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1.
Medicina UPB ; 41(1): 38-50, mar. 2022. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1362691

ABSTRACT

Las urgencias oncológicas son complicaciones comunes de la evolución natural del tumor o de su manejo. Algunas pueden presentarse de manera sutil y ser pasadas por alto, lo que aumenta la morbimortalidad. El objetivo de esta revisión narrativa es recopilar información actualizada de las principales complicaciones oncológicas, para ello se realizó una revisión de artículos originales, revisiones sistemáticas y narrativas en bases de datos como Scopus, SciELO, PubMed, ScienceDirect y en el buscador Google Scholar. Se seleccionaron 63 referencias que mostraran información relevante acerca de las urgencias oncológicas planteadas para el desarrollo del artículo. En la revisión se discute que las complicaciones pueden clasificarse de acuerdo con su origen en infecciosas (neutropenia febril), metabólicas (síndrome de lisis tumoral e hipercalcemia maligna) y obstructivas (síndrome de vena cava superior, obstrucción intestinal, compresión medular y taponamiento cardiaco). El diagnóstico requiere un alto índice de sospecha, el médico debe tener la capacidad resolutiva y el conocimiento necesarios para el manejo y hacer uso racional de los recursos diagnósticos. Es necesario adoptar medidas terapéuticas que impacten positivamente en el pronóstico y que reduzcan la morbimortalidad.


Oncological emergencies are common complications resulting from the natural evolution of the tumor or its management; however, some of them may be subtle or even overlooked, which contributes to greater morbidity and mortality. Our aim was to gather updated information on the main oncological complications. A narrative literatura review was performed by searching for original articles, systematic reviews and narratives, in databases such as Scopus, SciELO, PubMed, ScienceDirect and in the Google Scholar search engine. 63 references were selected that addressed relevant information about the oncological emergencies raised for the development of the article. According to their origin, complications can be classified into infectious (febrile neutropenia), metabolic (tumor lysis syndrome and malignant hypercalcemia) and obstructive (superior vena cava syndrome, intestinal obstruction, spinal cord compression and cardiac tamponade). Facing these complications requires a high level of suspicion; the physician must be able to resolve each complication and have the necessary knowledge to approach each case, with a rational use of diagnostic resources. It is also necessary to adopt therapeutic measures that positively impact patients. patient prognosis, decreasing morbidity and death.


As urgências oncológicas são complicações comuns da evolução natural do tumor ou do seu manejo. Algumas podem apresentar-se de maneira sutil e ser passadaspor encima, o que aumenta a morbimortalidade. O objetivo desta revisão narrativa é recopilar informação atualizada das principais complicações oncológicas, para isso se realizou uma revisão de artigos originais, revisões sistemáticas e narrativas em bases de dados como Scopus, SciELO, PubMed, ScienceDirect e no buscador Google Scholar. Se selecionaram 63 referências que mostraram informação relevante sobre às urgências oncológicas apresentadas para o desenvolvimento do artigo. Na revisão se discuteque as complicações podem classificar-se de acordo com a sua origem em infecciosas (neutropenia febril), metabólicas (síndrome de lise tumoral e hipercalcemia maligna) e obstrutivas (síndrome de veia cava superior, obstrução intestinal, compressão medular e entupimento cardíaco). O diagnóstico requere um alto índice de suspeita, o médico deve ter a capacidade resolutiva e o conhecimento necessário para o manejo e fazer uso racional dos recursos diagnósticos. É necessário adotar medidas terapêuticas que impactem positivamente no prognóstico e que reduzam a morbimortalidade.


Subject(s)
Humans , Neoplasms , Spinal Cord Compression , Superior Vena Cava Syndrome , Cardiac Tamponade , Tumor Lysis Syndrome , Emergencies , Febrile Neutropenia , Hypercalcemia
2.
Hematol., Transfus. Cell Ther. (Impr.) ; 44(1): 32-39, Jan.-Mar. 2022. tab, ilus
Article in English | LILACS | ID: biblio-1364905

ABSTRACT

Abstract Introduction Invasive fungal diseases represent important causes of morbidity and mortality among pediatric oncohematological patients. Acute invasive fungal rhinosinusitis is a rare and aggressive disease that occurs mainly in immunocompromised patients. The mortality rate is high and therefore, accurate and early diagnosis is essential. Objectives The aim of this study was to describe the frequency of acute invasive fungal rhinosinusitis among pediatric oncohematological patients and characterize them with confirmed diagnoses. Methods This was a retrospective study that analyzed the medical records of pediatric patients diagnosed with oncohematological diseases and suspected fungal infections, who were included after obtaining informed consent, from January to December 2017, in the pediatric unit of a tertiary university hospital. Data collected from medical record analysis included the following: underlying diagnosis, absolute neutrophil count, clinical presentation, culture and biopsy results, surgical procedures performed, survival and mortality. Results A total of 27 patients were evaluated, with three suspected cases of acute invasive fungal rhinosinusitis. Histopathological and microbiological analyses confirmed two cases. In both cases, the pathogen isolated in the culture was Fusarium sp. The two confirmed cases were female, aged 12 and 14 years, both with an absolute neutrophil count of 10 cells/μL. The underlying disease of the first patient was acute myeloid leukemia (subtype M5), whereas the second patient presented idiopathic bone marrow aplasia. Conclusion Both confirmed cases of acute invasive fungal rhinosinusitis presented with constitutional symptoms and signs of nasal and sinusital inflammation. This demonstrates the importance of fever as a symptom in immunocompromised patients and it should prompt otorhinolaryngological investigation.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Fusariosis , Invasive Fungal Infections , Hematologic Diseases , Sinusitis , Febrile Neutropenia , Fusarium
5.
J. pediatr. (Rio J.) ; 97(3): 302-308, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1279324

