavia - Genova Nervi, Italy
| | - M Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Department of Neurology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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7
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Prigitano A, Esposto MC, Grancini A, Passera M, Paolucci M, Stanzani M, Sartor A, Candoni A, Pitzurra L, Innocenti P, Micozzi A, Cascio GL, Delia M, Mosca A, Mikulska M, Ossi C, Fontana C, Pizzolante M, Gelmi M, Cavanna C, Lallitto F, Amato G, Vella A, Pagano L, Bandettini R, De Lorenzis G, Cogliati M, Romanò L, Tortorano A. Prospective multicentre study on azole resistance in Aspergillus isolates from surveillance cultures in haematological patients in Italy. J Glob Antimicrob Resist 2020; 22:231-237. [PMID: 32061880 DOI: 10.1016/j.jgar.2020.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/16/2020] [Accepted: 01/25/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES This study was conducted to assess the prevalence of azole resistance in Aspergillus isolates from patients with haematological malignancies or who were undergoing haematopoietic stem cell transplantation and to identify the molecular mechanism of resistance. METHODS In this 28-month prospective study involving 18 Italian centres, Aspergillus isolates from surveillance cultures were collected and screened for azole resistance, and mutations in the cyp51A gene were identified. Resistant isolates were genotyped by microsatellite analysis, and the allelic profiles were compared with those of resistant environmental and clinical isolates from the same geographical area that had been previously genotyped. RESULTS There were 292 Aspergillus isolates collected from 228 patients. The isolates belonged mainly to the section Fumigati (45.9%), Nigri (20.9%), Flavi (16.8%) and Terrei (4.8%). Three isolates showed itraconazole resistance: Aspergillus fumigatus sensu stricto, Aspergillus lentulus (section Fumigati) and Aspergillus awamori (section Nigri). The itraconazole resistance rates were 1% and 1.48% considering all Aspergillus spp. isolates and the Aspergillus section Fumigati, respectively. The prevalence of azole resistance among all the patients was 1.3%. Among patients harbouring A. fumigatus sensu stricto isolates, the resistance rate was 0.79%. The A. fumigatus isolate, with the TR34/L98H mutation, was genotypically distant from the environmental and clinical strains previously genotyped. CONCLUSIONS In this study, the Aspergillus azole resistance rate was 1% (3/292). In addition to A. fumigatus sensu stricto, A. lentulus and A. awamori azole-resistant isolates were identified. Therefore, it is important have a correct identification at the species level to address a rapid therapy better, quickly understand the shift towards cryptic species and have an updated knowledge of the local epidemiology.
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Affiliation(s)
- A Prigitano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
| | - M C Esposto
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - A Grancini
- I.R.C.C.S. Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Passera
- Microbiology and Virology Unit, Asst. Papa Giovanni XXIII, Bergamo, Italy
| | - M Paolucci
- Institute of Hematology, Lorenzo e Ariosto Seràgnoli, Sant'Orsola-Malpighi Hospital Policlinico, University of Bologna, Bologna, Italy
| | - M Stanzani
- Institute of Hematology, Lorenzo e Ariosto Seràgnoli, Sant'Orsola-Malpighi Hospital Policlinico, University of Bologna, Bologna, Italy
| | - A Sartor
- Division of Hematology, ASUIUD, University of Udine, Udine, Italy
| | - A Candoni
- Division of Hematology, ASUIUD, University of Udine, Udine, Italy
| | - L Pitzurra
- Dipartimento di Medicina, Università degli Studi di Perugia, Perugia, Italy
| | - P Innocenti
- Laboratory of Microbiology and Virology, Comprensorio Sanitario di Bolzano-AS Alto Adige, Bolzano, Italy
| | - A Micozzi
- Department of Translational and Precision Medicine, Sapienza Università di Roma, Rome, Italy
| | - G Lo Cascio
- Microbiology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M Delia
- Department of Emergency and Organ Transplantation-UO Haematology with transplantation, AO Universitaria Policlinico di Bari, Bari, Italy
| | - A Mosca
- Interdisciplinary Department of Medicine, AO Universitaria Policlinico di Bari, Bari, Italy
| | - M Mikulska
- Università degli Studi di Genova (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy
| | - C Ossi
- Laboratory of Microbiology and Virology, San Raffaele Scientific Institute, Milan, Italy
| | - C Fontana
- Department of Experimental Medicine, University of Tor Vergata Polyclinic of Tor Vergata, Rome, Italy
| | - M Pizzolante
- Laboratory of Microbiology, Vito Fazzi Regional Hospital Lecce, Lecce, Italy
| | - M Gelmi
- ASST Spedali Civili di Brescia, Brescia, Italy
| | - C Cavanna
- Microbiology and Virology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Lallitto
- Microbiology and Virology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
| | - G Amato
- UOC. Patologia Clinica, AO A. Cardarelli, Naples, Italy
| | - A Vella
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Pagano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Bandettini
- Clinical Pathology and Microbiology Laboratory Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - G De Lorenzis
- Department of Agricultural and Environmental Sciences-Production, Landscape, Agroenergy, Università degli Studi di Milano, Milan, Italy
| | - M Cogliati
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - L Romanò
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - A Tortorano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Lapucci C, Gualandi F, Mikulska M, Palmeri S, Mancardi G, Uccelli A, Laroni A. Serum sickness (Like Reaction) in a patient treated with alemtuzumab for multiple sclerosis: A case report. Mult Scler Relat Disord 2018; 26:52-54. [PMID: 30223229 DOI: 10.1016/j.msard.2018.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/04/2018] [Accepted: 09/10/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Alemtuzumab is a monoclonal antibody approved for relapsing-remitting multiple sclerosis (RRMS). The only report of Serum Sickness (SS) in a MS patient occurred during treatment with natalizumab. Non-protein drugs, such as some antibiotics, may induce "SS-like" reactions (SSLR), whose clinical and laboratory features may partially overlap with the traditional SS. OBJECTIVE To report a case of SS/SSLR in a RRMS patient treated with alemtuzumab. CASE REPORT A 42-year-old-woman with RRMS developed SS/SSLR in the first week after the first alemtuzumab treatment. Concomitant medications included trimethoprim-sulfamethoxazole at low dose. Intravenous methylprednisolone therapy led to clinical resolution and normalization of serum inflammatory markers. CONCLUSION SS/SSLR should be considered in patients treated with alemtuzumab developing delayed fever, rash and arthralgia and differentiated with Infusion Associated Reactions (IARs) and infections.
