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van de Velde ME, El Hassani SEM, Kaspers GJL, Broertjes J, Benninga MA, de Boer NKH, Budding AE, de Meij TGJ. Prediction of Bloodstream Infection in Pediatric Acute Leukemia by Microbiota and Volatile Organic Compounds Analysis. J Pediatr Hematol Oncol 2022; 44:e152-e159. [PMID: 34133377 DOI: 10.1097/mph.0000000000002210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 10/25/2020] [Accepted: 03/28/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Bloodstream infections (BSIs) cause treatment-related mortality in pediatric acute leukemia. We explored the potential of intestinal microbiota and fecal volatile organic compounds (VOCs) analyses to predict BSI. METHODS In this case-control study, fecal samples of pediatric acute leukemia patients were collected. Microbiota composition and fecal VOC profiles of BSI cases and matched non-BSI controls were compared. RESULTS In total, 6 patients were included, of which 1 developed BSI and 1 neutropenic fever. Both showed reduced microbial diversity and stability of Bacteroidetes. In the BSI case, Pantoea was identified 15 days before BSI. Significant differences in fecal VOC profiles were measured between the case and controls. CONCLUSION Microbiota and fecal VOC could serve as biomarkers to predict BSI in pediatric leukemia.
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Affiliation(s)
| | - Sofia El Manouni El Hassani
- Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam
| | - Gert Jan L Kaspers
- Departments of Pediatric Oncology
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jorrit Broertjes
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam
| | - Marc A Benninga
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam
| | - Nanne K H de Boer
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AG&M Research Institute
| | | | - Tim G J de Meij
- Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam
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Bačová E, Chovanec F, Makohusová M, Hederová S, Mikesková M, Hrašková A, Rudinský B, Plank L, Volfová P, Kolenová A. Invasive Rhino-Orbito-Cerebral Mucormycosis in Pediatric Patient with Acute Leukemia. Klin Onkol 2020; 33:138-144. [PMID: 32303134 DOI: 10.14735/amko2020138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Invasive fungal infections are a life-threatening complication of cancer treatments, especially in hemato-oncological patients. Mucormycosis is the third leading cause of invasive fungal infections after Aspergillus and Candida infections. The first clinical symptoms are usually non-specific, which can lead to a late diagnosis and delayed therapy. PURPOSE The objective of this report is to summarize data in the literature about mucormycosis and to present a case report of a patient with acute lymphoblastic leukemia, who developed this infection at our center. Risk factors for the development of mucormycosis, clinical symptoms, radiology, laboratory results, and outcome were retrospectively evaluated. CASE We describe a 6-years-old female patient with acute lymphoblastic leukemia. During the induction phase of therapy, the patient developed febrile neutropenia and did not respond to therapy with a combination of antibiotics and supportive treatment. Pansinusitis and orbitocellulitis developed. Examination of the biological material revealed that the etiological agent was a Rhizopus sp. The patient was treated with a combination of antimycotic drugs, but the infection disseminated to the central nervous system. She underwent radical surgical resection of the affected tissue. At this time, she is still under treatment with antimycotic and oncology agents, but is in remission of the main diagnosis and in good clinical condition. CONCLUSION Mucormycosis is an invasive fungal infection with high morbidity and mortality. Early diagnosis and initiation of effective therapy using a combination of amphotericin B administration and surgery are necessary to obtain a favorable outcome. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.
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Chua LL, Rajasuriar R, Lim YAL, Woo YL, Loke P, Ariffin H. Temporal changes in gut microbiota profile in children with acute lymphoblastic leukemia prior to commencement-, during-, and post-cessation of chemotherapy. BMC Cancer 2020; 20:151. [PMID: 32093640 PMCID: PMC7041273 DOI: 10.1186/s12885-020-6654-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/18/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Alteration in gut microbiota has been recently linked with childhood leukemia and the use of chemotherapy. Whether the perturbed microbiota community is restored after disease remission and cessation of cancer treatment has not been evaluated. This study examines the chronological changes of gut microbiota in children with acute lymphoblastic leukemia (ALL) prior to the start-, during-, and following cessation of chemotherapy. METHODOLOGY We conducted a longitudinal observational study in gut microbiota profile in a group of paediatric patients diagnosed with ALL using 16 s ribosomal RNA sequencing and compared these patients' microbiota pattern with age and ethnicity-matched healthy children. Temporal changes of gut microbiota in these patients with ALL were also examined at different time-points in relation to chemotherapy. RESULTS Prior to commencement of chemotherapy, gut microbiota in children with ALL had larger inter-individual variability compared to healthy controls and was enriched with bacteria belonging to Bacteroidetes phylum and Bacteroides genus. The relative abundance of Bacteroides decreased upon commencement of chemotherapy. Restitution of gut microbiota composition to resemble that of healthy controls occurred after cessation of chemotherapy. However, the microbiota composition (beta diversity) remained distinctive and a few bacteria were different in abundance among the patients with ALL compared to controls despite completion of chemotherapy and presumed restoration of normal health. CONCLUSION Our findings in this pilot study is the first to suggest that gut microbiota profile in children with ALL remains marginally different from healthy controls even after cessation of chemotherapy. These persistent microbiota changes may have a role in the long-term wellbeing in childhood cancer survivors but the impact of these changes in subsequent health perturbations in these survivors remain unexplored.
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Affiliation(s)
- Ling Ling Chua
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Yvonne Ai Lian Lim
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yin Ling Woo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - P'ng Loke
- Department of Microbiology, New York University School of Medicine, New York, NY, USA
| | - Hany Ariffin
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
- Department of Paediatrics, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Simona Z, Ondřej H, Jana P, Patrik M, Jana V, Magdaléna R, Dagmar H, Helena K. Occurrence and Antibiotic Resistance of Enterobacteriaceae in Acute Leukemia Patients. Klin Onkol 2019; 31:282-288. [PMID: 30541311 DOI: 10.14735/amko2018282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute leukemia (AL) is a heterogeneous group of malignant hematopoietic diseases and is divided into two basic types: acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Patients with these diseases are highly immunosuppressed and therefore at a high risk of serious infections. This study aimed to perform active surveillance of enterobacteria, which cause these infections, and to determine their antibiotic resistance in patients with AL who were hospitalized at the Hemato-Oncology Center of University Hospital Olomouc. MATERIALS AND METHODS This study involved 49 patients with AL, of whom 37 had AML (16 women and 21 men) and 12 had ALL (6 women and 6 men). The mean age of the patients was 50.5 years. Samples of clinical material were obtained over 12 months (September 2015 to August 2016) and subjected to standard microbiological examinations. Bacterial strains were identified by MALDI-TOF MS, and their antibiotic susceptibility was established by microdilution method. RESULTS A total of 292 samples were obtained from patients with AL. Some of these samples were excluded from analysis to prevent the inclusion of identical strains from the same patient. Consequently, 146 clinical samples obtained from the following nine types of clinical materials were analyzed - throat swabs (n = 47), stools (n = 40), urine (n = 33), hemocultures (n = 11), buccal swabs (n = 5), perianal swabs (n = 4), wound swabs (n = 3), sputum (n = 2), and puncture fluid (n = 1). The most prevalent enterobacteria was Escherichia coli (n = 42), followed by Klebsiella spp. (n = 46), specifically Klebsiella pneumoniae (n = 34) and Klebsiella oxytoca (n = 12), and Enterobacter cloacae (n = 19). The most of enterobacteria were highly resistant to many tested antibiotics. CONCLUSIONS Antibiotic-resistant enterobacteria colonize patients with hemato-oncological diseases and can cause serious infections. These antibiotic-resistant microorganisms are a serious and frequent problem. These findings together with the high level of immunosuppression mean that patients with hemato-oncological diseases are at a high risk of developing serious infections and consequently active surveillance is crucial.