ABSTRACT

Abstract Objective To evaluate the performance of risk stratification protocols for febrile neutropenia specific to the pediatric population. Methods Retrospective study of a cohort of pediatric patients undergoing cancer treatment with episodes of neutropenia due to chemotherapy and fever, treated at the emergency department of a tertiary cancer hospital from January 2015 to June 2017. Patients who were bone marrow transplant recipients and patients with neutropenia due to causes other than chemotherapy were excluded. Six protocols were applied to all patients: Rackoff, Alexander, Santolaya, Rondinelli, Ammann 2003, and Ammann 2010. The following outcomes were assessed: microbiological infection, death, ICU admission, and need for more than two antibiotics. The performance of each protocol was analyzed for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operator characteristic (ROC) curve. Results This study evaluated 199 episodes of febrile neutropenia in 118 patients. Microbiological infection was identified in 70 samples from 45 distinct episodes (22.6%), 30 patients used more than two antibiotics during treatment (15%), eight required ICU admission (4%), and one patient died (0.8%). Three protocols achieved high sensitivity indices and NPV regarding the outcomes of death and ICU admission: Alexander, Rackoff, and Ammann 2010; however, Rackoff showed higher sensitivity (0.82) and NPV (0.9) in relation to the microbiological infection outcome. Conclusion The Rackoff risk rating showed the best performance in relation to microbiological infection, death, and ICU admission, making it eligible for prospective evaluation.


Subject(s)
Humans , Child , Febrile Neutropenia , Neoplasms/complications , Neoplasms/drug therapy , Prospective Studies , Retrospective Studies , Risk Assessment , Anti-Bacterial Agents
6.
Oncol. (Guayaquil) ; 31(1): 75-85, Abril 30, 2021.
Article in Spanish | LILACS | ID: biblio-1222727

ABSTRACT

Introducción: La neutropenia febril es una complicación que predispone a infecciones bacterianas de etiología diversa y aumenta la mortalidad en los pacientes con leucemia. El objetivo general del presente trabajo determinó la frecuencia de la etiología bacteriana, en los objetivos específicos se cuantificó en porcentaje los tipos de bacterias encontradas, se identificó la susceptibilidad y la resistencia antimicrobiana, además de sus infecciones, se estableció los factores de alto riesgo de mal pronóstico más frecuentes. Métodos: En el presente descriptivo de tipo transversal se revisaron historias clínicas del servicio de oncología clínica del Instituto Oncológico Nacional "Dr. Juan Tanca Marengo" Solca_Guayquil. El período estudio fue del 1ro de enero del 2013 al 31 de diciembre del 2014. El cálculo muestral fue probabilístico de 60 casos. Se incluyeron pacientes con leucemia en curso de quimioterapia y que evolucionaron con leucopenia febril, adicionalmente se incluyeron los pacientes con focos infecciosos evidentes y cultivos positivos. Las variables fueron demográficas características clínicas de la leucemia, estudio bacteriológico, tratamiento antibiótico y comorbilidades. Se utiliza estadística descriptiva. Resultados: Ingresaron al estudio 58 pacientes, fueron 30/58 mujeres (51%). La mayoría con edades de 17 a 20 años 15/58 casos (25.9%). 35/58 casos (60%) correspondieron a leucemias linfobásticas y 23/58 casos (40%) a miloides. El foco infeccioso más frecuentemente fue gastrointestinal 18 %(n=27), la piel y tejidos blandos con un 17 %(n=26). Se realizaron 98 cultivos, con el 52% de culti-vos positivos, 25 % BLEE, 4% BLAC. La etiología fue E. Coli 26% aislada de sangre. La sensibilidad fue 100 % amikacina, 100 %, imipenem ,100 meropenem, 100 % tigeciclina, 90 % piperazilina tazobactam, 18 %, cefepime, 50% clindamicina y 50% oxacilina. El máximo tiempo de neutropenia fue 30 días, con una mediana de neutrófilos 230 u/ul, con un promedio de 3 días de fiebre. Los factores de riesgo fueron 17% desnutrición ,15% hepatopatías %, 6% hipertensión y diabetes. Conclusiones: La etiología bacteriana más frecuente fue E. Coli. Existe una sensibilidad antibiótica baja para los gram negativos en todas las cefalosporinas de primera hasta cuarta generación en los antibiogramas del estudio. Hay un perfil de baja resistencia a los antibióticos carbapenémicos junto a amikacina con piperacilina tazobactam. La vancomicina y el linezolid no tienen resistencia bacteriana la presentación etológica para gram positivos, el más prevalente fue el estafilococo aureus meticilino resistente tipo BLAC.