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Affiliation(s)
- C Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
| | - F Gualandi
- Department of Hematology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - M Mikulska
- Division of Infectious Diseases, University of Genova (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy
| | - S Palmeri
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - G Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - A Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - A Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy; Ospedale Policlinico San Martino IRCCS, Genoa, Italy; Center of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
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Drgona L, Gudiol C, Lanini S, Salzberger B, Ippolito G, Mikulska M. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Agents targeting lymphoid or myeloid cells surface antigens [II]: CD22, CD30, CD33, CD38, CD40, SLAMF-7 and CCR4). Clin Microbiol Infect 2018; 24 Suppl 2:S83-S94. [DOI: 10.1016/j.cmi.2018.03.022] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/05/2018] [Accepted: 02/11/2018] [Indexed: 01/12/2023]
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Averbuch D, Orasch C, Mikulska M, Livermore DM, Viscoli C, Gyssens IC, Kern WV, Klyasova G, Marchetti O, Engelhard D, Akova M, Calandra T, Cordonnier C. Re: "Comparison of antipseudomonal betalactams for febrile neutropenia empiric therapy: systematic review and network metaanalysis" by Horita et al. Clin Microbiol Infect 2018; 24:662-663. [PMID: 29410224 DOI: 10.1016/j.cmi.2018.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/08/2018] [Accepted: 01/10/2018] [Indexed: 11/27/2022]
Affiliation(s)
- D Averbuch
- Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.
| | - C Orasch
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV, Centre Hospitalier Universitaire Vaudois), Lausanne, Switzerland; Division for Infectious Diseases and Hospital Epidemiology, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - M Mikulska
- Infectious Disease Unit, University of Genova (DISSAL) and Ospedale Policlinico San Martino, Genova, Italy
| | - D M Livermore
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - C Viscoli
- Infectious Disease Unit, University of Genova (DISSAL) and Ospedale Policlinico San Martino, Genova, Italy
| | - I C Gyssens
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; Hasselt University, Hasselt, Belgium
| | - W V Kern
- Division of Infectious Diseases, University Hospital and Medical Centre, Freiburg, Germany
| | - G Klyasova
- Department of Clinical Microbiology, Mycology and Antimicrobial Treatment, National Research Centre for Haematology, Moscow, Russia
| | - O Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, CH-1011 Lausanne, Switzerland; Department of Medicine, Ensemble Hospitalier de la CÔte, CH-1110 Morges, Switzerland
| | - D Engelhard
- Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - M Akova
- Hacettepe University School of Medicine, Department of Infectious Diseases, Ankara, 06100 Turkey
| | - T Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - C Cordonnier
- Assistance Publique-Hôpitaux de Paris (APHP) - Henri Mondor, Haematology Department and University Paris-Est Créteil, F-94010, Créteil, France
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Przywitowski M, Mikulski D, Jankowski J, Juśkiewicz J, Mikulska M, Zdunczyk Z. The effect of varying levels of high- and low-tannin faba bean ( Vicia faba L.) seeds on gastrointestinal function and growth performance in turkeys. J Anim Feed Sci 2017. [DOI: 10.22358/jafs/75443/2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Styczynski J, Hoek J, Knelange N, Mikulska M, Cesaro S, Aljurf M, Gil L. No report on Zika virus infection in EBMT registry: Infectious Diseases Working Party statement. Bone Marrow Transplant 2017; 52:1345-1346. [PMID: 28692024 DOI: 10.1038/bmt.2017.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- J Styczynski
- Department of Pediatric Hematology and Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
| | - J Hoek
- EBMT Data Office, Leiden, The Netherlands
| | - N Knelange
- EBMT Data Office, Leiden, The Netherlands
| | - M Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genova, Ospedale Policlinco San Martino, Genova, Italy
| | - S Cesaro
- Department of Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Policlinico G.B. Rossi, Verona, Italy
| | - M Aljurf
- Department of Oncology, King Faisal Specialist Hospital &Research Centre, Riyadh, Saudi Arabia
| | - L Gil
- Department of Hematology and Stem Cell Transplantation, Medical University, Poznan, Poland
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Sarmati L, Andreoni M, Antonelli G, Arcese W, Bruno R, Coppola N, Gaeta GB, Galli M, Girmenia C, Mikulska M, Pane F, Perno CF, Picardi M, Puoti M, Rambaldi A, Svicher V, Taliani G, Gentile G. Recommendations for screening, monitoring, prevention, prophylaxis and therapy of hepatitis B virus reactivation in patients with haematologic malignancies and patients who underwent haematologic stem cell transplantation-a position paper. Clin Microbiol Infect 2017; 23:935-940. [PMID: 28668466 DOI: 10.1016/j.cmi.2017.06.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/15/2017] [Accepted: 06/17/2017] [Indexed: 12/18/2022]
Abstract