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Abstract
Bloodstream infection (BSI) is the major cause of mortality in acute lymphocytic leukemia (ALL). Causative pathogens in BSI originate from the gut microbiota due to an increase in intestinal permeability, a process known as bacterial translocation (BT). The gut microbiota in physiological conditions is controlled by a large number of immune cells as part of the gut-associated lymphoid tissue (GALT).The aim of the current study was to investigate the mechanism of bacterial translocation in leukemia by identifying and characterizing alterations in the GALT in leukemic mouse model. Our studies revealed a severe impairment of the GALT characterized by a loss of lymphatic cells in ALL, which eventually led to BSI. We identified differentially expressed genes in the intraepithelium and the lamina propria, which may contribute to BT and to the impairment of lymphocyte migration.
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Affiliation(s)
- Yajing Song
- University of Illinois College of Medicine Peoria, Peoria, Illinois, United States of America
| | - Peter Gyarmati
- University of Illinois College of Medicine Peoria, Peoria, Illinois, United States of America
- * E-mail:
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Chua LL, Rajasuriar R, Azanan MS, Abdullah NK, Tang MS, Lee SC, Woo YL, Lim YAL, Ariffin H, Loke P. Reduced microbial diversity in adult survivors of childhood acute lymphoblastic leukemia and microbial associations with increased immune activation. Microbiome 2017; 5:35. [PMID: 28320465 PMCID: PMC5359958 DOI: 10.1186/s40168-017-0250-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/02/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND Adult survivors of childhood cancers such as acute lymphoblastic leukemia (ALL) have health problems that persist or develop years after cessation of therapy. These late effects include chronic inflammation-related comorbidities such as obesity and type 2 diabetes, but the underlying cause is poorly understood. RESULTS We compared the anal microbiota composition of adult survivors of childhood ALL (N = 73) with healthy control subjects (N = 61). We identified an altered community with reduced microbial diversity in cancer survivors, who also exhibit signs of immune dysregulation including increased T cell activation and chronic inflammation. The bacterial community among cancer survivors was enriched for Actinobacteria (e.g. genus Corynebacterium) and depleted of Faecalibacterium, correlating with plasma concentrations of IL-6 and CRP and HLA-DR+CD4+ and HLA-DR+CD8+ T cells, which are established markers of inflammation and immune activation. CONCLUSIONS We demonstrated a relationship between microbial dysbiosis and immune dysregulation in adult ALL survivors. These observations suggest that interventions that could restore microbial diversity may ameliorate chronic inflammation and, consequently, development of late effects of childhood cancer survivors.
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Affiliation(s)
- Ling Ling Chua
- University Malaya Cancer Research Institute, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, 50603 Kuala Lumpur, Malaysia
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Mohamad Shafiq Azanan
- University Malaya Cancer Research Institute, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Pediatric, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Noor Kamila Abdullah
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mei San Tang
- Departments of Microbiology and Medicine, New York University School of Medicine, New York, NY 10016 USA
| | - Soo Ching Lee
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yin Ling Woo
- University Malaya Cancer Research Institute, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yvonne Ai Lian Lim
- Centre of Excellence for Research in AIDS (CERIA), University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hany Ariffin
- University Malaya Cancer Research Institute, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Pediatric, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - P’ng Loke
- Departments of Microbiology and Medicine, New York University School of Medicine, New York, NY 10016 USA
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Negishi T, Matsumoto T, Saito S, Kasuga E, Horiuchi K, Natori T, Takehara K, Sugano M, Honda T. Catheter-Related Bacteremia Due to Gordonia sputi in a Patient with Acute Lymphocytic Leukemia: a Case Report. Jpn J Infect Dis 2016; 69:342-3. [PMID: 26902218 DOI: 10.7883/yoken.jjid.2015.487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tatsuya Negishi
- Department of Laboratory Medicine, Shinshu University Hospital
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Cofré F, Villarroel M, Castellón L, Santolaya ME. [Successful treatment of a persistent rhino-cerebral mucormycosis in a pediatric patient with a debut of acute lymphoblastic leukemia]. Rev Chilena Infectol 2015; 32:458-63. [PMID: 26436794 DOI: 10.4067/s0716-10182015000500015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/04/2015] [Indexed: 11/17/2022] Open
Abstract
The fungi of the order Mucorales cause mucormycosis, which usually presents as an invasive fungal disease with rapid angioinvasion in immunocompromised patients. Rhinocerebral is the most common presentation. The lipid formulations of amphotericin B are used as primary treatment in invasive mucormycosis; the combined use of posaconazole could allow a reduction in the dose of amphotericin B improving tolerance and adherence to treatment. Caspofungin and amphotericin B association has been shown to be synergistic in vitro and effective in murine models. We present the case of a preschool patient that during the debut of acute lymphoblastic leukemia developed a rhinocerebral mucormycosis successfully responding to antifungal treatment with the combination of liposomal amphotericin and caspofungin.
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Loyola P, Tordecilla J, Benadof D, Yohannessen K, Acuña M. [Risk factor of intestinal colonization with vancomycin resistant Enterococcus spp in hospitalized pediatric patients with oncological disease]. Rev Chilena Infectol 2015; 32:393-8. [PMID: 26436782 DOI: 10.4067/s0716-10182015000500004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 05/19/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The isolation of vancomycin-resistant Enterococcus spp (ERV) has increased significantly within the last few years, along with the risk of infection and dissemination of these bacteria. Our aim was to determine risk factors (RF) for intestinal colonization in hospitalized pediatric patients with oncological disease at Hospital de Niños Roberto del Río. METHODS Between January 2012 and December 2013 a transversal study was performed with 107 rectal swabs and processed with a PCR for ERV. The patients were classified as "colonized with ERV" and "not colonized with ERV" and we evaluated possible RF for intestinal colonization in both groups. RESULTS VRE colonization was found in 51 patients (52%). The median of time elapsed between oncological diagnosis and VRE colonization was 35 days. The significant RF associated with VRE colonization were days of hospitalization prior to study, neutropenia and treatment with antibiotics within 30 days prior to study and mucositis. CONCLUSIONS According to the RF revealed in this study we may suggest prevention standards to avoid ERV colonization. This is the first investigation in our country in hospitalized pediatric patients with oncological disease and processed with a multiplex PCR for ERV, therefore it is a great contribution about this subject in Chile.