Introduction: Febrile neutropenia is a complication that predisposes to bacterial infections of diverse etiology and increases mortality in patients with leukemia. The general objective of this work determined the frequency of bacterial etiology, in the specific objectives the types of bacteria found were quantified in percentage, susceptibility and antimicrobial resistance were identified, in addition to their infections, factors were established high risk of poor prognosis more frequent. Methods: In this descriptive cross-sectional type, clinical records of the clinical oncology service of the National Oncological Institute "Dr. Juan Tanca Marengo "Solca_Guayquil. The study period was from January 1, 2013 to December 31, 2014. The sample calculation was probabilistic of 60 cases. Patients with leukemia undergoing chemotherapy and who evolved with febrile leukopenia were included, additionally patients with obvious infectious foci and positive cultures were included. The variables were demographic, clinical characteristics of the leukemia, bacteriological study, antibiotic treatment, and comorbidities. Descriptive statistics are used. Results: 58 patients entered the study, 30/58 were women (51%). The majority aged 17 to 20 years 15/58 cases (25.9%). 35/58 cases (60%) corresponded to lymphoblastic leukemias and 23/58 cases (40%) to myloids. The most frequent infectious focus was gastrointestinal 18% (n = 27), skin and soft tissues with 17% (n = 26). 98 cultures were performed, with 52% positive cultures, 25% ESBL, 4% BLAC. The etiology was E. Coli 26% isolated from blood. The sensitivity was 100% amika-cin, 100%, imipenem, 100 meropenem, 100% tigecycline, 90% tazobactam piperazilin, 18%, ce-fepime, 50% clindamycin, and 50% oxacillin. The maximum time of neutropenia was 30 days, with a neutrophil average of 230 u / ul, with an average of 3 days of fever. The risk factors were 17% malnutrition, 15% liver disease, 6% hypertension and diabetes. Conclusions: The most frequent bacterial etiology was E. Coli. There is a low antibiotic sensitivity for gram negatives in all first through fourth generation cephalosporins in the study antibiograms. There is a profile of low resistance to carbapenemic antibiotics together with amikacin with piperacillin tazobactam. Vancomycin and linezolid do not have bacterial resistance in the ethological presentation for gram positives, the most prevalent was methicillin-resistant staphylococcus aureus BLAC type.


Subject(s)
Leukemia , Chemotherapy-Induced Febrile Neutropenia , Blood Culture , Febrile Neutropenia , Neutropenia
7.
Rev. epidemiol. controle infecç ; 11(1): 46-53, jan.-mar. 2021. ilus
Article in English, Portuguese | LILACS | ID: biblio-1362317

ABSTRACT

Background and Objectives: cancer cases are gradually increasing, and most treatments still cause several adverse reactions, such as myelosuppression. When neutrophils decline, febrile neutropenia (FN) can be triggered, considered an oncological emergency, leaving patients susceptible to infections. Therefore, it is necessary to determine the best treatment, seeking to reduce the risk of complications. The purpose of this review is to identify, in literature, randomized clinical studies that compare different treatments for FN in pediatric onco-hematological patients. Content: a systematic search was carried out on the PubMed database, for randomized clinical studies, from 2009 to 2019, in English, using "Febrile Neutropenia", "Pediatric", and "Therapeutics" as descriptors. A total of 233 articles were found, seven of which were selected for review. The most described antimicrobial for FN treatment was Piperacillin/Tazobactam (PIP/TAZ) and its use is justified by its spectrum of action to cover the most frequent microorganisms in patients with FN. The possibility of using oral antimicrobials may be an alternative and should be analyzed. The description of the risk classification criteria is essential to guide the therapy, and new tools, such as the stewardship, add safety to patient care. Conclusion: the most used antimicrobial to treat FN was PIP/TAZ, and the establishment of standardized risk classification scores in pediatric onco-hematological patients is essential to guide clinical management in FN treatment.(AU)


