ABSTRACT
Recently, we experienced a case of disseminated fusarial blood stream infection with varicelloid skin eruptions, who had suffered from persistent neutropenic fever after salvage chemotherapy for relapsed acute lymphocytic leukemia (ALL). Neutropenia continued in spite of G-CSF and granulocyte transfusion, and he failed to respond to conventional amphotericin B initially, and then liposomal amphotericin B and voriconazole combination therapy. Disseminated fusariosis can be diagnosed by blood cultures in 50% of patients and present skin lesions in more than 80% of patients. So, typical skin lesions are important clue to diagnose of the disseminated fusariosis. However, many skin lesions in immunocompromised hosts are due to various infectious and non-infectious causes. So, this case shows that it is important to obtain biopsy specimens of skin lesions for histopathologic examination, culture and staining. Here, we present our case with the review of the literatures reported in our country, so far.
Subject(s)
Humans , Amphotericin B , Biopsy , Chickenpox , Drug Therapy , Fever , Fusariosis , Fusarium , Granulocyte Colony-Stimulating Factor , Granulocytes , Immunocompromised Host , Leukemia , Neutropenia , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Rivers , SkinABSTRACT
Recently, we experienced a case of disseminated fusarial blood stream infection with varicelloid skin eruptions, who had suffered from persistent neutropenic fever after salvage chemotherapy for relapsed acute lymphocytic leukemia (ALL). Neutropenia continued in spite of G-CSF and granulocyte transfusion, and he failed to respond to conventional amphotericin B initially, and then liposomal amphotericin B and voriconazole combination therapy. Disseminated fusariosis can be diagnosed by blood cultures in 50% of patients and present skin lesions in more than 80% of patients. So, typical skin lesions are important clue to diagnose of the disseminated fusariosis. However, many skin lesions in immunocompromised hosts are due to various infectious and non-infectious causes. So, this case shows that it is important to obtain biopsy specimens of skin lesions for histopathologic examination, culture and staining. Here, we present our case with the review of the literatures reported in our country, so far.
Subject(s)
Humans , Amphotericin B , Biopsy , Chickenpox , Drug Therapy , Fever , Fusariosis , Fusarium , Granulocyte Colony-Stimulating Factor , Granulocytes , Immunocompromised Host , Leukemia , Neutropenia , Precursor Cell Lymphoblastic Leukemia-Lymphoma , Rivers , SkinABSTRACT
BACKGROUND: Enterococcal infections have become extremely difficult to manage because of an increase in antibiotic resistance among enterococci. In Europe, the use of avoparcin in animals was reported to be the cause of vancomycin-resistant enterococci (VRE) transmission to humans. In this study, we performed antimicrobial susceptibility testing and pulsed-field gel electrophoresis (PFGE) to characterize the genetic relatedness of VRE of human and chicken. METHODS: Ninety strains of VRE were isolated from clinical specimens in three University hospitals located in Seoul and Kyungi province in 2001-2002. Thirty isolates of VRE were collected from four chicken farms located in areas remotely distanced from each other. The isolates were identified to the species level by conventional biochemical tests and commercial kits. Antimicrobial susceptibilities were tested by the NCCLS disk diffusion and agar dilution methods. For a molecular epidemiologic analysis, PFGE was performed. RESULTS: Among the 90 clinical isolates were 73 vancomycin-resistant Enterococcus faecium (VREFM) and 17 vancomycin-resistant E. faecalis (VREFA). The resistant rates of VREFA to ampicillin, levofloxacin and tetracycline were 0%, 100%, and 100%, respectively, and for VREFM, 100%, 96%, and 26%, respectively. However, the resistant rates of VREFM isolated from chicken were 19% to ampicillin, 0% to levofloxacin, and 100% to tetracycline. The PFGE patterns of genomic DNA of the clinical isolates were very diverse, suggesting a polyclonal spread of VRE, although some isolates had an identical PFGE pattern, indicating a mini-outbreak due to a clonal spread. The PFGE patterns of genomic DNA of the chicken isolates were very different from those of the human isolates. CONCLUSIONS: VRE isolates from human and chicken showed very different antimicrobial susceptibilities and PFGE patterns. These results suggest that VRE isolated from human and chicken are not closely related genetically.