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Affiliation(s)
- Selçuk Kaya
- Karadeniz Technical University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey.
| | - Gülçin Bayramoğlu
- Karadeniz Technical University, School of Medicine, Department of Medical Microbiology, Trabzon, Turkey
| | - Mehmet Sönmez
- Karadeniz Technical University, School of Medicine, Department of Hematology, Trabzon, Turkey
| | - İftihar Köksal
- Karadeniz Technical University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey
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Barranco-Lampón G, Mendoza-García CA, Cabrera-Osuna S, Olarte-Carrillo I, Ventura Y, Gutiérrez-Romero M, Martínez-Murillo C, Martínez-Tovar A, Ramos-Peñafiel CO. [Isolated bacteria from nasal cultures. Are they important in patients with acute leukemia?]. Rev Med Inst Mex Seguro Soc 2014; 52:258-261. [PMID: 24878082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The nasal colonization by Staphylococcal (epidermidis or aureus) is frequent and it has importance when it is associated to bacteremia in immunocompromised patients. The objective was to determine the frequency of strains that colonize the nasal mucosa in patients with leukemia and its relationship with peripheral blood cultures. METHODS A retrospective, observational, transversal, retrolective study was done. We analyzed the weekly results of nasal cultures and peripheral blood cultures in patients with leukemia undergoing chemotherapy. The chi-squared test and odds ratio value were estimated in the statistical analysis. RESULTS We included 67 patients, 55 of them with acute lymphocytic leukemia (ALL); 28.5 % of the cultures (n = 47) corresponded to a positive nasal culture. Staphylococcus epidermidis and Staphylococcus aureus were the most isolated bacteria. During the first week of treatment, the positive cultures were the most frequently. All the samples isolated were sensitive to vancomycin or linezolid. It was established only the association between negative nasal cultures and negative peripheral blood cultures (p = 0.0005). Odds ratio for positive nasal cultures and the risk of bacteremia was 0.0269. CONCLUSIONS The frequency of the positive bacteria culture was low, with an adequate sensitivity measure. The presence of bacteria in nasal culture was not identified as a risk factor for the occurrence of bacteremia.
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Altclas J, Salgueira C, Riarte A. Reactivation of Chagas disease after a bone marrow transplant. Blood Transfus 2014; 12 Suppl 1:s380. [PMID: 23867177 PMCID: PMC3934264 DOI: 10.2450/2013.0009-13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/27/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Javier Altclas
- Trinidad Mitre Hospital, Anchorena Hospital, Buenos Aires, Argentina
| | - Claudia Salgueira
- Trinidad Mitre Hospital, Anchorena Hospital, Buenos Aires, Argentina
| | - Adelina Riarte
- “Dr M Fatala Chaben” National Institute of Parasitology, Buenos Aires, Argentina
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García-Elorriaga G, Corona-de Los Santos JC, Méndez-Tovar S, del Rey-Pineda G, Pérez-Casillas RX. [Opportunistic bacteria and microbial flora in children with leukemia and neutropenic enterocolitis]. Rev Med Inst Mex Seguro Soc 2013; 51:424-427. [PMID: 24021072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE to determine the prevalence of opportunistic microorganisms and microbial flora in neutropenic enterocolitis in oncohematological pediatric patients. METHODS a prospective and observational study was done. Patients with diagnosis of acute leukemia and neutropenia were included. Stool cultures were taken to identify microorganisms and microbial flora. A χ(2) test with Yates corrections and Fisher exact test were used in the statistical analysis. RESULTS 21 patients were included (12 male, 57.1 %). The stool cultures showed that 68 % of microorganisms were Gram-negative. The presence of microorganisms Gram-positive was 20 %, 6 % for Candida sp.; 3 % for Cryptosporidium sp.; and in 3 % were acid fast bacilli. Staphylococcus epidermidis, Enterobacter sp., and Escherichia coli were presented in pure culture. No association was found between Gram-positive and Gram-negative microorganisms with age, white cell count or pure or mixed cultures. CONCLUSIONS although Gram-negative microorganisms were the most frequent, Gram-positive and other microorganisms that are not detected habitually in feces culture were isolated.
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Jensen RH, Johansen HK, Arendrup MC. Stepwise development of a homozygous S80P substitution in Fks1p, conferring echinocandin resistance in Candida tropicalis. Antimicrob Agents Chemother 2013; 57:614-7. [PMID: 23089761 PMCID: PMC3535961 DOI: 10.1128/aac.01193-12] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 10/17/2012] [Indexed: 11/20/2022] Open
Abstract
Three Candida tropicalis isolates were obtained from a patient with acute lymphoblastic leukemia. The first isolate was susceptible to all drug classes, while isolates 2 and 3, obtained after 8 and 8.5 weeks of caspofungin treatment, respectively, were resistant to the three echinocandins. Multilocus sequence genotyping suggested a clonal relation among all isolates. FKS1 sequencing revealed a stepwise development of a heterozygous and finally a homozygous mutation, leading to S80S/P and S80P amino acid substitutions.
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Affiliation(s)
| | - Helle Krogh Johansen
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Angheben A, Giaconi E, Menconi M, Casazza G, Najajreh M, Anselmi M, Gobbi F, Bisoffi Z, Tascini C, Favre C. Reactivation of Chagas disease after a bone marrow transplant in Italy: first case report. Blood Transfus 2012; 10:542-544. [PMID: 22790268 PMCID: PMC3496236 DOI: 10.2450/2012.0015-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 02/09/2012] [Indexed: 06/01/2023]
Affiliation(s)
- Andrea Angheben
- Centre for Tropical Diseases, S. Cuore-Don Calabria Hospital, Negrar, Italy.
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Björkholm M, Kalin M, Grane P, Celsing F. Long-term treatment of invasive sinus, tracheobroncheal, pulmonary and intracerebral aspergillosis in acute lymphoblastic leukaemia. Infection 2011; 40:81-5. [PMID: 21779887 DOI: 10.1007/s15010-011-0158-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 06/21/2011] [Indexed: 11/25/2022]
Abstract
A 59-year-old male with acute lymphoblastic leukemia developed sinus, tracheobroncheal, pulmonary, and intracerebral aspergillosis. All lesions except the intracerebral aspergillosis healed after combination antifungal treatment. Long-term voriconazole--but not posaconazole--therapy induced partial regression of the cerebral manifestations. At the time of writing, 3.5 years after the initial diagnosis, the patient is working half-time and suffers from a possible voriconazole-induced polyneuropathy.