Justificativa e objetivos: os casos de câncer estão aumentando gradativamente, e a maioria dos tratamentos ainda causa várias reações adversas, como a mielossupressão. Com o declínio dos neutrófilos, pode-se desencadear a neutropenia febril (NF), considerada uma emergência oncológica, deixando o paciente suscetível a infecções. Portanto, é necessário determinar o melhor tratamento, visando reduzir o risco de complicações. O objetivo desta revisão é identificar, na literatura, estudos clínicos randomizados que comparem diferentes tratamentos para NF em pacientes onco-hematológicos pediátricos. Conteúdo: foi realizada busca sistemática na base de dados PubMed, de estudos clínicos randomizados, no período de 2009 a 2019, na língua inglesa, utilizando como descritores "Febrile Neutropenia", "Pediatric" e "Therapeutics". Foram encontrados 233 artigos, dos quais sete foram selecionados para revisão. O antimicrobiano mais descrito para o tratamento com FN foi Piperacilina / Tazobactam (PIP / TAZ) e seu uso justifica-se por seu espectro de ação para cobrir os microrganismos mais frequentes em pacientes com FN. A possibilidade de uso de antimicrobianos orais pode ser uma alternativa e deve ser analisada. A descrição dos critérios de classificação de risco é essencial para orientar a terapia, e novas ferramentas, como o stewardship, agregam segurança ao atendimento ao paciente. Conclusão: o antimicrobiano mais utilizado para tratar FN foi o PIP / TAZ, e o estabelecimento de escores de classificação de risco padronizados em pacientes onco-hematológicos pediátricos é essencial para orientar o manejo clínico no tratamento de FN.(AU)


Antecedentes y objetivos: los casos de cáncer están aumentando gradualmente y la mayoría de los tratamientos aún causan varias reacciones adversas, como la mielosupresión. Cuando los neutrófilos disminuyen, se puede desencadenar la neutropenia febril (FN), considerada una emergencia oncológica, dejando a los pacientes susceptibles a infecciones. Por tanto, es necesario determinar el mejor tratamiento, buscando reducir el riesgo de complicaciones. El propósito de esta revisión es identificar, en la literatura, estudios clínicos aleatorizados que comparen diferentes tratamientos para la FN en pacientes pediátricos oncohematológicos. Contenido: se realizó una búsqueda sistemática en la base de datos PubMed, de estudios clínicos aleatorizados, de 2009 a 2019, en inglés, utilizando como descriptores "Febrile Neutropenia", "Pediatric" y "Therapeutics". Se encontraron un total de 233 artículos, siete de los cuales fueron seleccionados para revisión. El antimicrobiano más descrito para el tratamiento de FN fue Piperacilina / Tazobactam (PIP / TAZ) y su uso se justifica por su espectro de acción para cubrir los microorganismos más frecuentes en pacientes con FN. La posibilidad de utilizar antimicrobianos orales puede ser una alternativa y debe analizarse. La descripción de los criterios de clasificación de riesgo es fundamental para orientar la terapia, y nuevas herramientas, como la rectoría, añaden seguridad a la atención al paciente. Conclusión: el antimicrobiano más utilizado para tratar la FN fue la PIP / TAZ, y el establecimiento de puntuaciones estandarizadas de clasificación de riesgo en pacientes pediátricos oncohematológicos es fundamental para orientar el manejo clínico en el tratamiento de la FN.(AU)


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Pediatrics , Febrile Neutropenia , Chemotherapy-Induced Febrile Neutropenia , Medical Oncology , Neutrophils/drug effects , Anti-Infective Agents
8.
Rev. cuba. hematol. inmunol. hemoter ; 36(4): e1285, oct.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1289413

ABSTRACT

Introducción: La neutropenia febril incide frecuentemente en pacientes con hemopatías malignas y representa una urgencia médica; actualmente su manejo terapéutico constituye un verdadero reto debido a la aparición de infecciones por microorganismos multirresistentes y la coexistencia de factores dependientes del paciente y del tratamiento, lo cual contribuye a situaciones de riesgo para el desarrollo de complicaciones graves. Métodos: Se realizó una revisión exhaustiva del tema en las principales bases de datos de la Biblioteca Virtual de Salud, se utilizó como referencia artículos actualizados publicados principalmente en los últimos 5 años. Análisis y síntesis de la información: Se abordó fundamentalmente el enfoque diagnóstico y terapéutico en los pacientes de alto riesgo de complicaciones por infecciones bacterianas, así como su evaluación integral. Se incluyen herramientas recientes de pesquisa de sepsis y daño orgánico relacionado con ella, que constituyen elementos predictivos de mortalidad en estos pacientes. Conclusiones: El abordaje integral de la neutropenia febril incluye además de una evaluación clínica y humoral exquisita, la aplicación de herramientas pronósticas para la estratificación de riesgo de cada paciente. El tratamiento de los pacientes debe comenzar en la primera hora de haberse documentado la fiebre, ya que las infecciones pueden ser rápidamente progresivas con un alto riesgo de desarrollo de sepsis, inestabilidad hemodinámica y disfunción multiorgánica(AU)