SCOPE Hepatitis B virus (HBV) infection reactivation is associated with high morbidity and mortality in patients with haematologic malignancy and/or haematopoietic stem cell transplantation (HSCT). However, information on this issue is limited. The scope of this position paper is to provide recommendations on HBV screening, monitoring, prophylaxis, treatment and vaccination in the patients described above. METHODS These recommendations were developed from one meeting of experts attended by different Italian scientific societies as well as from a systematic literature review (of articles published through December 31, 2016) on HBV infection in haematologic patients and in patients who underwent haematopoietic stem cell transplantation published in the same issue of the journal. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess each recommendation's quality. QUESTIONS ADDRESSED These recommendations provide the answers to the following questions: (a) HBV screening and monitoring: Who should be screened before chemotherapy? Which screening tests should be used? Should HBV-DNA detection be used to monitor HBV reactivation before starting antivirals? What is the best timeline to monitor HBV reactivation? (b) Prophylaxis in HBsAg-positive patients: Which antiviral drugs should be used to treat HBsAg-positive patients? How long should antiviral prophylaxis be provided to HBsAg-positive patients? (c) Prophylaxis in patients with resolved HBV infection: Which patients with resolved HBV infection should receive antiviral prophylaxis? Which antiviral drug should be used? How long should antiviral prophylaxis be provided? (d) HBV infection management strategy in autologous (auto-HSCT) and allogeneic HSCT (allo-HSCT): Which HSCT recipients should receive antiviral prophylaxis? Which antiviral drug should be used? How long should antiviral prophylaxis be provided? (e) Choice of antiviral drugs in the treatment of HBV reactivation: Should third-generation anti-HBV drugs be preferred to first- or second-generation antiviral drugs in the treatment of HBV reactivation with or without hepatitis flare in haematologic patients? (f) Immunization against HBV in patients with haematologic malignancies and/or patients who underwent HSCT: Should these patients be vaccinated? Which HBV vaccination schedule should be adopted? RECOMMENDATIONS Haematologic patients should be screened for hepatitis B surface antigen (HBsAg) plus anti-hepatitis B core protein (HBc), and HBV DNA before chemotherapy. HBV DNA levels should be monitored monthly in all HBV-positive patients who do not receive prophylaxis. HBsAg-positive haematologic patients and those undergoing HSCT should receive third-generation antiviral therapy as prophylaxis. Anti-HBc-positive lymphoma patients and those receiving HSCT should receive antiviral prophylaxis. All HBV-negative haematologic patients should be vaccinated for HBV. The acquisition of data from well-designed studies is desirable in the near future.
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Affiliation(s)
- L Sarmati
- Department of System Medicine, Clinical Infectious Diseases, Tor Vergata University, Rome, Italy.
| | - M Andreoni
- Department of System Medicine, Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | - G Antonelli
- Department of Molecular Medicine, 'La Sapienza' University, Rome, Italy
| | - W Arcese
- Department of Hematology, Stem Cell Transplant Unit, Tor Vergata University, Rome, Italy
| | - R Bruno
- Department of Infectious Diseases, Hepatology Outpatients Unit, University of Pavia, IRCCS Policlinico San Matteo, Pavia, Italy
| | - N Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy
| | - G B Gaeta
- Infectious Diseases and Viral Hepatitis, Department of Mental and Physical Health and Preventive Medicine, Università della Campania, Naples, Italy
| | - M Galli
- Infectious Diseases Unit, University of Milan, L. Sacco Hospital, Milan, Italy
| | - C Girmenia
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I, La Sapienza University, Rome, Italy
| | - M Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; Division of Infectious Diseases, IRCCS San Martino University Hospital-IST, Genoa, Italy
| | - F Pane
- Department of Clinical Medicine and Surgery, Hematology, Federico II University, Naples, Italy
| | - C F Perno
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - M Picardi
- Department of Clinical Medicine and Surgery, Hematology, Federico II University, Naples, Italy
| | - M Puoti
- Infectious Diseases Department, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
| | - A Rambaldi
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy; Hematology and Bone Marrow Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - V Svicher
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - G Taliani
- Clinic of Infectious and Tropical Medicine, Policlinico Umberto I, Rome, Italy
| | - G Gentile
- Department of Cellular Biotechnologies and Hematology, 'La Sapienza' University, Rome, Italy
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Mikulska M, Giacobbe DR, Furfaro E, Mesini A, Marchese A, Del Bono V, Viscoli C. Lower sensitivity of serum (1,3)-β-d-glucan for the diagnosis of candidaemia due to Candida parapsilosis. Clin Microbiol Infect 2016; 22:646.e5-8. [PMID: 27256062 DOI: 10.1016/j.cmi.2016.05.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/18/2016] [Accepted: 05/22/2016] [Indexed: 10/21/2022]
Abstract
The aim of this study was to evaluate the sensitivity and the levels of 1,3-β-d-glucan (BDG) among patients with candidaemia due to different Candida species. Retrospective study of all patients who had a single-species candidaemia and BDG testing performed within 48 h from the onset of candidaemia during 2009-2015 was performed. Factors influencing the sensitivity of BDG, including the presence of a central venous catheter, antifungal therapy and Candida species, were analysed in univariate and multivariate models. In all, 107 patients with the following Candida distribution were included: 46 (43%) Candida albicans, 37 (35%) Candida parapsilosis, and 24 (22%) other species. BDG sensitivity and levels were the highest in C. albicans candidaemia and lowest for C. parapsilosis (respectively, 72% and 410 pg/mL for C. albicans, 41% and 39 pg/mL for C. parapsilosis, and 63% and 149 pg/mL for other species; p 0.015 and p 0.003). In multivariate analysis, Candida species (parapsilosis versus others) was the only factor influencing the sensitivity of BDG (OR 0.3, 95% CI 0.1-0.7, p 0.006). The sensitivity of BDG in candidaemia seems highly dependent on the fungal species, with the lowest being for C. parapsilosis.