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Affiliation(s)
- M Björkholm
- Division of Hematology, Department of Medicine, Karolinska University Hospital and Institutet, Stockholm, Sweden.
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Mohammed K, Dignan F, Ethell ME, Davies FE, Morgan GJ, Riley U, Evans S, Potter MN, Shaw BE. An early computed tomography-guided antifungal treatment strategy is safe and efficacious in patients undergoing chemotherapy for high-risk acute leukemia. Leuk Lymphoma 2011; 52:339-40. [PMID: 21281242 DOI: 10.3109/10428194.2010.527407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ou-Yang LW, Chang PC, Tsai AI, Jaing TH, Lin SY. Salivary microbial counts and buffer capacity in children with acute lymphoblastic leukemia. Pediatr Dent 2010; 32:218-222. [PMID: 20557705] [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: 05/29/2023]
Abstract
PURPOSE The aim of this study was to evaluate the caries activity in children undergoing maintenance stage chemotherapy courses. METHODS Forty-six children with acute lymphoblastic leukemia (ALL) were examined, the age ranged from 3 to 12 years with a mean age of 7(1/2) years. They were under maintenance stage chemotherapy at the Department of Pediatric Hematology of Chang-Gung Memorial Hospital, Taoyuan, Taiwan. A control group of healthy children was recruited by age and sex-matching criteria. The children received only a clinical dental examination without radiographs. Decayed (D), Missing (M), and Filled (F) Tooth surfaces (S) scores were recorded following the WHO criteria. After oral examination, stimulated saliva samples were collected from the subjects to exam the salivary Streptococcus mutans counts, salivary lactobacilli counts and salivary buffer capacity. RESULT The Wilcoxon signed-rank test shows that the salivary Streptococcus mutans counts in ALL children were significantly lower than healthy subjects (P<.001) and lactobacilli counts were similar on both groups (P=.47). However, the ALL group tended to have lower salivary buffer capacity than the control group (P=.002). The mean DEFTS/DMFTS scores of the ALL group were higher than the control group, but the differences did not reach statistical significance. CONCLUSIONS Specific oral prevention regimens for ALL children undergoing chemotherapy should be planned for patients with unusually low salivary buffer capacity.
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Affiliation(s)
- Li-Wei Ou-Yang
- Department of Pediatric Dentistry, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan (Republic of China)
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Hatzistilianou M, Rekliti A, Athanassiadou F, Catriu D. Procalcitonin as an early marker of bacterial infection in neutropenic febrile children with acute lymphoblastic leukemia. Inflamm Res 2009; 59:339-47. [PMID: 19806318 DOI: 10.1007/s00011-009-0100-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Revised: 07/15/2009] [Accepted: 09/22/2009] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE AND DESIGN The aim of this study was to assess the value of procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-a), interleukin (IL)-1b, IL-8, and soluble TNF receptor II (sTNFRII) in early and rapid diagnosis of infection in neutropenic children with acute lymphoblastic leukemia (ALL) and to distinguish bacterial from viral infections. PATIENTS The study included five groups (A, B, C, D, and E) of children with ALL undergoing intensive chemotherapy. Groups A and B consisted of neutropenic children with bacterial and viral infection, respectively. Groups C and D consisted of nonneutropenic children with bacterial and viral infection, respectively. Group E consisted of children without neutropenia and without fever. METHODS In all groups, blood samples were collected upon admission and then for 7 days on a daily basis. Levels of CRP, PCT, TNF-a, IL-1b, IL-8, and sTNFRII were determined in all blood samples. RESULTS We found a highly significant difference in PCT levels between bacterial and nonbacterial episodes. Sensitivity and specificity of PCT were 94 and 96.5%, respectively. CONCLUSIONS Serial measurement of PCT levels on a daily basis seems to be helpful for early prediction of severe bacterial infections, monitoring febrile episodes regarding response to antibiotic therapy, and early detection of complications in the infectious process.
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Affiliation(s)
- Maria Hatzistilianou
- 2nd Department of Paediatrics, Aristotle University of Thessaloniki, Agiou Ioannou 23, Kalamaria, 551 32, Thessaloniki, Greece.
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20
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Pirrotta MT, Bucalossi A, Forconi F, Gozzetti A, Bocchia M, Mazzotta S, Sammassimo S, Lauria F. Massive intravascular hemolysis: a fatal complication ofClostridium perfringenssepticemia in a patient with acute lymphoblastic leukemia. Leuk Lymphoma 2009; 46:793. [PMID: 16019522 DOI: 10.1080/10428190500032687] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Muda Z, Ibrahim H, Abdulrahman EJ, Menon BS, Zahari Z, Zaleha AM, Talib A. Invasive aspergillosis in paediatric oncology patients. Med J Malaysia 2008; 63:415-416. [PMID: 19803305] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Invasive aspergillosis predominantly occurs in immunocompromised patients and is often resistant to different therapeutically strategies. However, mortality significantly increases if the central nervous system is affected. In this report we describe two cases of invasive aspergilosis, one with kidney involvement with a successful treatment while the other with pulmonary and cerebral involvement with a grave outcome.
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Affiliation(s)
- Z Muda
- Haematology-Oncology Unit, Hospital Kuala Lumpur, Malaysia.
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22
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Hermansen NEU, Ralfkiaer EM, Kjeldsen L. [Disseminated fusariosis in a patient with acute lymphoblastic leukaemia]. Ugeskr Laeger 2008; 170:2892. [PMID: 18796288] [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: 05/26/2023]
Abstract
Invasive mould infections are a major cause of infectious mortality in highly immunosuppressed patients. Incidence in this high risk group is 10-20% with a death rate in excess of 50%. Most invasive moulds are Aspergillus spp. We present a case of a 74-year-old woman with acute lymphoblastic leukaemia who developed a rare disseminated mould infection with Fusarium solani during induction chemotherapy. We present the case story and discuss the pathogenesis, clinical characteristics and treatment of invasive fusariosis.
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Malhotra P, Menon MC, Varma N, Mishra B, Saikia UN, Suri V, Varma S. Cytomegalovirus pneumonia in adult acute lymphoblastic leukemia. J Assoc Physicians India 2008; 56:541-542. [PMID: 18846908] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Cytomegalovirus (CMV) is an important cause of morbidity and mortality in immunosuppressed patients. Though acute lymphoblastic leukemia (ALL) is an immunosuppressed state, CMV disease has been reported infrequently. We present a patient of adult B lineage ALL who was on maintenance chemotherapy and developed CMV pneumonia. Patient was managed with intravenous ganciclovir and had successful outcome. However, three weeks later patient had a relapse of ALL and died shortly after high dose chemotherapy.