Subject(s)
Animals , Humans , Agar , Ampicillin , Chickens , Diffusion , DNA , Drug Resistance, Microbial , Electrophoresis, Gel, Pulsed-Field , Enterococcus faecium , Enterococcus , Epidemiology , Europe , Hospitals, University , Levofloxacin , Seoul , Tetracycline , VancomycinABSTRACT
As a result of the enlarging pool of unvaccinated children and young adults, there has been an increase in measles in our countries. In these situation, it has been reported that measles associated pneumoinia is easily complicated with fatal respiratory failure, especially in immunocompromised patients. Herein we report the case of lethal measles pneumonia after allogenic hematopoietic stem cell transplantation in adults proven by autopsy. Recently, one case of measles was encountered in a 39-year-old female patients after allogenic bone marrow transplanted case (chronic myelogenous leukemia), who progressed into interstitial pneumonia pattern, despite treatment including antibiotics, immunoglobulin. The patient died of giant cell pneumonia compatible with that of measles which was comfirmed in the section of necropsy lung specimen.
Subject(s)
Adult , Child , Female , Humans , Young Adult , Anti-Bacterial Agents , Autopsy , Bone Marrow , Bone Marrow Transplantation , Giant Cells , Hematopoietic Stem Cell Transplantation , Hematopoietic Stem Cells , Immunocompromised Host , Immunoglobulins , Lung , Lung Diseases, Interstitial , Measles , Pneumonia , Respiratory InsufficiencyABSTRACT
BACKGROUND: Loss of bone mass is usually detected after BMT. The causes of bone loss are related with gonadal dysfunction and immunosuppressants. Cytokines, especially IL-6, play an important role in the pathogenesis of postmenopausal osteoporosis. However, the pathogenetic role of cytokines in post-BMT bone loss is unknown and data on the changes of cytokines in accordance with bone turnover markers are scarce. The aim of this study is to assess the relationship of bone turnover markers and cytokines of peripheral blood and bone marrow before and after allogeneic BMT. METHODS: This prospective study included two analyses. The first was a study of 46 BMT recipients, examining the relationship between bone turnover markers and cytokines of serum which were measured before and 1, 2, 3, 4 week and 3 months after BMT. The second was a study of 14 BMT patients, measuring bone marrow plasma cytokines such as IL-6 and TNF-alpha at post-BMT 3 week and bone turnover marker at the same time to assess the relationship between two parameters. RESULTS: Serum ICTP, bone resorption marker, increased progressively until 4 weeks (peak) after BMT and then decreased thereafter. Serum osteocalcin, bone formation marker, decreased progressively until 3 weeks after BMT and then increased thereafter. There was positive correlation between serum ICTP and bone marrow IL-6 levels at the post-BMT 3 week with a statistical significance, but the correlation between bone turnover markers and bone marrow TNF-alpha or peripheral blood cytokines was not found. CONCLUSION: Our data suggest that the progressive increase of bone resorption after BMT is related with the increase of bone marrow IL-6, which is a potent stimulator of bone resorption in vivo.
Subject(s)
Female , Humans , Bone Marrow Transplantation , Bone Marrow , Bone Resorption , Cytokines , Gonads , Immunosuppressive Agents , Interleukin-6 , Osteocalcin , Osteogenesis , Osteoporosis , Osteoporosis, Postmenopausal , Plasma , Prospective Studies , Tumor Necrosis Factor-alphaABSTRACT
BACKGROUND: Loss of bone mass is usually detected after bone marrow transplantation (BMT), especially during the early post-transplant period. But little is known about the long-term effects of BMT on bone mineral metabolism. METHODS: We have investigated prospectively 12 patients undergoing BMT (4 autologous, 8 allogeneic) for hematologic diseases (8 leukemia, 3 SAA, 1 MDS). Serum concentrations of calcium, phosphorus, creatinine, gonadotropins, sex hormones and bone turnover markers (osteocalcin and ICTP) were measured. The samples were collected before BMT and 1, 2, 3, 4, and 12 weeks, 6 months and 1, 2 years thereafter. Bone mineral density (BMD) was measured with DEXA (Dual Energy X-ray Absorptiometry) before BMT, 1 year and 2 year after BMT. In patients with amenorrbea, hormone replacement therapy was started from around 1 year after BMT RESULTS: 1. The mean bone loss in the lumbar spine, calculated as the percent change from the baseline to the level at 1 year and 2 year was 7.3% and 1.9%, respectively. The mean bone loss in the total proximal femur from the baseline to the level at 1 year and 2 year was 8.0% and 8.3% respectively. 2. The serum ICTP increased progressively until four weeks after BMT. Thereafter, it decreased gradually to reach basal values after one year and thereafter no more change until 2 year. Serum osteocalcin decreased progressively until three weeks after BMT. After that, it increased and reached basal values after 3 months. Osteocalcin increased at 6 month transiently but thereafter, it decreased to the level of slightly above basal value at 2 year. 3. Patients who were treated with TBI or pateints with GVHD had a tendency of lower BMD at l year and 2 year after BMT than those of patients without TBI or GVHD. 4. Eight out of nine women went into a menopausal state immediately after BMT and remained amenorrhea, evidenced by high gonadotropins and low estradiol levels. In contrast to women, gonadotropins and testosterone levels were not changed significantly in men after BMT. CONCLUSION: The rapid impairment of bone formation and the increase in bone resorption, as shown by the biochemical markers in this study, might play a role in bone loss after BMT. The efficacy of HRT for the correction of hypogonadism and bone loss was evidenced by 2 year BMD which was much more increased compared to 1 year BMD, especially in vertebra.