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Affiliation(s)
- M Mikulska
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; Division of Infectious Diseases, IRCCS San Martino University Hospital-IST, Genoa, Italy.
| | - D R Giacobbe
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; Division of Infectious Diseases, IRCCS San Martino University Hospital-IST, Genoa, Italy
| | - E Furfaro
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - A Mesini
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - A Marchese
- Microbiology Unit, University of Genoa (DISC) and IRCCS San Martino-IST, Genoa, Italy
| | - V Del Bono
- Division of Infectious Diseases, IRCCS San Martino University Hospital-IST, Genoa, Italy
| | - C Viscoli
- Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy; Division of Infectious Diseases, IRCCS San Martino University Hospital-IST, Genoa, Italy
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Giacobbe D, Esteves P, Bruzzi P, Mikulska M, Furfaro E, Mesini A, Tatarelli P, Grignolo S, Viscoli C, Colombo A, Del Bono V. Initial serum (1,3)-β-d-glucan as a predictor of mortality in proven candidaemia: findings from a retrospective study in two teaching hospitals in Italy and Brazil. Clin Microbiol Infect 2015; 21:954.e9-17. [DOI: 10.1016/j.cmi.2015.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/29/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
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Orasch C, Averbuch D, Mikulska M, Cordonnier C, Livermore D, Gyssens I, Klyasova G, Engelhard D, Kern W, Viscoli C, Akova M, Marchetti O. Discontinuation of empirical antibiotic therapy in neutropenic leukaemia patients with fever of unknown origin is ethical. Clin Microbiol Infect 2015; 21:e25-7. [DOI: 10.1016/j.cmi.2014.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/03/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
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Mikulska M, Nicolini L, Signori A, Rivoli G, Del Bono V, Raiola A, Di Grazia C, Dominietto A, Varaldo R, Ghiso A, Bacigalupo A, Viscoli C. Hepatitis B reactivation in HBsAg-negative/HBcAb-positive allogeneic haematopoietic stem cell transplant recipients: risk factors and outcome. Clin Microbiol Infect 2014; 20:O694-701. [DOI: 10.1111/1469-0691.12611] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 02/04/2014] [Accepted: 02/21/2014] [Indexed: 12/13/2022]
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Averbuch D, Orasch C, Cordonnier C, Livermore DM, Mikulska M, Viscoli C, Gyssens IC, Kern WV, Klyasova G, Marchetti O, Engelhard D, Akova M. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica 2014. [DOI: 10.3324/haematol.2014.103770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Montagna MT, Lovero G, Coretti C, Martinelli D, Delia M, De Giglio O, Caira M, Puntillo F, D'Antonio D, Venditti M, Sambri V, Di Bernardo F, Barbui A, Lo Cascio G, Concia E, Mikulska M, Viscoli C, Maximova N, Candoni A, Oliveri S, Lombardi G, Pitzurra L, Sanguinetti M, Masciari R, Santantonio T, Andreoni S, Barchiesi F, Pecile P, Farina C, Viale P, Specchia G, Caggiano G, Pagano L. SIMIFF study: Italian fungal registry of mold infections in hematological and non-hematological patients. Infection 2013; 42:141-51. [PMID: 24150958 PMCID: PMC3906525 DOI: 10.1007/s15010-013-0539-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 09/24/2013] [Indexed: 11/29/2022]
Abstract
Purpose We compared the risk factors, the diagnostic tools and the outcome of filamentous fungal infections (FFIs) in hematological patients (HAEs) and non-hematological patients (non-HAEs). Methods Prospective surveillance (2009–2011) of proven and probable FFIs was implemented in 23 Italian hospitals. Results Out of 232 FFIs, 113 occurred in HAEs and 119 in non-HAEs. The most frequent infection was invasive aspergillosis (76.1 % for HAEs, 56.3 % for non-HAEs), and the localization was principally pulmonary (83.2 % for HAEs, 74.8 % for non-HAEs). Neutropenia was a risk factor for 89.4 % HAEs; the main underlying condition was corticosteroid treatment (52.9 %) for non-HAEs. The distribution of proven and probable FFIs was different in the two groups: proven FFIs occurred more frequently in non-HAEs, whereas probable FFIs were correlated with the HAEs. The sensitivity of the galactomannan assay was higher for HAEs than for non-HAEs (95.3 vs. 48.1 %). The overall mortality rate was 44.2 % among the HAEs and 35.3 % among the non-HAEs. The etiology influenced the patient outcomes: mucormycosis was associated with a high mortality rate (57.1 % for HAEs, 77.8 % for non-HAEs). Conclusions The epidemiological and clinical data for FFIs were not identical in the HAEs and non-HAEs. The differences should be considered to improve the management of FFIs according to the patients’ setting.
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Affiliation(s)
- M T Montagna
- Hygiene Section, Department of Biomedical Science and Human Oncology, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy,
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Bassetti M, Mikulska M, Nicco E, Viscoli C. Pulmonary Cryptococcosis with Severe Eosinophilia in an Immunocompetent Patient. J Chemother 2013; 22:366-7. [DOI: 10.1179/joc.2010.22.5.366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Mikulska M, Furfaro E, Del Bono V, Raiola AM, Di Grazia C, Bacigalupo A, Viscoli C. (1-3)- -D-Glucan in Cerebrospinal Fluid Is Useful for the Diagnosis of Central Nervous System Fungal Infections. Clin Infect Dis 2013; 56:1511-2. [DOI: 10.1093/cid/cit073] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jankowski J, Mikulski D, Zduńczyk Z, Mikulska M, Juśkiewicz J. The effect of diluting diets with ground and pelleted
or with whole wheat on the performance of growing
turkeys. J Anim Feed Sci 2012. [DOI: 10.22358/jafs/66145/2012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mikulski D, Jankowski J, Naczmanski J, Mikulska M, Demey V. Effects of dietary probiotic (Pediococcus acidilactici) supplementation on performance, nutrient digestibility, egg traits, egg yolk cholesterol, and fatty acid profile in laying hens. Poult Sci 2012; 91:2691-700. [DOI: 10.3382/ps.2012-02370] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mikulska M, Del Bono V, Raiola AM, Signori A, Prinapori R, Ghiso A, Bacigalupo A, Viscoli C. Enterococcal Bloodstream Infection After Hematopoietic Stem Cell Transplant: Experience of a Center With a Low Prevalence of Vancomycin-Resistant Enterococci. Clin Infect Dis 2012; 55:1744. [DOI: 10.1093/cid/cis765] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mikulska M, Furfaro E, Del Bono V, Raiola AM, Ratto S, Bacigalupo A, Viscoli C. Piperacillin/tazobactam (TazocinTM) seems to be no longer responsible for false-positive results of the galactomannan assay. J Antimicrob Chemother 2012; 67:1746-8. [DOI: 10.1093/jac/dks111] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Furfaro E, Mikulska M, Miletich F, Viscoli C. Galactomannan: testing the same sample twice? Transpl Infect Dis 2012; 14:E38-9. [DOI: 10.1111/j.1399-3062.2012.00733.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 11/09/2011] [Accepted: 12/21/2011] [Indexed: 11/26/2022]