Introduction: Febrile neutropenia frequently affects patients with hematological malignancies and constitutes a medical emergency. Its therapeutic management is a real challenge at present, due to the appearance of infections caused by multiresistant microorganisms and the coexistence of patient- and treatment-dependent factors leading to risk for serious complications. Methods: An exhaustive review was conducted about the topic in the main databases of the Virtual Health Library, for which papers mainly published in the last five years were used as reference. Data analysis and synthesis: A diagnostic and therapeutic approach was applied to the study of patients at high risk for complications due to bacterial infections and their comprehensive evaluation. Recent tools to screen sepsis and sepsis-related organ damage are included which constitute mortality prediction elements in these patients. Conclusions: Comprehensive management of febrile neutropenia includes not only a detailed clinical and humoral evaluation, but also the application of prognostic tools for risk stratification in each patient. Patient treatment should be started within the first hour after fever documentation, since infections may be rapidly progressive with a high risk for the development of sepsis, hemodynamic instability and multiple organ dysfunction(AU)


Subject(s)
Humans , Febrile Neutropenia/diagnosis , Neutropenia/drug therapy , Hematologic Diseases/diagnosis
9.
Rev. chil. infectol ; 37(4): 383-388, ago. 2020. tab
Article in Spanish | LILACS | ID: biblio-1138562

ABSTRACT

Resumen Introducción: Streptococcus grupo viridans (SGV) ha adquirido relevancia como microorganismo causante de neutropenia febril, asociándose a morbilidad significativa. Objetivo: Caracterizar episodios de bacteriemia causados por SGV en niños con cáncer que desarrollaron neutropenia febril de alto riesgo (NFAR) desde abril de 2004 a junio de 2018 en seis hospitales pediátricos de Santiago, Chile. Pacientes y Métodos: Análisis retrospectivo de bases de datos de cuatro proyectos FONDECYT sucesivos, prospectivos y multicéntricos, registrando características clínicas y de laboratorio de los pacientes, además de patrón de resistencia antimicrobiana de las cepas aisladas. Resultados: Se registraron 95 episodios de bacteriemia asociada a SGV en 91 niños con NFAR. Destacan: leucemia mieloide aguda como enfermedad de base, neutropenia profunda, hospitalización prolongada (15 días), uso extendido de antimicrobianos (14 días), uso de citarabina en esquemas de quimioterapia (86% episodios). Las manifestaciones clínicas más frecuentes fueron respiratoria y gastrointestinal, asociándose en 26% a síndrome de shock por Streptococcus grupo viridans. Hubo elevada resistencia a β lactámicos, sin cepas no susceptibles a vancomicina. Discusión: SGV es un patógeno relevante en niños con cáncer, fiebre y neutropenia en nuestro medio, asociado a casos de sepsis. La resistencia a β lactámicos es un aspecto que requiere vigilancia epidemiológica estricta en esta población.


Abstract Background: Viridans group streptococci (VGS) has acquired relevance as a microorganism causing febrile neutropenia, associated with significant morbidity. Aim: To characterize episodes of bacteremia caused by VGS in children with cancer who developed high-risk febrile neutropenia (HRFN) during the period from April 2004 to June 2018 in six pediatric hospitals of Santiago, Chile. Method: Database analysis of 4 successive, prospective and multicentric studies recording clinical and laboratory characteristics of patients, as well as antimicrobial susceptibility pattern of isolated strains. Results: 95 episodes of VGS bacteremia in 91 children with HRFN were analyzed. It emphasizes acute myeloid leukemia as cancer type, deep neutropenia, prolonged hospitalization (15 days), with extended use of antimicrobials (14 days) and use of cytarabine in chemotherapy schemes (86% episodes). The most frequent clinical manifestations were respiratory and gastrointestinal, associating up to 26% viridans group shock syndrome. There was high resistance to β lactams. As expected, there were not non-susceptible strains to vancomycin. Discussion: VGS is a relevant microorganism in children with cancer, fever and neutropenia, with a high percentage of sepsis. Resistance to β lactams is an issue that requires strict epidemiological surveillance in this population.


Subject(s)
Humans , Child , Streptococcal Infections/drug therapy , Bacteremia/drug therapy , Febrile Neutropenia/drug therapy , Neoplasms/complications , Neoplasms/drug therapy , Chile/epidemiology , Prospective Studies , Anti-Bacterial Agents/therapeutic use
10.
Rev. Asoc. Med. Bahía Blanca ; 30(1): 9-19, 20 de junio de 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1099862