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Affiliation(s)
- P Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Yang W, Liu H, Duan J, Zhang Y, Huang YK, He W, Lu P, Li HL. [Effects of high-dose methotrexate therapy on intestinal bacterial flora in children with acute lymphoblastic leukemia]. Zhonghua Er Ke Za Zhi 2008; 46:252-256. [PMID: 19099724] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To investigate the effects of high-dose methotrexate (HDMTX) therapy on intestinal bacterial flora in children with acute lymphoblastic leukemia (ALL). METHODS Thirty-six children with ALL of pre-and post-HDMTX therapy and 36 control children were enrolled. The bacterial DNA in stool was extracted. The primers for Bacillus bifidus and Escherichia coli with the 16SrRNA/DNA sequence of bacteria were designed. The bacteria were identified through general PCR. The standard curve of both bacterial DNA was produced using a series of dilution of accurately quantified bacterial DNA. The unknown samples were measured by 16SrRNA/DNA-targeted PCR. The amount of stool Bacillus bifidus and Escherichia coli among 36 control children and 36 children with ALL of pre- and post-HDMTX therapy were obtained by using the standard curves. RESULTS Bacillus bifidus logarithmic absolute value of the first day before treatment, of third day after treatment, of seventh day after treatment in patients with ALL and the control was 7.24 +/- 0.33, 6.00 +/- 0.27, 6.59 +/- 0.33, and 9.49 +/- 0.41, respectively (P < 0.01). Escherichia coli logarithmic absolute value of the first day before treatment, of third day after treatment, of seventh day after treatment in patients with ALL and the control was 6.62 +/- 0.42, 5.96 +/- 0.42, 7.02 +/- 0.41, and 7.52 +/- 0.43, respectively (P < 0.01). The logarithm of the amount of stool Bacillus bifidus and Escherichia coli in control group was higher in ALL group (F = 739.61, 88.67, P < 0.01). There were significant difference (P < 0.01) in the logarithm of the amount of stool Bacillus bifidus and Escherichia coli between pre-therapy and post-therapy group. The logarithm of the bacterium was very low on third day after treatment, but gradually increased on the seventh day after treatment. CONCLUSIONS (1) HDMTX therapy has great effects on intestinal flora of Bacillus bifidus and Escherichia coli and significantly reduced the bacteria in children with ALL. (2) Probiotics had significantly decreased in ALL group than in control group.
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Affiliation(s)
- Wu Yang
- Department of Pediatrics, the First Affiliated Hospital, Kunming Medical College, Kunming 650032, China
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Graubner UB, Porzig S, Jorch N, Kolb R, Wessalowski R, Escherich G, Janka GE. Impact of reduction of therapy on infectious complications in childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2008; 50:259-63. [PMID: 17635005 DOI: 10.1002/pbc.21298] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [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: 11/09/2022]
Abstract
BACKGROUND Infections are a major cause of morbidity and mortality in childhood acute lymphoblastic leukemia (ALL) and only limited information is available on infectious complications. PATIENTS AND METHODS We investigated infectious complications in 293 children during different treatment phases of the multicenter protocol COALL-06-97. We also evaluated whether therapy reduction in prognostically good risk patients receiving either the low risk or high risk treatment arm would lead to fewer infectious complications. RESULTS Thirty of 293 patients had no infections; 263 patients had 682 infectious complications (median 2, range 1-9), five of them lethal. Two thirds of the infections occurred during periods of neutropenia. The most frequent infectious episodes were fever of unknown origin (FUO): 483/682 (70.8%), microbiologically documented infections (MDI): 100/682 (14.6%), (61 gram-positive, 36 gram-negative, 3 fungal isolates), and clinically documented infections (CDI): 99/682 (14.5%). With standard reinduction, 44% low risk and 57% high risk patients had infections versus 26% low risk and 38% high risk patients with reduced reinduction therapy (P < 0.01). CONCLUSIONS Most patients treated with intensive combination therapy for ALL experience one to several serious infections during treatment. The wide range in number of infectious episodes and the lack of infections in a small subset of patients in spite of uniform treatment suggest genetic as well as possibly environmental factors to have a role. Moderate reduction of chemotherapy may significantly reduce the rate of infectious episodes.
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Affiliation(s)
- Ulrike B Graubner
- University Children's Hospital, Department of Hematology and Oncology, Munich, Germany
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Abstract
Here we report two patients with hematological malignancies associated with complications of fatal cardiac zygomycosis. The first case, a 72-year-old man with myelodysplastic syndrome being treated with low-dose cytarabine, died of sudden cardiac arrest. An autopsy revealed disseminated zygomycosis accompanied with occlusion of the coronary artery by fungal thrombi. The second case, a 52-year-old woman with acute lymphoblastic leukemia, developed febrile neutropenia and skin eruptions with induration on the face and extremities during the first induction chemotherapy. She experienced sudden bradycardia with unstable hemodynamics and died of acute myocardial infarction. Histological examination of a skin biopsy demonstrated zygomycosis. In light of the above, it should be kept in mind that cardiac zygomycosis might occur in hematologically compromised patients presenting with acute myocardial infarction.
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Affiliation(s)
- Satoru Joshita
- Department of Internal Medicine, Matsumoto National Hospital, Matsumoto.
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Anirudhan D, Bakhshi S, Xess I, Broor S, Arya LS. Etiology and outcome of oral mucosal lesions in children on chemotherapy for acute lymphoblastic leukemia. Indian Pediatr 2008; 45:47-51. [PMID: 18250506] [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: 05/25/2023]
Abstract
Microbiological cultures were taken from oral cavity and blood in 100 mucositis episodes in 70 children with acute lymphoblastic leukemia (ALL). Oral mucositis was commonest in neutropenic children during induction chemotherapy. Fungal organisms (n=39) were commonest isolate from mucosa followed by bacteria (n=28). Isolation of organism from oral cavity had no association with those isolated from blood. Herpes serology was positive in 16% episodes compared to 2% of controls. Obtaining cultures from oral lesions is useful in appropriate management of lesions and thereby possibly preventing systemic spread.
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Affiliation(s)
- Deepa Anirudhan
- Department of Pediatrics, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Yilmaz M, Demirel AE, Izmir S, Soysal T, Mert A. Pneumopericardium due to invasive pulmonary aspergillosis. J Infect Chemother 2007; 13:341-2. [PMID: 17982724 DOI: 10.1007/s10156-007-0542-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 06/05/2007] [Indexed: 11/25/2022]
Abstract
We describe a 59-year-old female patient with leukemia who developed pneumopericardium as a complication of invasive pulmonary aspergillosis. Spiral computed tomography (CT) was very helpful for the detection of such complications.
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Affiliation(s)
- Mesut Yilmaz
- Infectious Diseases and Clinical Microbiology Department, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey.