Affiliation(s)
- E. Furfaro
- Division of Infectious Diseases; San Martino University Hospital; Genoa; Italy
| | - M. Mikulska
- Division of Infectious Diseases; San Martino University Hospital; Genoa; Italy
| | - F. Miletich
- Division of Infectious Diseases; San Martino University Hospital; Genoa; Italy
| | - C. Viscoli
- Division of Infectious Diseases; San Martino University Hospital; Genoa; Italy
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Jankowski J, Zduńczyk P, Mikulski D, Juśkiewicz J, Mikulska M, Zduńczyk Z. Effects of dietary soyabean, rapeseed and linseed oils on performance, slaughter yield and fatty acid profile of breast meat in turkeys. J Anim Feed Sci 2012. [DOI: 10.22358/jafs/66059/2012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mikulska M, Del Bono V, Bruzzi P, Raiola AM, Gualandi F, Van Lint MT, Bacigalupo A, Viscoli C. Mortality after bloodstream infections in allogeneic haematopoietic stem cell transplant (HSCT) recipients. Infection 2011; 40:271-8. [PMID: 22187340 DOI: 10.1007/s15010-011-0229-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 11/28/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Bloodstream infections (BSIs) are frequent after allogeneic haematopoietic stem cell transplantation (HSCT). The aim of this study was to identify predictors of mortality after BSI in patients who undergo HSCT. METHODS Patients who underwent HSCT between 1 January 2004 and 31 January 2008 and developed BSI during the first year post-transplantation were included. Variables influencing overall mortality at 7 and 30 days after BSI were analysed. RESULTS BSIs developed in 149 patients, within a median of 9 days after undergoing HSCT. Early and late mortality were 15 and 27%, respectively. Of the BSI, 54% were due to Gram-positive microorganisms, 33% were due to Gram-negative microogranisms, 10% were polymicrobial and 3% were fungal. The associated 7-and 30-day mortality was respectively 10 and 24% (Gram positive), 22 and 31% (Gram negative; Pseudomonas aeruginosa mortality 67%, all within 7 days), 13 and 27% (polymicrobial) and 40% (fungal, all within 7 days). Early mortality was higher in relapsed disease at HSCT (25.9%, p = 0.01), but lower in early (i.e. within 20 days of HSCT) BSI (11.7%, p = 0.03) and BSI due to Gram-positive infective agents (10%, p = 0.05). Multivariate analysis confirmed a higher mortality in late BSI [odds ratio (OR) 3.29, p = 0.03] and relapsed disease at HSCT (OR 2.2, p = 0.04). Late mortality was associated with the type of underlying disease (OR 0.44 for diseases other than acute leukaemia, p = 0.05) and its status (OR 6.04 for relapse at HSCT, p = 0.001). Appropriate empirical therapy was associated with lower early and late mortality in single Gram-negative BSI (16 vs. 45% for 7-day mortality, p = 0.09; 21 vs. 64% for 30-day mortality, p = 0.02). CONCLUSIONS BSIs are frequent during the first year after HSCT and are associated with a high mortality rate. The aetiology influenced early mortality, while the type and phase of the underlying disease played a pivotal role in late mortality. Appropriate empirical therapy is crucial in BSI due to Gram-negative infective agents.
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Affiliation(s)
- M Mikulska
- Division of Infectious Diseases, San Martino University Hospital, L.go R. Benzi, 10-16132, Genoa, Italy.
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Mikulska M, Del Bono V, Prinapori R, Boni L, Raiola A, Gualandi F, Van Lint M, Dominietto A, Lamparelli T, Cappellano P, Bacigalupo A, Viscoli C. Risk factors for enterococcal bacteremia in allogeneic hematopoietic stem cell transplant recipients. Transpl Infect Dis 2010; 12:505-12. [DOI: 10.1111/j.1399-3062.2010.00544.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mikulska M, Jasiński R, Barański A. Synthesis and properties of azoles and their derivatives. 68.* [2+3] cycloaddition of 2-nitro-1-propene to (Z)-C,N-diphenylnitrone relative to AM1 and AM1/COSMO quantum-chemical calculations. Chem Heterocycl Compd (N Y) 2010. [DOI: 10.1007/s10593-010-0496-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bassetti M, Mikulska M, Repetto E, Bernardini C, Soro O, Molinari MP, Mussap M, Pallavicini F, Viscoli C. Invasive pulmonary aspergillosis in intensive care units: is it a real problem? J Hosp Infect 2010; 74:186-7. [DOI: 10.1016/j.jhin.2009.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 07/09/2009] [Indexed: 11/26/2022]
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Mikulski D, Jankowski J, Zduńczyk Z, Wróblewska M, Mikulska M. Copper balance, bone mineralization and the growth
performance of turkeys fed diet with two types of
Cu supplements. J Anim Feed Sci 2009. [DOI: 10.22358/jafs/66441/2009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bassetti M, Repetto E, Mikulska M, Miglino M, Clavio M, Gobbi M, Righi E, Viscoli C. Cryptococcus neoformans fatal sepsis in a chronic lymphocytic leukemia patient treated with alemtuzumab: case report and review of the literature. J Chemother 2009; 21:211-4. [PMID: 19423476 DOI: 10.1179/joc.2009.21.2.211] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Cryptococcosis is a disseminated fungal disease typically associated with immunosuppression and characterized by high mortality rates. Cryptococcus neoformans has been reported to be isolated from blood cultures in around 20% of patients with cryptococcosis, and cryptococcemia has been correlated with poor prognosis. We report a case of fatal C. neoformans fungemia in a neutropenic patient with a history of chronic lymphocytic leukemia treated with alemtuzumab. The patient presented with loss of consciousness and died after 5 days of antifungal therapy with liposomal amphotericin B. The international literature regarding opportunistic infections after immunosuppressive therapy with alemtuzumab with particular attention on fungal infections has also been reviewed.