ABSTRACT

Introducción: La neutropenia febril es una urgencia infectológica con agentes etiológicos diversos. La causa más frecuente es la postquimioterapia, con una incidencia del 80%en inmunocomprometidos. Requiere el uso de antimicrobianos de amplio espectro, que originan mayores gastos en el sistema de salud. Objetivos: identificar los agentes microbiológicos en pacientes con neutropenia febril internados en el Hospital de la Asociación Médica de Bahía Blanca "Dr.Felipe Glasman" (HAMBB), en el periodo enero-diciembre de 2017; evaluar la sensibilidad y resistencia antimicrobiana; determinar el porcentaje de rédito de los cultivos. Materiales y Métodos: Estudio retrospectivo, descriptivo. Se obtuvieron datos de historias clínicas y de registros informatizados de los pacientes hospitalizados por neutropenia febril. Resultados: Se analizaron 52 episodios de 49 de pacientes. Las patologías de base fueron: tumores sólidos (54%); oncohematológicos (36%); enfermedades no neoplásicas (8%). El episodio febril fue postquimioterapia (48 %): por infección (35%); otras causas (17%). El 31% de los episodios postquimioterapia ocurrieron postratamiento (7-15 días). Los cultivos fueron negativos en el 69%. Se identificaron E.coli (15%); S.aureus (8%), P.aeruginosa (4%); 2% enterobacter (2%); E.faecalis ( 2%). Sensibilidad antibiótica: E.coli sensible a aminoglucósidos y fluoroquinolonas en el 87,5%, con resistencia de 50% para betalactámicos; a betalactámicos+IBL, cefalosporinas de 1° generación y cotrimoxazol (37,5%). S.aureus, E.faecalis, Enterobacter y P. aeruginosa fueron 100% sensibles a los antibióticos testeados. Conclusiones: El mayor porcentaje: bacterias Gram (-); principal agente causal: E. coli; principal agente Gram (+): S. aureus. La mayoría fueron pacientes con tumores sólidos. El 50 % de los episodios fue posterior postquimioterapia. El mayor rédito se obtuvo en hemocultivos. La mayor parte de los gérmenes fueron sensibles a la terapéutica empírica utilizada en nuestro hospital. (AU)


Introduction: Febrile neutropenia is an infectious emergency with diverse etiological agents. The most frequent cause is post-chemotherapy, with an incidence of 80% in immunocompromised patients. It requires the use of broadspectrum antimicrobials, which lead to higher expenses in the health system. Objectives: To identify the microbiological agents in patients with febrile neutropenia admitted to Bahía Blanca Medical Association "Dr. Felipe Glasman " Hospital (HAMBB) in the January-December 2017 period; to evaluate antimicrobial susceptibility and resistance; to determine the percentage of positive cultures. Materials and Methods: Retrospective, descriptive study. Data from medical records and computerized records of patients hospitalized for febrile neutropenia were obtained. Results: 52 episodes from 49 patients were analyzed. Underlying pathologies were: solid tumors (54%); oncohaematological (36%); non-neoplastic diseases (8%). The febrile episode was postchemotherapy (48%); due to infection (35%); other causes (17%). Thirty one per cent (31%) of post-chemotherapy episodes occurred after treatment (7-15 days). Cultures were negative in 69% of the cases. We could identify E.coli (15%); S.aureus (8%), P. aeruginosa (4%); 2% enterobacter (2%); E.faecalis (2%). Antibiotic susceptibility: E.coli sensitive to aminoglycosides and fluoroquinolones in 87.5%, with 50% resistance to betalactams; to beta-lactamases + IBL, 1st generation cephalosporins and cotrimoxazole (37.5%). S.aureus, E.faecalis, Enterobacter and P. aeruginosa were 100% susceptible to the antibiotics tested. Conclusions: The highest percentage: Gram bacteria (-); main causal agent: E. coli; Main agent Gram (+): S. aureus. The majority were patients with solid tumors. 50% of the episodes were post-chemotherapy. The occurrence was obtained in blood cultures. Most germs were susceptible to the empirical therapy used in our hospital. (AU)


Subject(s)
Humans , Febrile Neutropenia/drug therapy , Drug Therapy , Drug-Related Side Effects and Adverse Reactions/complications
11.
Infectio ; 23(4): 347-351, Dec. 2019. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1019864

ABSTRACT

Resumen Objetivo: Describir las características clínicas, demográficas, frecuencia, tipo de aislamientos microbiológicos y resistencia a los antimicrobianos de pacientes con neoplasias hematológicas que presentaron como complicación neutropenia febril en el Hospital Universitario de San Ignacio Métodos: Estudio descriptivo observacional, se tomaron datos de historias clínicas de los pacientes adultos hospitalizados en la Unidad de Hematología y Trasplante de Médula Ósea, que cumplieron criterios de neutropenia febril entre enero de 2013 y diciembre de 2014 Resultados: se recolectaron 345 episodios de neutropenia febril, correspondientes a 193 pacientes. Se documentó foco infeccioso en el 68,1% de los episodios, con aislamiento microbiológico en el 62.9% de los episodios, con predominio de bacilos gram negativos, en 63,7% de los casos, seguido por los cocos gram positivos en 27,9% y hongos en 4,9%. En cuanto a los mecanismos de resistencia, en los aislamientos Escherichia coli y Klebsiella peumoniae se encontró producción de Beta Lactamasas de Espectro Extendido (BLEEs) en 17,5 y 13,8%; Carbapenemasas tipo KPC en 1,25 y 2,8% respectivamente. En cuanto a Staphylococcus aureus, se encontró resistencia a meticilina en 6,8% de los aislamientos. Mortalidad asociada a infección en 16,5% de los casos. Conclusión: En pacientes con Neoplasias Hematológicas con neutropenia febril post quimioterapia en el Hospital Universitario de San Ignacio encontramos alta probabilidad de documentación de foco infeccioso, con predominio de microorganismos gram negativos, especialmente enterobacterias; con comportamiento similar en pacientes post trasplante de precursores hematopoyéticos.


