Jagdish P Meena, Aditya K Gupta, Rachna Seth
In low-risk febrile neutropenia (FN) patients, outpatient management is now an accepted treatment, but there is a scarcity of data on high-risk patients. The aim of our study was to describe the outcome of FN treated primarily in an outpatient setting on the basis of the severity of illness at presentation, irrespective of the intensity of chemotherapy, and absolute neutrophil count. In this prospective study, not severely ill (NSI) patients were treated with empiric antibiotics at the daycare center (outpatient) and were admitted subsequently if there was persistent fever or any complication arose...
August 18, 2020: Journal of Pediatric Hematology/oncology
Ryoji Kobayashi, Satoru Matsushima, Daiki Hori, Hirozumi Sano, Daisuke Suzuki, Kenji Kishimoto, Kunihiko Kobayashi
BACKGROUND: Antibiotics have been widely and efficaciously used for febrile neutropenia in pediatric patients. However, reports are scant regarding the risk factors for recurrent fever after discontinuation of antibiotics in a neutropenic state. Here, we investigated these factors using data from our previously reported randomized study regarding meropenem and piperacillin/tazobactam for pediatric patients with febrile neutropenia. PROCEDURE: We analyzed a total of 170 febrile episodes where first line antibiotic treatment was effective and discontinued before neutrophil recovery...
August 6, 2020: Journal of Microbiology Immunology and Infection
Kerry A Rogers, Ying Huang, Amy S Ruppert, Lynne V Abruzzo, Barbara L Andersen, Farrukh T Awan, Seema A Bhat, Allison Dean, Margaret Lucas, Christin Banks, Cara Grantier, Nyla A Heerema, Gerard Lozanski, Kami J Maddocks, Thomas R Valentine, David M Weiss, Jeffrey A Jones, Jennifer A Woyach, John C Byrd
PURPOSE: The development of highly effective targeted agents for chronic lymphocytic leukemia offers the potential for fixed-duration combinations that achieve deep remissions without cytotoxic chemotherapy. PATIENTS AND METHODS: This phase II study tested a combination regimen of obinutuzumab, ibrutinib, and venetoclax for a total of 14 cycles in both patients with treatment-naïve (n = 25) and relapsed or refractory (n = 25) chronic lymphocytic leukemia to determine the response to therapy and safety...
August 14, 2020: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Jack E Heron, Mark Bloch, Vinay Vanguru, John Saunders, David M Gracey
BACKGROUND: The nucleotide reverse transcriptase inhibitor Tenofovir Alafenamide (TAF) is a novel pro-drug of tenofovir (TFV) and possesses a superior renal safety profile compared with tenofovir disoproxil fumerate (TDF). Due to unique pharmacokinetic characteristics, treatment with TAF is not associated with significant renal proximal tubular accumulation of TFV. TAF is associated with a lower risk of acute kidney injury, chronic kidney disease, proteinuria and renal proximal tubular dysfunction than treatment with TDF...
August 12, 2020: BMC Nephrology
Brandon Maser, Marie-Claude Pelland-Marcotte, Sarah Alexander, Lillian Sung, Sumit Gupta
BACKGROUND: Infections are common and are a major cause of morbidity and mortality during treatment of childhood leukemia. We evaluated the cost effectiveness of levofloxacin antibiotic prophylaxis, compared to no prophylaxis, in children receiving chemotherapy for acute myeloid leukemia (AML) or relapsed acute lymphoblastic leukemia (ALL). PROCEDURES: A cost-utility analysis was conducted from the perspective of the single-payer health care system using a lifetime horizon...
August 12, 2020: Pediatric Blood & Cancer
Ai Mogi, Hidenori Sasaki, Yuta Nakashima, Shotaro Chinen, Masanao Ishizu, Toshihiro Tanaka, Tohru Takata, Yasushi Takamatsu
The safety and feasibility of oral fluoroquinolone monotherapy in patients with low-risk febrile neutropenia (FN) were demonstrated in recent studies. Levofloxacin (LVFX) is a commonly prescribed antibiotic; however, evidence for its efficacy against FN is limited. Therefore, in this study, we retrospectively investigated the efficacy of LVFX against low-risk FN in patients with malignant lymphoma at our institution. Treatment success was defined as recovery from fever and neutropenia without alteration of the initial regimen...
August 8, 2020: Journal of Clinical and Experimental Hematopathology: JCEH
Victoria Zaccone, Mary Lockwood, Javier Ticona, Pedram Jouharian, Michelle Zamora, Christopher Hampton, Baho Sidiqi, Samir Kumar, Isabel M McFarlane
Neutropenia is a serious complication found in immunocompromised patients, particularly those with cancer and human immunodeficiency virus (HIV). The etiology of neutropenia is multifactorial and can be caused by the direct effects of HIV infection, cytotoxic antineoplastic therapy, and malignancy. The main complication of neutropenia is a bloodstream infection caused by gram-positive bacteria (GPB) and gram-negative bacteria (GNB). GPB, specifically S. epidermidis , tend to affect cancer patients more often than GNB...
2020: American Journal of Medical Case Reports
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
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