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Affiliation(s)
- M Bassetti
- Infectious Diseases Division, S. Martino Hospital, University of Genoa, Genoa, Italy.
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Mikulska M, Durando P, Pia Molinari M, Alberti M, Del Bono V, Dominietto A, Raiola AM, Van Lint MT, Bregante S, Orengo G, Bacigalupo A, Viscoli C. Outbreak of Ralstonia pickettii bacteraemia in patients with haematological malignancies and haematopoietic stem cell transplant recipients. J Hosp Infect 2009; 72:187-8. [PMID: 19376610 DOI: 10.1016/j.jhin.2009.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Accepted: 02/24/2009] [Indexed: 10/20/2022]
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35
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Mikulska M, Raiola AM, Bruno B, Furfaro E, Van Lint MT, Bregante S, Ibatici A, Del Bono V, Bacigalupo A, Viscoli C. Risk factors for invasive aspergillosis and related mortality in recipients of allogeneic SCT from alternative donors: an analysis of 306 patients. Bone Marrow Transplant 2009; 44:361-70. [PMID: 19308042 DOI: 10.1038/bmt.2009.39] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Invasive aspergillosis (IA) is a serious complication in patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT), particularly from donors other than HLA-identical sibling. All 306 patients who underwent alternative donor HSCT between 01 January 1999 and 31 December 2006 were studied. Late IA was defined as occurring >or=40 days after HSCT. The median follow-up was 284 days (range, 1-2709). Donors were matched unrelated (n=185), mismatched related (n=69), mismatched unrelated (n=35) and unrelated cord blood (n=17). According to European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria, 2 patients already had IA at HSCT, 23 had early IA and 20 had late IA (IA incidence 15%). Eight patients had proven and 37 probable IA. Multivariate analyses showed that significant predictors of IA were delayed neutrophil engraftment, extensive chronic GVHD (cGVHD), secondary neutropenia and relapse after transplant. Early IA was associated with active malignancy at HSCT, CMV reactivation and delayed lymphocyte engraftment. Late IA was predicted by cGVHD, steroid therapy, secondary neutropenia and relapse after HSCT. IA-related mortality among IA patients was 67% and was influenced by use of anti-thymocyte globulin, steroids, higher levels of creatinine, and lower levels of IgA and platelets. The outcome of IA depends on the severity of immunodeficiency and the status of the underlying disease.
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Affiliation(s)
- M Mikulska
- Division of Infectious Diseases, San Martino University Hospital and University of Genoa, Genoa, Italy
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Czarkowski M, Hilgertner L, Powałowski T, Radomski D, Mikulska M. Is the resistance of large conduit arteries also decreased in thyrotoxic patients with Graves' disease? Thyroid 2005; 15:377-81. [PMID: 15876163 DOI: 10.1089/thy.2005.15.377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Longitudinal arterial resistance (RL) originates during blood flow in large conduit arteries while peripheral resistance (RP) reflects the tension of arterioles. Using a new noninvasive ultrasonic system of assessment of mechanical properties of arterial walls, we aimed to discover whether both RL and RP are affected by excess of thyroid hormones (TH). We compared two groups: hyperthyroid (Graves' group, n = 25) and euthyroid (control group, n = 23). RL and RP values were obtained from the analysis of the four-element lumped parameters model describing the vascular input impedance. The vascular input impedance was determined on the basis of simultaneous measurements of blood pressure, blood flow and arterial diameter using oscillometric and ultrasonic methods. RL and RP were lower in the Graves' group (3.71 +/- 1.98 versus 4.49 +/- 1.81 10(8)kgm(4)s(1), p < 0.05 and 8.43 +/- 3.56 versus 11.23 +/- 2.69 0(8)kgm(4)s(1), p < 0.00002, respectively). There was strong correlation between RP and TH in the Graves' group (r(s)= -0.6710, p = 0.000001 for RP and free triiodothyronine (FT3); r(s)= -0.4683, p < 0.001 for RP and free thyroxine [FT4]). This relationship remained significant after the statistical correction for total cholesterol (r(p)= -0.7064 p = 0.0000001 for RP and FT3). No similar correlation between RL and TH was found what suggests a different character of relations between TH and RL and between TH and RP.
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Affiliation(s)
- M Czarkowski
- Department of Internal Medicine and Endocrinology, University of Warsaw, 02-097 Warsaw, Banacha 1A, Poland.
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Brojer E, Gronowska A, Medyńska J, Grabarczyk P, Mikulska M, Letowska M, Kryczka W, Gietka A. The hepatitis C virus genotype and subtype frequency in hepatitis C virus RNA-positive, hepatitis C virus antibody-negative blood donors identified in the nucleic acid test screening program in Poland. Transfusion 2004; 44:1706-10. [PMID: 15584984 DOI: 10.1111/j.0041-1132.2004.04156.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Since 2002, blood donors in Poland have been tested not only for hepatitis C virus antibodies (anti-HCV) but also for HCV RNA or HCV core antigen. This screening program identifies asymptomatic, recently infected individuals with no anti-HCV (in the "window period"). The aim of this study was to compare HCV genotype and subtype distribution in window-period (wp) donors, anti-HCV-positive donors, and chronic hepatitis C (CHC) patients. STUDY DESIGN AND METHODS A total of 2.37 million donors were investigated for HCV RNA, and 340,000 for HCV core antigen. HCV genotypes and subtypes were investigated in 50 HCV RNA-positive, anti-HCV-negative donors; in 70 anti-HCV-positive donors; and in 170 CHC patients. Re-questioning of wp donors for probable risk factors was introduced. RESULTS HCV RNA was detected in 50 donors of 2.71 million (1:54,200) anti-HCV-negative blood donations. Of these 50 donors, 36 percent exhibited Subtype 1b, whereas Subtypes 3a and 4c/d were identified in 40 and 14 percent, respectively. In anti-HCV-positive donors and CHC patients, the frequency of Subtype 1b was significantly higher (75.7 and 85.3%, respectively); in both groups the lower frequency of Subtypes 3a (14.3 and 10.6%, respectively) and 4c/d (4.3 and 1.2%, respectively) was found. The probable source of infection was identified in 9 wp donors. CONCLUSIONS The frequency of wp donors is 18.5 per 1 million. The unexpected high frequency of Genotype 4 and Subtype 3a and the low frequency of Subtype 1b was observed in wp donors compared to anti-HCV-positive individuals. Additional epidemiologic questioning introduced after HCV RNA detection may help to identify infection source.