Abstract Objective: To describe the demographic and clinical characteristics, as well as frequency and type of bacterial isolate and resistance patterns in patients with hematological neoplasms complicated by febrile neutropenia at San Ignacio University Hospital Methods: This is a retrospective observational study. Data were collected from medical records of adult patients admitted in the Hemato-oncology and Bone Marrow Transplant Unit. Inclusion criteria was presence of febrile neutropenia in the setting of a hematological neoplasm from January 2013 to December 2014. Results: 345 episodes of febrile neutropenia from 193 patients were studied. An infectious focus was identified in 68.1% of episodes, and a bacterial isolate was obtained in 62.9% of episodes. The predominant microorganisms were gram-negative rods, gram-positive cocci, and fungi with a frequency of 63.7%, 27.9%, and 4.9% respectively. In term of resistance patterns, Escherichia coli and Klebsiella peumoniae isolates had a frequency of ESBL susceptibility pattern of 17.5% and 13.8% respectively; and a frequency of KPC susceptibility pattern of 1.25% and 2.8% respectively. The frequency of methicillin resistant Staphylococcus aureus was 6.8%. Death associated to infection ocurred in 16.5% of episodes. Conclusions: In patients with hematological neoplasms complicated by febrile neutropenia at San Ignacio University Hospital, we found a high rate of documentation of infectious focus, with a predominance of gram-negative rods, specially Enterobacteriacea; with a similar pattern in receptors of hematopoietic stem cell transplantation.


Subject(s)
Humans , Male , Female , Adult , Bone Marrow Transplantation , Febrile Neutropenia , Neoplasms , Staphylococcus , Drug Resistance, Microbial , Epidemiology, Descriptive , Sepsis , Drug Resistance, Neoplasm , Drug Therapy
12.
Med. U.P.B ; 38(2): 108-113, 17 de octubre de 2019. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1023402

ABSTRACT

Objetivo: la neutropenia febril es una urgencia médica que se presenta frecuentemente en pacientes con inmunosupresión asociada a tratamientos oncológicos, que aumenta el riesgo de complicaciones infecciosas y de morir. El objetivo de esta investigación es describir las características clínicas, microbiológicas y pronósticas de los pacientes con neutropenia febril en un hospital universitario. Metodología: estudio observacional descriptivo, entre enero de 2012 y junio de 2016, en pacientes con diagnóstico de neutropenia febril (neutrófilos menores de 500 cel/mm, temperatura mayor de 38 °C) hospitalizados en el Hospital Pablo Tobón Uribe de Medellín, Colombia. Resultados: se evaluaron 226 pacientes con neutropenia febril, de los que el 96% tenía enfermedad oncológica de base. Las principales fuentes de infección fueron la piel y el tracto gastrointestinal. Del total de los hemocultivos, el 31% fue positivo. El principal aislamiento fue Escherichia coli (E. coli) y la mortalidad hospitalaria fue del 17%. Conclusiones: las características clínicas de la población fueron similares a las de la literatura internacional. Se encontraron algunas discrepancias en cuanto a epidemiología de los microorganismos aislados, resistencia microbiana y mortalidad. Solo un tercio de los pacientes presentó bacteriemia, E. coli sigue siendo el principal patógeno.


Objective: Febrile neutropenia is a condition present in patients with some degree of immunosuppression associated to oncology treatment, which leads to risks of infectious complications and death. The aim of this research is to describe the clinical, microbiological and prognostic characteristics in patients with febrile neutropenia in a university hospital. Methodology: Retrospective cohort study developed between January of 2012 and June of 2016 in patients with febrile neutropenia (neutrophils <500 cell/mm, temperature >38.3 °C), who were hospitalized in the Pablo Tobon Uribe Hospital of Medellin, Colombia. Results: 226 patients were evaluated, 96% of who had an oncological diagnostic. The main infectious sources were the skin and the gastrointestinal tract. Blood cultures were positive in 31%. The main pathogen was Escherichia coli in 26% and the overall hospital mortality rate was 17%. Conclusions: The clinical characteristics of our population were similar to the national and international reports, but we found epidemiological differences in microbiological agents, bacterial resistance and mortality. Only one third of the patients presented bacteremia. E. coli remains the main pathogen involved.