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29
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Meisel R, Toschke AM, Heiligensetzer C, Dilloo D, Laws HJ, von Kries R. Increased risk for invasive pneumococcal diseases in children with acute lymphoblastic leukaemia. Br J Haematol 2007; 137:457-60. [PMID: 17488489 DOI: 10.1111/j.1365-2141.2007.06601.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [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: 11/28/2022]
Abstract
Asplenia and other conditions of immunodeficiency are established risk factors for invasive pneumococcal disease (IPD). There are no current data available on the risk of IPD in children with acute lymphoblastic leukaemia (ALL), the most common type of childhood malignancy. This study combined data from a nation-wide surveillance for IPD and the German childhood cancer registry, and showed that children with ALL carry a more than 10-fold higher risk for IPD than the general paediatric population. As a substantial proportion of IPD occurs during maintenance chemotherapy, children with ALL may represent candidates for the evaluation of prophylactic interventions including vaccination.
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Affiliation(s)
- Roland Meisel
- Clinic for Paediatric Oncology, Haematology and Clinical Immunology, University Clinic of Düsseldorf, Heinrich-Heine-University, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
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30
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Nyari TA, Kajtár P, Parker L. Seasonality of birth and acute lymphoblastic leukemia. J Perinat Med 2007; 34:507-8. [PMID: 17140306 DOI: 10.1515/jpm.2006.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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31
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van der Velden VHJ, Cazzaniga G, Schrauder A, Hancock J, Bader P, Panzer-Grumayer ER, Flohr T, Sutton R, Cave H, Madsen HO, Cayuela JM, Trka J, Eckert C, Foroni L, Zur Stadt U, Beldjord K, Raff T, van der Schoot CE, van Dongen JJM. Analysis of minimal residual disease by Ig/TCR gene rearrangements: guidelines for interpretation of real-time quantitative PCR data. Leukemia 2007; 21:604-11. [PMID: 17287850 DOI: 10.1038/sj.leu.2404586] [Citation(s) in RCA: 534] [Impact Index Per Article: 31.4] [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: 01/19/2023]
Abstract
Most modern treatment protocols for acute lymphoblastic leukaemia (ALL) include the analysis of minimal residual disease (MRD). To ensure comparable MRD results between different MRD-polymerase chain reaction (PCR) laboratories, standardization and quality control are essential. The European Study Group on MRD detection in ALL (ESG-MRD-ALL), consisting of 30 MRD-PCR laboratories worldwide, has developed guidelines for the interpretation of real-time quantitative PCR-based MRD data. The application of these guidelines ensures identical interpretation of MRD data between different laboratories of the same MRD-based clinical protocol. Furthermore, the ESG-MRD-ALL guidelines will facilitate the comparison of MRD data obtained in different treatment protocols, including those with new drugs.
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Majoros L, Szegedi I, Kardos G, Erdész C, Kónya J, Kiss C. Slow response of invasive Candida krusei infection to amphotericin B in a clinical time-kill study. Eur J Clin Microbiol Infect Dis 2007; 25:803-6. [PMID: 17058066 DOI: 10.1007/s10096-006-0200-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L Majoros
- Department of Medical Microbiology, University of Debrecen, Nagyerdei körút 98, Debrecen 4032, Hungary.
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Carrillo-Esper R, Elizondo-Argueta S, Vicuña-González RM, González-Trueba EF. [Isolated renal mucormicosis]. GAC MED MEX 2006; 142:511-4. [PMID: 17201115] [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: 05/13/2023] Open
Abstract
Mucormycosis is an infection caused by a class Zygomycetes fungi. The rhinocerebral and pulmonary are the most common clinical presentations. Renal mucormycosis is a very rare form. To date, only 25 cases have been reported in the literature. We describe the case of a patient with leukemia who developed isolated renal mucormycosis and review the literature.
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Huang M, Zhou JF, Ran D, Zhang YC, Sun HY, Liu WL. [Ph+ acute lymphoblastic leukemia combined with lung and brain invasive aspergillosis]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2006; 14:610-3. [PMID: 16800953] [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] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This study was aimed to investigate the clinical features and therapy of Ph(+) acute lymphoblastic leukemia (Ph(+)ALL) combined with invasive aspergillosis. A series of examination, including routine blood and bone marrow picture analysis, chest roentgenography, cranial computerized tomography and detection of cell genetics etc were carried out for a Ph(+)ALL patient combined with invasive aspergillosis. This patient received chemotherapy with DVCP, idarubicin and imatinib mesylate and was treated with sporanox and amphotericin B (Amb; including Amb-L) and cerebrotomy for drainage because the invasive aspergillosis occurred during myelosuppression. The results showed that patient gained complete remission and the invasive aspergillosis was controlled successfully. It is concluded that patient with Ph(+)ALL has poor prognosis despite intensive conventional chemotherapy, imatinib mesylate may prove to be an effective treatment for Ph(+)ALL. Because detection rate of the fungus is very low, itraconazole in combination with surgical excision of focus is the best treatment of lung and brain invasive aspergillosis.
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Affiliation(s)
- Mei Huang
- Department of Hematology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China.
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Abstract
Roseomonas is a newly described genus of pink-pigmented, gram-negative bacteria. Human infections caused by Roseomonas species are very rare. We report two cases of central venous catheter-related bacteremia associated with Roseomonas species (one case with R. gilardii and one with R. fauriae), and review the clinical spectrum of previously reported cases in the literature. Clinicals should be aware that Roseomonas species may cause serious infections in children.
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Affiliation(s)
- Thomas W McLean
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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Pimentel JD, Baker M, Woodgyer AJ, Harris OC. Fatal disseminated Blastoschizomyces capitatus (Geotrichum capitatum) in a patient with relapse of acute lymphoblastic leukaemia. Pathology 2005; 37:319-21. [PMID: 16194836 DOI: 10.1080/00313020500169222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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38
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Lehtinen M, Ogmundsdottir HM, Bloigu A, Hakulinen T, Hemminki E, Gudnadottir M, Kjartansdottir A, Paavonen J, Pukkala E, Tulinius H, Lehtinen T, Koskela P. Associations between three types of maternal bacterial infection and risk of leukemia in the offspring. Am J Epidemiol 2005; 162:662-7. [PMID: 16120707 DOI: 10.1093/aje/kwi261] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [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: 12/14/2022] Open
Abstract
A case-control study was nested within two maternity cohorts with a total of 7 million years of follow-up for assessment of the role of bacterial infections in childhood leukemia. Offspring of 550,000 mothers in Finland and Iceland were combined to form a joint cohort that was followed for cancer up to age 15 years during 1975-1997 through national cancer registries. For each index mother-case pair, three or four matched control mother-control pairs were identified from population registers. First-trimester serum samples were retrieved from mothers of 341 acute lymphoblastic leukemia cases and 61 other leukemia cases and from 1,212 control mothers. Sera were tested for antibodies to the genus Chlamydia, Helicobacter pylori, and Mycoplasma pneumoniae. Odds ratios and 95% confidence intervals, adjusted for sibship size, were calculated as estimates of relative risk. M. pneumoniae immunoglobulin M appeared to be associated with increased risk (odds ratio (OR) = 1.6), but the association lost statistical significance when the specificity of the immunoglobulin M was considered (OR = 1.5, 95% confidence interval: 0.9, 2.4). In Iceland, H. pylori immunoglobulin G was associated with increased risk of childhood leukemia in offspring (OR = 2.8, 95% confidence interval: 1.1, 6.9). Since H. pylori immunoglobulin G indicates chronic carriage of the microorganism, early colonization of the offspring probably differs between Iceland and Finland, two affluent countries.
