Pınar Çayıröz, Mehmet Umut Çayıröz, Utku Iltar, Erdal Kurtoğlu
Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease that can be presented with fever, fatigue, generalized joint/body pain, diarrhea and bleeding in various parts of the body. The risk of developing a severe fatal disease in humans, the possibility of being infected with aerosols and the risk of being used as a biological weapon make the disease still an important health problem all over the world as there is no a specific treatment and vaccine that has proven effective againt the virus today. The pathogenesis of the disease is not known, but vascular endothelial damage is prominent...
April 2020: Mikrobiyoloji Bülteni
Brigitte Lamy, Sarah Dutron, Stéphanie Haouy, Laure Saumet, Hélène Marchandin, Nicolas Sirvent
BACKGROUND: Poor and delayed microbiological documentation of episodes of febrile neutropenia (EFN) deserves improvement. We assessed the impact of a new blood culture (BC) sampling protocol to optimize the diagnosis of bloodstream infection during EFN, compared with standard of care protocol. METHODS: This pre/post intervention included patients who presented an EFN in a pediatric hematology-oncology center. Data were compared between 1-year periods P1 (110 EFN, 53 patients) and P2 (124 EFN, 53 patients)...
July 28, 2020: Pediatric Research
Eugene Leibovitz, Joseph Kapelushnik, Sabrin Alsanaa, Dov Tschernin, Ruslan Sergienko, Ron Leibovitz, Julia Mazar, Yariv Fruchtman
We compared the etiologic, microbiologic, clinical, and outcome picture among febrile and non-febrile immunocompetent children hospitalized during 2013-2015 with acute neutropenia (absolute neutrophil count < 1.5 × 109 /L). Serious bacterial infections (SBI) were defined as culture-positive blood, urine, cerebrospinal fluid, articular fluid or stool infections, pneumonia, brucellosis, and rickettsiosis. Overall, 664 children < 18 years of age were enrolled; 407 (62.2%) had fever > 38.0 °C and 247 (37...
July 27, 2020: European Journal of Clinical Microbiology & Infectious Diseases
Hemant S Murthy, Raad Z Gharaibeh, Zeina Al-Mansour, Andrew Kozlov, Gaurav Trikha, Rachel C Newsome, Josee Gauthier, Nosha Farhadfar, Yu Wang, Debra Lynch Kelly, John Lybarger, Christian Jobin, Gary P Wang, John R Wingard
BACKGROUND: Infection is a major cause of morbidity and mortality after hematopoietic cell transplantation (HCT). Gut microbiota (GM) composition and metabolites provide colonization resistance against dominance of potential pathogens. GM dysbiosis following HCT can be deleterious to immune reconstitution. Little is known about the composition, diversity, and evolution of GM communities in HCT patients and their association with subsequent febrile neutropenia (FN) and infection. Identification of markers before HCT that predict subsequent infection could be useful in developing individualized antimicrobial strategies...
July 24, 2020: Biology of Blood and Marrow Transplantation
Shylah M Moore Pardo, Raj H Patel, Asha Ramsakal, John Greene
Corynebacterium jeikeium is a multidrug-resistant gram-positive bacterium of the human skin flora and one of the most clinically important nondiphtherial corynebacteria in the acute care setting. C. jeikeium can cause different forms of infections, especially in immunocompromised patients with underlying risk factors and comorbidities. C. jeikeium was initially described in 1976 as a highly resistant coryneform bacteria causing severe sepsis in patients with hematologic malignancies and profound neutropenia...
June 22, 2020: Curēus
Ali Amanati, Mehrzad Lotfi, Mohammad Sadegh Masoudi, Hadis Jafarian, Fatemeh Ghasemi, Haleh Bozorgi, Parisa Badiee
BACKGROUND: Breakthrough invasive fungal infections (bIFIs) are an area of concern in the scarcity of new antifungals. The mixed form of bIFIs is a rare phenomenon but could be potentially a troublesome challenge when caused by azole-resistant strains or non-Aspergillus fumigatus. To raise awareness and emphasize diagnostic challenges, we present a case of mixed bIFIs in a child with acute lymphoblastic leukemia. CASE PRESENTATION: A newly diagnosed 18-month-old boy with acute lymphoblastic leukemia was complicated with prolonged severe neutropenia after induction chemotherapy...
July 23, 2020: BMC Infectious Diseases
Arun Garg, Shuvadeep Ganguly, Sreenivas Vishnubhatla, Anita Chopra, Sameer Bakhshi
BACKGROUND: Approximately 40% children with acute myeloid leukemia (AML) invariably relapse, after attaining the first complete remission (CR), with dismal long-term outcome. There is little consensus regarding choice of optimal induction chemotherapy regimen for relapsed pediatric AML. PROCEDURE: A prospective single arm phase II study (CTRI/2017/02/007757) was carried out at our center to evaluate the safety and efficacy of outpatient cytarabine, daunorubicin, and etoposide (ADE) regimen in pediatric AML (≤18 years) at the first relapse...
