ABSTRACT
BACKGROUND: Hyperleukocytic acute myelogenous leukemia (H-AML) is a relatively rare disease found in adults and it should have different characteristics from those of non-hyperleukocytic acute myelogenous leukemia (non-H-AML). We analyzed adult patients with H-AML whose peripheral WBC count was over 100, 000/ L, and compared laboratory and clinical findings of H-AML with those of non-H-AML cases. METHODS: This study included 19 patients with H-AML who were diagnosed between July 1994 and February 2001 at Chonnam University Hospital. The laboratory data, including peripheral blood smear, bone marrow study, immunophenotyping and cytogenetic study, were reviewed and the clinical out-comes of the patients were assessed. The results were compared with those of 127 non-H-AML cases. RESULTS: Of all adult AML cases, 13.1% (19/146) were H-AML. In H-AML, the subtypes were in the order of M5 (36.8%), M4 (21.1%) and M2 (21.1%), while in non-H-AML were in the order of M2 (40.9%), M3 (28.3%) and M4 (11.0%), respectively. HLA-DR and CD14 were more frequent in H-AML than in non-H-AML (83.3% vs. 47.2%, P=0.005; and 23.5% vs. 56.4%, P=0.042; respectively). H-AML had a tendency for low complete remission and short overall survival. Disease-free survival of H-AML was significantly shorter than that for the non-H-AML (6.0 vs 22.1 months, P=0.006). CONCLUSIONS: It suggests that hyperleukocytosis could be a predictor of unfavorable clinical out-comes and survival in acute myelogenous leukemia.
Subject(s)
Adult , Humans , Bone Marrow , Cytogenetics , Disease-Free Survival , HLA-DR Antigens , Immunophenotyping , Leukemia, Myeloid, Acute , Rare DiseasesABSTRACT
BACKGROUND: Nosocomial candidemia has increased over the past 2 decades. The rank order of occurrence and antifungal resistance profiles of the various species of Candida causing candidemia is important in establishing empiric treatment protocols. METHODS: We investigated antifungal susceptibilities and distribution of Candida species recovered from blood cultures over an 8-year period in Chonnam National University Hospital. The results obtained from the period 1994 through 1997 (period 1) were compared with those from the period 1998 through 2001 (period 2). Minimal inhibitory concentrations (MICs) of amphotericin B, fluconazole and itraconazole for each isolate were determined by the NCCLS broth microdilution method. RESULTS: During an 8-year period, 805 strains of Candida species were isolated from 290 patients. In period 1, the Candida species recovered most frequently from candidemic patients was C.albicans(29.5%), followed by C. parapsilosis (25.9%) and C. tropicalis (18.8%). In period 2, C. parapsilosis (31.5%) was the most common species, followed by C. albicans (23.6%), and C.glabrata (14.0%). These data, compared to those of period 1, indicate a variation in species distribution, with the proportions of C. glabrata increasing by 10.0% (Por=64 microgram/mL) and itraconazole (>or=1 microgram/mL) was observed more frequently in period 2 (8.0% and 20.9%, respectively) than in period 1 (2.0% and 7.0%, respectively)(P<0.05). CONCLUSIONS: These data showed that MICs of amphotericin B, fluconazole and itraconazole for each species did not change during the 8-year span, but azole resistant Candida species such as C. glabrata, increased in the latter four years (period 2).
Subject(s)
Humans , Amphotericin B , Candida , Candidemia , Clinical Protocols , Danazol , Fluconazole , ItraconazoleABSTRACT
BACKGROUND: Nosocomial candidemia has increased over the past 2 decades. The rank order of occurrence and antifungal resistance profiles of the various species of Candida causing candidemia is important in establishing empiric treatment protocols. METHODS: We investigated antifungal susceptibilities and distribution of Candida species recovered from blood cultures over an 8-year period in Chonnam National University Hospital. The results obtained from the period 1994 through 1997 (period 1) were compared with those from the period 1998 through 2001 (period 2). Minimal inhibitory concentrations (MICs) of amphotericin B, fluconazole and itraconazole for each isolate were determined by the NCCLS broth microdilution method. RESULTS: During an 8-year period, 805 strains of Candida species were isolated from 290 patients. In period 1, the Candida species recovered most frequently from candidemic patients was C.albicans(29.5%), followed by C. parapsilosis (25.9%) and C. tropicalis (18.8%). In period 2, C. parapsilosis (31.5%) was the most common species, followed by C. albicans (23.6%), and C.glabrata (14.0%). These data, compared to those of period 1, indicate a variation in species distribution, with the proportions of C. glabrata increasing by 10.0% (Por=64 microgram/mL) and itraconazole (>or=1 microgram/mL) was observed more frequently in period 2 (8.0% and 20.9%, respectively) than in period 1 (2.0% and 7.0%, respectively)(P<0.05). CONCLUSIONS: These data showed that MICs of amphotericin B, fluconazole and itraconazole for each species did not change during the 8-year span, but azole resistant Candida species such as C. glabrata, increased in the latter four years (period 2).
Subject(s)
Humans , Amphotericin B , Candida , Candidemia , Clinical Protocols , Danazol , Fluconazole , ItraconazoleABSTRACT
BACKGROUND: Although the broth microdilution method has been recently established for antifungal susceptibility testing of the Candida species, there is still an argue in the interpretation of the trailing endpoint. We evaluated the spectrophotometric broth microdilution method (SBM) to determine the fluconazole MICs from five different Candida species. METHODS: A total of 252 clinical isolates of five Candida species (144 C. albicans, 42 C. tropicalis, 32 C. glabrata, 28 C. parapsilosis, and 6 C. krusei) were tested for fluconazole susceptibility with the broth microdilution method. The MICs were spectrophotometrically determined at 80% (Spec-80%) and 50% (Spec-50%) decrease in absorbance as compared with growth control, respectively. The results were compared with the fluconazole MICs tested by the National Committee for the Clinical Laboratory Standards (NCCLS) macrodilution method. RESULTS: When MICs were obtained by Spec-80%, the agreements of SBM and the NCCLS macro dilution method within two doubling dilutions were 92.4% (220/238) at 24 h and 78.6% (198/252) at 48 h for all Candida species. Using the Spec-50%, those were increased to 97.9% (233/238) at 24 h and 98.8% (249/252) at 48 h (P<0.01). Especially, for C. albicans and C. tropicalis, the agreement of the Spec-50% was significantly higher than those of the Spec-80% at 48 h; 97.9% vs. 75.0%, for C. albicans (P<0.01), and 100% vs. 57.1%, for C. tropicalis (P<0.01). CONCLUSIONS: These data suggest that the SBM using Spec-50% can provide a more precise and objective mean for fluconazole susceptibility testing, especially for C. albicans and C. tropicalis.