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Schuster F, Moelter C, Schmid I, Graubner UB, Kammer B, Belohradsky BH, Führer M. Successful antifungal combination therapy with voriconazole and caspofungin. Pediatr Blood Cancer 2005; 44:682-5. [PMID: 15700260 DOI: 10.1002/pbc.20302] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [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: 11/06/2022]
Abstract
A 12-year-old boy in third remission of an acute lymphoblastic leukaemia developed infection of lung and paranasal sinuses with Aspergillus flavus in neutropenia. Because of the high risk of leukaemia-relapse bone marrow transplantation (BMT) from a matched unrelated donor was carried out despite invasive pulmonary aspergillosis (IPA). It is the first reported patient with IPA, who was successfully treated by the antifungal combination therapy with voriconazole and caspofungin therapy during myeloablative BMT. Despite 6 weeks of aplasia, a dramatic decrease of lesions highly suggestive of aspergillosis was observed after BMT. Since discharge-oral voriconazole monotherapy has been continued.
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Affiliation(s)
- Friedhelm Schuster
- Division of Pediatric Hematology/Oncology, Dr. v. Haunersches Kinderspital, LMU-University of Munich, Munich, Germany.
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40
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Affiliation(s)
- Daryl C L Tan
- Department of Haematology, Singapore General Hospital, Singapore.
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41
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Fanci R, Casini C, Leoni F. Empiric antifungal strategies for acute leukemia patients. J Chemother 2005; 17:115-6. [PMID: 15828454 DOI: 10.1179/joc.2005.17.1.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Fanci R, Casini C, Leoni F, Ciolli S, Bosi A. Incidence and management of proven and probable fungal infections in patients with acute leukemia: a single center experience. J Chemother 2005; 16:557-60. [PMID: 15700847 DOI: 10.1179/joc.2004.16.6.557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/31/2022]
Abstract
The incidence of fungal infections and the role of liposomal amphotericin B (Ambisome) in proven and probable infections were evaluated in acute leukemic patients, intolerant to conventional amphotericin B. During 1999-2002, 307 febrile episodes occurred in 231 patients. Fungi were responsible for 3% of bloodstream infections. Ambisome was employed in 5 fungal sepsis (1 Candida albicans, 1 C. famata, 1 C. tropicalis, 1 C. krusei, 1 Geotrichum capitatum) 2 Aspergillosis, 2 probable fungal pneumonia cases. A favorable response was achieved in 78% of patients (4 fungemia, 2 aspergillosis, 1 probable), an unfavorable response in 1 C. krusei fungemia and in 1 probable pneumonia. Our antimicrobial pattern documented a high resistance rate to azoles. We concluded that Ambisome is an effective and well tolerated agent and its introduction has changed the outcome for many patients, although in some refractory diseases other strategies must be considered.
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Affiliation(s)
- R Fanci
- Department of Hematology and University of Florence, Careggi Hospital, Florence, Italy.
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Abstract
We retrospectively reviewed the medical records of 284 patients with neutropenic fever following chemotherapy for acute leukemia at the Catholic Hematopoietic Stem Cell Transplantation Center from January 1998 to December 1999, to identify prognostic factors for infection-related mortality. Twenty-eight patients died of infections. There was no difference in median age, gender ratio, or underlying disease between the dying and surviving groups. Bacteria were the main pathogens following chemotherapy, and Gram positive organisms predominated in the dying group. Pneumonia and sepsis were the main causes of death. There were 72 cases of invasive fungal infection and their mortality was 27.8%. Invasive fungal infection and previous history of fungal infection were independent prognostic factors for outcome. Recovery from neutropenia was the significant protective factor for mortality. In conclusion, the prognostic factors identified in this study could be useful for deciding on more intensive treatment for those patients at greater risk of death. To our knowledge, this is the first Korean study delineating prognostic factors in acute leukemic patients with infectious complications.
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Affiliation(s)
- Jin-Hong Yoo
- The Catholic Hemopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Su Mi Choi
- The Catholic Hemopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Dong-Gun Lee
- The Catholic Hemopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Jung-Hyun Choi
- The Catholic Hemopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Wan-Shik Shin
- The Catholic Hemopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Woo-Sung Min
- The Catholic Hemopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Chun-Choo Kim
- The Catholic Hemopoietic Stem Cell Transplantation Center, The Catholic University of Korea, College of Medicine, Seoul, Korea
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44
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Abstract
There are three current hypotheses concerning infectious mechanisms in the aetiology of childhood leukaemia: exposure in utero or around the time of birth, delayed exposure beyond the first year of life to common infections and unusual population mixing. No specific virus has been definitively linked with childhood leukaemia and there is no evidence to date of viral genomic inclusions within leukaemic cells. The case-control and cohort studies have revealed equivocal results. Maternal infection during pregnancy has been linked with increased risk whilst breast feeding and day care attendance in the first year of life appear to be protective. There is inconclusive evidence from studies on early childhood infectious exposures, vaccination and social mixing. Some supportive evidence for an infectious aetiology is provided by the findings of space-time clustering and seasonal variation. Spatial clustering suggests that higher incidence is confined to specific areas with increased levels of population mixing, particularly in previously isolated populations. Ecological studies have also shown excess incidence with higher population mixing. The marked childhood peak in resource-rich countries and an increased incidence of the childhood peak in acute lymphoblastic leukaemia (ALL) (occurring at ages 2-6 years predominantly with precursor B-cell ALL) is supportive of the concept that reduced early infection may play a role. Genetically determined individual response to infection may be critical in the proliferation of preleukaemic clones as evidenced by the human leucocyte antigen class II polymorphic variant association with precursor B-cell and T-cell ALL.
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Affiliation(s)
- Richard J Q McNally
- Cancer Research UK Paediatric and Familial Cancer Research Group, Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, UK.
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45
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Westling K, Julander I, Ljungman P, Heimdahl A, Thalme A, Nord CE. Reduced susceptibility to penicillin of viridans group streptococci in the oral cavity of patients with haematological disease. Clin Microbiol Infect 2004; 10:899-903. [PMID: 15373884 DOI: 10.1111/j.1469-0691.2004.00975.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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: 11/30/2022]
Abstract
The occurrence of oral penicillin-resistant viridans group streptococci (VGS) was studied in 50 patients with either newly diagnosed acute leukaemia or autologous peripheral stem cell transplants. One patient was excluded because of Staphylococcus aureus growth in the stem cell harvest. VGS were isolated from the oral cavity of 48 of the remaining 49 patients. Of these 48 patients, 12 (25%) yielded VGS resistant (MIC > 2 mg/L) to penicillin. These 12 patients had a higher frequency of septicaemia (p 0.04) and more days of treatment with trimethoprim-sulphamethoxazole (p 0.04) than patients who harboured susceptible or intermediately resistant VGS (MIC 2 mg/L). There were no other statistically significant differences between the two groups. It is important to be aware of the high level of penicillin resistance in oral VGS in patients with haematological disease, and this parameter should be considered when selecting antibiotic therapy for cases of septicaemia caused by VGS in immunocompromised patients.