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Affiliation(s)
- E Brojer
- Institute of Haematology and Blood Transfusion,Warsaw, Poland.
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Czarkowski M, Mikulska M, Zebrowski M, Baran A, Rózanowski K. Tilt test alters accuracy of the oscillometric device Omron HEM-705CP. J Hum Hypertens 2004; 18:293-4. [PMID: 15037881 DOI: 10.1038/sj.jhh.1001667] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mikulska M, Wolnicka B. [The significance breast feeding on the course of the adaptation period in neonates from multiple pregnancies]. Ginekol Pol 2000; 71:1410-6. [PMID: 11216153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Neonates from multiple pregnancies were evaluated taking into account their condition in the 1st and 5th minutes after birth, their birth weight, time which they spent in the neonatal department and occurrence of complications during the adaptation period, such as respiratory insufficiency, intrauterine infection and hyperbilirubinaemia. On the basis of our research, we think that multiple pregnancy requires particular diagnostics and individualisation of prenatal care. We believe also that neonates from such pregnancies are particularly exposed to development of a severe form of diverse complications. In our investigations, we observed a beneficial influence of breast-feeding--from the first hours of life--on the course of adaptation of neonates. However, we think that confirmation of these findings requires more detailed investigations.
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Affiliation(s)
- M Mikulska
- Katedry I Oddziału Klinicznego Połoznictwa i Ginekologii Sl. A.M. w Bytomiu
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Mikulska M, Wolnicka B. Characteristics of adaptation period for extrauterine life of neonates from multiple pregnancies. Acta Genet Med Gemellol (Roma) 2000; 47:219-26. [PMID: 10916567 DOI: 10.1017/s0001566000000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Multiple pregnancies pose numerous threats both for foetuses and neonates. The following disorders are encountered among the most important perinatal disturbances: EPH – gestosis, immature labour and premature rupture of foetal membranes. Also during the labour, particularly the second one and the following ones, various lesions that may cause increased incidence of diseases and mortality in this group of neonates [5, 6, 10, 18, 21, 22, 25]. Complications encountered in neonates from multiple pregnancies, resulting both from abnormal conditions of intrauterine development and from perinatal pathology, require still wider studies, particularly within the context of intensified obstetrical care of women with multiple pregnancies [7, 11, 13, 16, 24].In the years 1996-1998, out of 3883 neonates born in the Chair of Obstetrics and Gynaecology of the Silesian Medical Academy, 152 (3,9%) came from multiple pregnancies. This period included one case of quadruplets, eight cases of triplets and 62 twin pregnancies. Pregnant women were directed to our Chair within the program of multidisciplinary care of women with complicated pregnancies and they also came from the Department of Pathology of Pregnancy in our Chair. In 18 women, treated for infertility, the pregnancy was accomplished as a result of application of various techniques of assisted procreation. In one case – 4 foetuses were indicated, in five cases – three foetuses and in 12 cases – two foetuses.
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Affiliation(s)
- M Mikulska
- Chair of Obstetrics and Gynaecology, Silesian Medical Academy, Bytom, Poland
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Mikulska M, Wolnicka B, Zamłyński J. [Complications of the adaptation period of newborns born to diabetic mothers in years 1993-1998]. Ginekol Pol 1999; 70:789-94. [PMID: 10615823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Diabetic fetopathy is a complex the pathophysiology of which is not all that clear and that is why all neonates whose mothers develop diabetes demand, regardless of their body weight, from the first hours of their live an intensive neonatal care. In the period from 1993 to 1998 in the Chair of Obstetrics and Gynaecology in Bytom 237 babies were born in whom, in the first day of their live, clinical and biochemical screening was carried out in order to determine degree of diabetic fetopathy progression. Summary results of six years care of newborns, born by diabetic mothers. The following parameters were measured: morphometric parameters, course and complications of adaptation processes.
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Affiliation(s)
- M Mikulska
- Katedry i Oddziału Klinicznego Połoznictwa i Ginekologii Sl.A.M. w Bytomiu
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Zamłyński J, Bodzek P, Mikulska M, Urban A, Wolnicka B, Kozioł M. [Results of six-years-term perinatal care of diabetic woman in Silesia district]. Ginekol Pol 1999; 70:700-6. [PMID: 10615810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Authors had retrospectively analyzed basic exponents of perinatal care of 256 pregnant diabetic woman in years 1993-1998 hospitalized and delivered in Clinic of Obstetrics and Gynaecology in the town of Bytom. Our results were very similar to the other of Referent Centres Of Technical Methods Bank Used in Diagnostic and Therapy of Diabetes: cesarean sections percentage 51.56%, 4.7% of undelivered pregnancies, 2.34% of new-born delivered with multiple congenital defaults, 17.2% of macrosomies and 39.8% pre-term deliveries were noted. Disadvantage perinatal effects in diabetic women might be reduced by very early diagnosis of diabetic and intensive biophysical and biochemical fetal care, which is strongly suggests by the authors.