Subject(s)
Female , Humans , Male , Amenorrhea , Biomarkers , Bone Density , Bone Marrow Transplantation , Bone Marrow , Bone Resorption , Calcium , Creatinine , Estradiol , Femur , Gonadal Steroid Hormones , Gonadotropins , Hematologic Diseases , Hormone Replacement Therapy , Hypogonadism , Leukemia , Metabolism , Osteocalcin , Osteogenesis , Phosphorus , Prospective Studies , Spine , TestosteroneABSTRACT
BACKGROUND: Alteration of thyroid hormone parameters are frequently observed in sick patients and commonly known as nonthyroidal illness syndrome(NTIS) or euthyroid sick syndrome(ESS). NTIS is seen in starvation, surgery, severe illness, and also bone marrow transplantation(BMT). The degree of reduction in thyroid hormone parameters correlated with the severity of NTIS and might predict the prognosis of underlying illness. Recently, particular attention is focused on the role of cytokines in developing the NTIS. This prospective study was designed to assess the relationship of serum thyroid hormone parameters and serum cytokine levels before and in the short-term follow-up after allogeneic BMT in order to predict patients outcome. METHODS: Included 80 patients that were mainly leukemia and severe aplastic anemia. Serum thyroid hormone parameters and serum cytokine levels were measured before and 7, 14, 21, 28 days and 3, and 6 months after BMT. RESULTS: Near-all patients experienced significant decrease of thyroid hormone levels and also significant increase of cytokine levels after BMT. After post-BMT 3 weeks, the serum cytokine levels were negatively correlated with the serum T3 and T4 levels, but not with the serum TSH levels. The patients treated with high-dose steroid or total-body irradiation tended to show lower levels of TSH and more delayed recovery compared to non-treated patients. The patients died after BMT represented generally lower levels of all thyroid hormone parameters than survival patients during entire follow-up period. CONCLUSION: Development of NTIS is associated with higher probability of fatal outcome after BMT and has prognostic relationship in this group of patients. Increased levels of cytokines, especially IL-6 and TNF-alpha, are often found in post-BMT NTIS patients and correlated with the changes in the levels of thyroid hormone parameters.
Subject(s)
Humans , Anemia, Aplastic , Bone Marrow Transplantation , Bone Marrow , Cytokines , Euthyroid Sick Syndromes , Fatal Outcome , Follow-Up Studies , Interleukin-6 , Leukemia , Prognosis , Prospective Studies , Starvation , Thyroid Gland , Tumor Necrosis Factor-alphaABSTRACT
Tuberculous splenic abscess is extremely rare in non- immunocompromised host. Although it has been increased since 1991, particularly in the HIV positive patients, it remains rare in the healthy patients. Only three cases have been reported in Korea. We report two cases of tuberculous splenic abscess presented as FUO in the previously healthy. One was improved by medical therapy and the other by splenectomy. It is important to include tuberculous splenic abscess in differential diagnosis of FUO, especially in case of splenic abscess that do not respond to empirical antibiotic therapy.
Subject(s)
Humans , Abscess , Diagnosis, Differential , HIV , Immunocompromised Host , Korea , Splenectomy , TuberculosisABSTRACT
No abstract available.