July 16, 2020: Pediatric Blood & Cancer
Sylvester Homsy, Ahmed Elfiky, Mohammad Abureesh, Danial Daneshvar, Alexander Bershadskiy
Neutropenic enterocolitis (NE) also known as typhlitis is a serious condition that has been described in immunosuppressed hosts including patients with leukemia, HIV and in patients on chemotherapy. We present the first case of female on sulfasalazine for psoriatic arthritis, otherwise healthy, who was diagnosed with NE involving the cecum and rectum. This adds up to the cases of NE diagnosed in nononcologic conditions. A 65-year-old female with a history of psoriatic arthritis on sulfasalazine, presented to the emergency department (ED) after an episode of syncope...
June 12, 2020: Curēus
Wen-I Lee, Jing-Long Huang, Syh-Jae Lin, Kuo-Wei Yeh, Li-Chen Chen, Liang-Shiou Ou, Tsung-Chieh Yao, Tang-Her Jaing, Ying-Fan Shih, Chao-Yi Wu
Deficiencies in T regulatory (Treg) and Th17 cells attenuate peripheral tolerance and the IL-17 family of cytokines, contributing to autoimmune disorders and opportunistic (fungal) infections, respectively. Because of limited blood samples from patients with primary immunodeficiency diseases (PIDs), a positive correlation/linear relationship between Treg and Th17 cells and their respective expressions of transcription factors forkhead box P3 (FOXP3) and retinoic acid-related orphan receptor γ (RORγt) by real-time PCR (RT-PCR) amplification, was used to predict the percentages of Treg and Th17 cells in peripheral blood...
2020: Frontiers in Immunology
Alifaiz Saiyed, Debapriya Datta
A 57-year-old woman with a history of mantle cell lymphoma presented to the ED with complaints of vomiting, bleeding per rectum, and leg cramps, that started 6 h prior to her arrival. She had received chemotherapy a week prior. Her leg cramps were not associated with pain or swelling of the legs; she also denied any trauma to the legs. She did complain of mild lower abdominal pain at presentation. Review of systems was negative for fever, chills, diarrhea, chest pain, and dizziness. She denied using alcohol or nonsteroidal anti-inflammatory drugs...
July 2020: Chest
Anas Alsharawneh, Joy Maddigan, Alice Gaudine, Holly Etchegary, Zhiwei Gao
INTRODUCTION: The emergency department (ED) is an important entry point for patients with cancer requiring acute care due to oncological emergencies. Febrile neutropenia (FN) is one of the most common oncological emergencies and carries a significant risk of morbidity and mortality. There is evidence from previous studies that FN patients wait far longer in the ED than recommended by international guidelines. PURPOSE: The aim was to examine whether individuals with cancer presenting at the ED with FN were triaged appropriately, and to explore if, and how, triage affected their treatment outcomes...
July 1, 2020: International Emergency Nursing
Jaspreet S Batra, Muhammad Junaid Niaz, Young E Whang, Arif Sheikh, Charlene Thomas, Paul Christos, Shankar Vallabhajosula, Yuliya S Jhanwar, Ana M Molina, David M Nanus, Joseph R Osborne, Neil H Bander, Scott T Tagawa
BACKGROUND: Docetaxel remains a standard of care for metatsatic castration resistant porstate cancer (mCRPC) and has radiosensitizing properties. The dose limiting toxicity (DLT) of radioimmunotherapy is myelosuppression; dose fractionation of 177 Lu-J591 allows similar administered doses with less toxicity. This study (NCT00916123) was designed to determine the safety, DLT, and maximum tolerated dose of fractionated 177 Lu-J591 administered concurrently with standard docetaxel. METHODS: Men with progressive mCRPC received docetaxel 75 mg/m2 every 3 weeks with escalating 2 fractionated doses of 177 Lu-J591 (1...
June 27, 2020: Urologic Oncology
Lindsey Rearigh, Erica Stohs, Alison Freifeld, Andrea Zimmer
Febrile neutropenia (FN) is a common serious complication in patients undergoing hematopoietic stem cell transplantation (HSCT) requiring urgent evaluation and initiation of empiric broad spectrum antibiotics (BSA). The appropriate duration of BSA for FN in patients with negative cultures and no identifiable infection remains undefined. We retrospectively analyzed allogenic and autologous HSCT patients with FN and negative infectious work-up at our facility from 2012 to 2018. The early de-escalation group (EDG) included those who had BSA de-escalation to fluoroquinolone prophylaxis at least 24 h prior to absolute neutrophil count (ANC) recovery after the patient was fever-free for at least 48 h...
June 17, 2020: Annals of Hematology
Siobhan Gee, Fiona Gaughran, James MacCabe, Sukhi Shergill, Eromona Whiskey, David Taylor
Clozapine is the only available treatment for refractory schizophrenia but its use involves frequent physical contact with healthcare workers for the purpose of mandatory blood monitoring. During the COVID-19 pandemic, patients taking clozapine will be self-isolating to reduce the risk of infection, not least because these patients are at high risk of serious illness and fatality because of high rates of diabetes, obesity and pulmonary disease and an increased risk of pneumonia. Problems may also arise because both clozapine-induced myocarditis and neutropenic sepsis share signs and symptoms with COVID-19 (fever, chest pain, dyspnoea, etc...