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Affiliation(s)
- K Westling
- Division of Infectious Diseases, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden.
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46
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Yousef AA, Fryer CJH, Chedid FD, Abbas AAH, Felimban SK, Khattab TM. A pilot study of prophylactic ciprofloxacin during delayed intensification in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2004; 43:637-43. [PMID: 15390313 DOI: 10.1002/pbc.20065] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [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: 11/06/2022]
Abstract
BACKGROUND We hypothesized that prophylactic administration of an appropriate antibiotic following each delayed intensification (DI) in children with acute lymphoblastic leukemia (ALL) would reduce the episodes of fever and bacteremia associated with neutropenia, and hence reduce both the rate and duration of hospitalization. PROCEDURE All patients in the study were treated according to a modified Medical Research Council United Kingdom ALL XI (MRC UKALL XI) protocol utilizing three DI courses. Between June and December 2000 patients received prophylactic ciprofloxacin following DI courses. The rates of hospitalization and bacteremias were compared to ALL patients who had received between one and three DI courses prior to June 2000. RESULTS There were 69 patients who received a total of 194 DIs (controls 130; study group 64). The rate of hospitalization was 90% in the controls and 58% in the study group (P < 0.001). The median hospital stay was 10.1 days for controls and 6.0 for the study group (P < 0.001). Intensive care unit admissions were reduced from 12 to 1.5% (P = 0.02). The overall rate of proven bacteremia was reduced from 22 to 9% (P = 0.028). There were no Gram-negative bacteremias in the study group compared to 10 (7.7%) in the controls (P < 0.001). CONCLUSIONS Compared to historical controls, patients in this study receiving prophylactic ciprofloxacin had a reduced rate and duration of hospitalization and incidence of Gram-negative bacteremia.
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Affiliation(s)
- Abdelmottaleb A Yousef
- Princess Noorah Oncology Center, King Abdullaziz Medical City, Jeddah, Kingdom of Saudi Arabia
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47
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Abstract
We evaluated the infectious aetiology hypothesis of childhood leukaemia that rapid population influx into rural areas is associated with increased risk. Using data from the US SEER program, we found that in changes in rural county population sizes from 1980 to 1989 were associated with incidence rates for childhood acute lymphocytic leukaemia (ALL). The observed associations were strongest among children 0-4 years of age, born in the same state as diagnosis, in extremely rural counties, and when counties adjacent to nonrural counties were excluded. Similar analyses for brain and central nervous system (CNS) cancer in children, a disease less linked to this infectious hypothesis, provide evidence against methodologic bias. Similar evaluations for other decades were not meaningful due to limited sample sizes and, perhaps, increased population mobility.
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Affiliation(s)
- D Wartenberg
- UMDNJ-Robert Wood Johnson Medical School, The Cancer Institute of New Jersey, New Brunswick, NJ, 170 Frelinghuysen Road, Piscataway, NJ 08854, USA.
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48
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Vicari P, Feitosa Pinheiro R, Chauffaille MDLLF, Yamamoto M, Figueiredo MS. Septic arthritis as the first sign of Candida tropicalis fungaemia in an acute lymphoid leukemia patient. Braz J Infect Dis 2004; 7:426-8. [PMID: 14636484 DOI: 10.1590/s1413-86702003000600012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 11/22/2022] Open
Abstract
Fungal infections caused by Candida species have increased in incidence during the past two decades in England, North America and Europe. Candidal arthritis is rare in patients who are not intravenous drug users or are who not using a prostheses. We report the case of a 24-year-old man with acute lymphoid leukemia, who developed Candida tropicalis arthritis during an aplastic period after chemotherapy. This is the eighth case described in the literature of C. tropicalis causing arthritis without intra-articular inoculation. We call attention to an unusual first sign of fungal infection: septic arthritis without intra-articular inoculation. However, this case differs from the other seven, since despite therapy a fast and lethal evolution was observed. We reviewed reported cases, incidence, risk factors, mortality and treatment of neutropenic patients with fungal infections.
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49
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Lassaletta A, Perez A, Díaz MA, Sevilla J, González-Vicent M, Madero L. Successful treatment of invasive aspergillosis with oral voriconazole following intravenous liposomal amphotericin in a child with acute lymphoblastic leukemia. J Pediatr Hematol Oncol 2004; 26:117-9. [PMID: 14767202 DOI: 10.1097/00043426-200402000-00012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Grigull L, Beier R, Schrauder A, Kirschner P, Loening L, Jack T, Welte K, Sykora KW, Schrappe M. Invasive fungal infections are responsible for one-fifth of the infectious deaths in children with ALL. Mycoses 2003; 46:441-6. [PMID: 14641615 DOI: 10.1046/j.0933-7407.2003.00931.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [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: 11/20/2022]
Abstract
The following report will discuss in detail all lethal invasive fungal infections (IFI) that occurred in a group of 2021 children with acute lymphoblasic leukaemia (ALL). The German ALL-Berlin-Frankfurt-Muenster (BFM) study group is one of the largest cooperation for the treatment of childhood ALL. Between 1995 and 2000, 2021 children with ALL received chemotherapy according to the German BFM 95 protocols (ALL-BFM 95). This population was retrospectively screened, whether a lethal fungal infection occurred: totally, in this group, 43 of 2021 (2.1%) children died because of infections. Nine of 43 (21%) patients died in the context of an IFI: six fatal Aspergillus infections and three fatal yeast infections were reported. The following report will focus on the nine children with ALL who died from IFI. The underlying risk factors (RF) included neutropenia (seven of nine patients) and steroid medication (nine of nine patients). Seven of nine children had additional medical complications (e.g. liver failure, haemolytic uraemic syndrome and acute renal failure). In six of nine children the fungal infection was progressive despite intravenous antimycotic therapy, three patients received no antifungal therapy, as IFI was not considered. The progression of IFI despite antimycotic therapy illustrates the inherent problems of diagnosis and the need for innovative therapeutic modalities. The high percentage (21%) of death from IFI among lethal infections in paediatric ALL patients illustrates the relevance of fungi in this group of patients. On the contrary, the total number of IFI in paediatric ALL patients remains to be determined, as only lethal infections were included in this report.
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Affiliation(s)
- L Grigull
- Departments of Paediatric Haematology and Oncology, Medical School Hannover, Germany.
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