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Affiliation(s)
- J Zamłyński
- Katedry i Oddziału Klinicznego Połoznictwa i Ginekologii Sl.A.M. w Bytomiu
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Rzempołuch J, Bodzek P, Zamłyński J, Mikulska M, Urban A, Kozioł M, Wolnicka B. [Analysis of indications for cesarean section in pregnancy complicated by diabetes mellitus]. Ginekol Pol 1999; 70:732-6. [PMID: 10615814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
The authors analysed a way of pregnancy ending and indications to cesarean section in group 256 diabetic pregnant women. We estimated that percentage for cesarean sections was 51.56%. We noticed downward tendency of elective indications to cesarean section (the most common was gestosis) and upward tendency of intrapartum indications (the most common was fetal distress syndrome). The percentage of cesarean sections in diabetic pregnant women group in our study is similar to results from the other centres.
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Affiliation(s)
- J Rzempołuch
- Katedry i Oddziału Klinicznego Połoznictwa i Ginekologii Sl.A.M. w Bytomiu
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Mikulska M, Wolnicka B, Zamłyński J, Bodzek P, Michalska A. [Results of five year care of newborns born from diabetic mothers]. Ginekol Pol 1998; 69:1103-9. [PMID: 10224785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Diabetic fetopathy is a complex the pathophysiology of which is not all that clear and that is why all neonates whose mothers develop diabetes demand--regardless of their body weight--from the first hours of their live an intensive neonatal care. In the period from 1993 to 1997 in the Chair I of the Hospital of Obstetrics and Gynaecology in Bytom 191 babies were born in whom--in the first day of their live clinical and biochemical screening was carried out in order to determine degree of diabetic fetopathy progression. Summary results of five years care of newborn, born by diabetic mothers. The following parameter were measured: morphometric parameters, the course of adaptation processes, congenital defect occurrence, morbidity and motility in this group of newborn.
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Affiliation(s)
- M Mikulska
- I Katedry i Kliniki Połoznictwa i Ginekologii SlAM w Bytomiu
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Bodzek P, Zamłyński J, Mikulska M, Urban A. [Results of five-year term perinatal care of a diabetic woman]. Ginekol Pol 1998; 69:1110-5. [PMID: 10224786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Authors had retrospectively analysed basic exponents of perinatal care of 199 pregnant diabetic woman in years 1993-1997 hospitalised and delivered in The First Clinic of Obstetrics and Gynaecology in the town of Bytom. Our results were very similar to the other Referent Centres Of Technical Methods Bank Used in Diagnostic and Therapy of Diabetes: average gestation age 38 +/- 1 hbd, caesars sections percentage 53.4%, 5.5% of undelivered pregnancies, 0.5% of new-born delivered with multiple congenital defaults, 16.1% of macrosomies and 28.1% pre-term deliveries were noted. Disadvantage perinatal effects in diabetic women might be reduced very early diagnosis of diabetic and intensive biophysical and biochemical fatal care, which is strongly suggests by the authors.
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Affiliation(s)
- P Bodzek
- I Katedry i Kliniki Połoznictwa i Ginekologii w Bytomiu Sl.A.M. w Katowicach
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Abstract
The aim of the study was to analyze retrospectively the perinatal mortality of newborn babies with low body weight and the causes of their deaths in the years 1985-1995. A gradual significant increase in the perinatal mortality rate from 11.9 to 24.0 per thousand (per mille) was observed during this period. At the same time, a decrease in the rate of premature births from 19.9 to 13.7% was noted. The perinatal mortality rate in the years 1985-1995 was influenced predominantly by a significantly increasing percentage of newborn babies with extremely low body weight at birth--from 3.1 to 10.4%. In the remaining weight groups, there was a decrease in this percentage or its value remained at the same level. The most common causes of intrauterine mortality in these 10 years were placental, umbilical cord, and fetal membrane complications (30.7%); complications in pregnancy due to the mother's illness (29.3%); and developmental anomalies (23.%). The most common causes of neonatal deaths in the same years were developmental anomalies (38.29%).
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Affiliation(s)
- M Mikulska
- Obstetrics and Gynecology, Neonatal Department of the Silesian Medical Academy, Bytom, Poland
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Mikulski D, Jankowski J, Faruga A, Mikulska M. The effect of enzyme supplementation of
triticale-barley feeds on fattening performance
of turkeys. J Anim Feed Sci 1997. [DOI: 10.22358/jafs/69535/1997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Bean (Phaseolus vulgaris L.) seedlings were cultured on complete or phosphate-deficient nutrient medium. After 14 days of culture on phosphate-deficient medium the visible symptoms of P(i) deficiency were observed only in the shoot, the fresh and dry weights of the roots were slightly higher than in control plants. The decreased P(i) content in the roots had little effect on total respiration rate but had an effect on the level of inhibition of respiration by cyanide. The high resistance of respiration to cyanide observed in P(i) -deficient roots was the result of the suppression of cytochrome path activity and an increased participation of the alternative, cyanide-resistant pathway. The cytochrome pathway activity increased when inorganic phosphate was supplied to P(i) -deficient roots for 1 or 3.5 h. It is speculated that the suppression of cytochrome pathway in P(i) -deficient roots may result from restriction of the phosphorylating capacity or a partial inhibition of cytochrome oxidase activity.
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Affiliation(s)
- A M Rychter
- Inst. of Botany, Univ. of Warsaw, Krakowskie Przedmiescie 26/28, PL-00-927, Warszawa, Poland
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Mikulska M, Rzempołuch J, Skowron Z, Madej P, Zamłyński J. [Clinico-pathomorphological evaluation of biochemical trauma as the cause of death of low birth-weight neonates]. Patol Pol 1986; 37:342-9. [PMID: 3588036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Mikulska M, Rokicki W, Cichoń-Wardas D, Ulfik B. [Condition of newborn infants born to epileptic mothers]. Pediatr Pol 1982; 57:415-20. [PMID: 6891454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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