2020: Therapeutic Advances in Psychopharmacology
Akash Kumar, Bivas Biswas, Anita Chopra, Arti Kapil, Sreenivas Vishnubhatla, Sameer Bakhshi
OBJECTIVE: To determine if early discontinuation of antimicrobials in pediatric patients with low risk febrile neutropenia is as effective as continuing therapy before recovery of counts, in an outpatient setting. METHODS: In an open label, non-inferiority, randomized controlled phase 3 trial at a tertiary cancer center, patients aged 3-18 y, with low risk febrile neutropenia were started on empirical intra-venous antibiotics in an outpatient setting. Randomization was done when the patients became afebrile for at least 24 h; standard arm consisted of oral antibiotics, while antibiotics were stopped in the experimental arm...
June 15, 2020: Indian Journal of Pediatrics
Cinzia Rotondo, Addolorata Corrado, Natalia Mansueto, Daniela Cici, Fabrizio Corsi, Antonio Pennella, Francesco Paolo Cantatore
Pfeifer-Weber-Christian disease (PWCD) is a rare idiopathic disease characterized by lobular panniculitis of adipose tissue with systemic symptoms and multiple organ involvement. Even though the systemic involvement is rare, it is life-threatening and represent a treatment challenge for the clinicians. We report a case of PWCD characterized by hepatic, hematologic, and renal involvement, with good response to mofetil mycophenolate and prednisone treatment. A 47-year-old female presented several months' history of painful subcutaneous nodules, fever and lymphadenopathy with recent appearing of microcytic hypochromic anemia, leucopenia with neutropenia, and increase in transaminase...
2020: Clinical Medicine Insights. Case Reports
Max Scheler, Thomas Lehrnbecher, Andreas H Groll, Ruth Volland, Hans-Jürgen Laws, Roland A Ammann, Philipp Agyeman, Andishe Attarbaschi, Margaux Lux, Arne Simon
PURPOSE: Investigation of the current practice of diagnostics and treatment in pediatric cancer patients with febrile neutropenia. METHODS: On behalf of the German Society for Pediatric Oncology and Hematology and the German Society for Pediatric Infectious Diseases, an Internet-based survey was conducted in 2016 concerning the management of febrile neutropenia in pediatric oncology centers (POC). This survey accompanied the release of the corresponding German guideline to document current practice before its implementation in clinical practice...
June 10, 2020: Infection
Yizhen Liu, Kai Xue, Zuguang Xia, Jia Jin, Jiachen Wang, Hui Sun, Fangfang Lv, Xiaojian Liu, Junning Cao, Xiaonan Hong, Ye Guo, Xuejun Ma, Qunling Zhang
BACKGROUND: The optimal treatment strategies for extranodal natural killer/ T-cell lymphoma (ENKTL) have not been defined. We conducted this prospective, open-label, phase II, single-center study aimed to explore the efficacy and safety of radiotherapy followed by DICEP (Dexamethasone, ifosfamide, cisplatin, etoposide, and pegaspargase) regimen in the treatment of patients with untreated, stage IE/IIE, extranodal NK/T-cell lymphoma. METHODS: Thirty eligible patients were enrolled in this study, receiving radiotherapy of 50Gy/25fx, and followed by chemotherapy with DICEP regimen for 3 cycles if tolerated...
June 9, 2020: Cancer Medicine
Alicia White, Priya Mukherjee, Jane Stremming, Laura G Sherlock, Regina M Reynolds, Danielle Smith, Edwin J Asturias, Theresa R Grover, Robert M Dietz
IMPORTANCE: The novel coronavirus 2019 (SARS-CoV-2) has been well described in adults. Further, the impact on older children and during the perinatal time is becoming better studied. As community spread increases, it is important to recognize that neonates are vulnerable to community spread as well. The impact that community-acquired SARS-CoV-2 has in the neonatal time period is unclear, as this population has unique immunity considerations. OBJECTIVE: To report on a case series of SARS-CoV-2 in neonates through community acquisition in the USA...
June 4, 2020: Neonatology
Christa Koenig, Nicole Bodmer, Philipp K A Agyeman, Felix Niggli, Cécile Adam, Marc Ansari, Bernhard Eisenreich, Nanette Keller, Kurt Leibundgut, David Nadal, Jochen Roessler, Katrin Scheinemann, Arne Simon, Oliver Teuffel, Nicolas X von der Weid, Michael Zeller, Karin Zimmermann, Roland A Ammann
BACKGROUND: Fever in neutropenia is the most frequent complication of chemotherapy for cancer. The temperature limit defining fever used clinically varies. A higher limit can avoid unnecessary diagnoses in patients spontaneously recovering from fever. This trial primarily aimed to determine if a limit of 39·0°C ear temperature is non-inferior to 38·5°C regarding safety. METHODS: This cluster-randomised, multiple crossover, non-blinded, non-inferiority trial was done in six Swiss Paediatric Oncology Group centres (clusters) in Switzerland...
June 1, 2020: Lancet Child & Adolescent Health
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