Objetivo: a neutropenia febril é uma urgência médica que se apresenta frequentemente em pacientes com imunossupressão associada a tratamentos oncológicos, que aumenta o risco de complicações infecciosas e de morte. O objetivo desta investigação é descrever as características clínicas, microbiológicas e prognósticas dos pacientes com neutropenia febril em um hospital universitário. Metodologia: estudo observacional descritivo, entre janeiro de 2012 e junho de 2016, em pacientes com diagnóstico de neutropenia febril (neutrófilos menores de 500 cel/mm, temperatura maior de 38 °C) hospitalizados no Hospital Pablo Tobón Uribe de Medellín, Colômbia. Resultados: se avaliaram 226 pacientes com neutropenia febril, dos quais, 96% tinha doença oncológica de base. As principais fontes de infecção foram a pele e o trato gastrointestinal. Do total das hemoculturas, 31% foi positivo. O principal isolamento foi Escherichia coli (E. coli) e a mortalidade hospitalar foi de 17%. Conclusões: as características clínicas da população foram similares às da literatura internacional. Se encontraram algumas discrepâncias em quanto a epidemiologia dos microrganismos isolados, resistência microbiana e mortalidade. Só um terço dos pacientes apresentou bacteriemia, E. coli segue sendo o principal patógeno.


Subject(s)
Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Febrile Neutropenia , Patient Isolation , Bacteria , Immunosuppression , Medical Oncology , Anti-Bacterial Agents
13.
Actual. SIDA. infectol ; 27(100): 31-38, 20190000. tab
Article in Spanish | LILACS | ID: biblio-1354035

ABSTRACT

Introducción: El tratamiento antimicrobiano para los pacientes neutropénicos febriles (NF) se ha convertido en un desafío debido a la emergencia de microorganismos multirresistentes (MOR). El objetivo de este trabajo es analizar las características de estos pacientes y la incidencia de MOR. Materiales y métodos: Estudio retrospectivo, observacional y descriptivo desde junio de 2015 hasta agosto de 2017 en adultos neutropénicos febriles hospitalizados en un hospital público de la ciudad de Buenos Aires. Se analizaron características demográficas, clínicas y microbiológicas, incluyendo los siguientes MOR: enterobacterias productoras de carbapenemasas (EPC) y beta-lactamasas de espectro extendido (BLEE), Acinetobacter baumannii complex, Enterococcus vancomicina resistente (EVR) y Stenotrophomonas maltophilia. Resultados: Fueron incluidos 32 pacientes, 56% mujeres con 84% de neoplasias hematológicas. Hubo colonización por EPC o EVR en el 59% de los pacientes. Se registraron 148 episodios infecciosos con 41% de documentación microbiológica. Los MOR fueron responsables del 25% de los episodios, siendo los más frecuentes Klebsiella pneumoniae productora de carbapenemasa y BLEE; los focos más frecuentes fueron bacteriemias e infecciones urinarias. Los pacientes con leucemias agudas (67%) presentaron colonización por EPC o EVR en el 80%. El tratamiento fue inadecuado en el 63% de las infecciones RESUMENARTÍCULO ORIGINALpor MOR y en el 12% por microorganismos sensibles (MS) (p<0,01). La mortalidad global fue 53% con MOR y del 27% con MS (p=ns). Conclusión: las infecciones por MOR fueron frecuentes con predominio de bacteriemias, especialmente EPC y BLEE. Por ello los MOR deben ser tenidos en cuenta para el tratamiento empírico en pacientes neutropénicos febriles


Background: Antimicrobial treatment for febrile neutropenic (FN) patients has become a challenge due to the growing emergence of multidrug-resistant microorganisms (MDR-MO). The objective of this study was to analyze the characteristics of these population and the incidence of MDR-MO. Methods & Materials: Retrospective, observational and descriptive study from June 2015 to August 2017 in FN adults hospitalized at a public hospital in Buenos Aires city, Argentina. Demographic, clinical and microbiological characteristics were analyzed. We included the following MDR-MO: extended spectrum beta-lactamase (ESBL) and carbapenemase-producing Enterobacteriaceae (CPE), Acinetobacter baumannii complex, vancomycin resistant Enterococcus (VRE) and Stenotrophomonas maltophilia. Results: Thirty-two patients were included; 56% were women, with 84% haematological diseases. Colonization by CPE or VRE was observed in a 59% of the patients. There were 148 infectious episodes. Of them 41% had microbiological documentation. MDR-MO were responsible for 25% of the episodes and the most frequent were carbapenemase-producing Klebsiella pneumoniae and ESBL producing Enterobacteriaceae. MDR-MO were isolated mainly from bacteremia and urinary infections, patients had acute leukemia in a 67% and colonization CPKP or VRE in 80%. Inadequate treatment for MDR-MO was observed in 63% of the cases and 12% for susceptible microorganisms (p<0,01). The mortality was 53% for MDR-MO and 27% for susceptible microorganisms (p=ns). Conclusion: MDR-MO infections were frequent with predominance of bacteremia especially CPE and ESBL producing Enterobacteriaceae. According to these results MDR-MO should be taken into account for the empiric antimicrobial treatment in febrile neutropenic patients


Subject(s)
Humans , Adult , Middle Aged , Aged , Drug Resistance, Microbial , Epidemiology, Descriptive , Retrospective Studies , Enterobacteriaceae Infections/therapy , Febrile Neutropenia/therapy , Carbapenem-Resistant Enterobacteriaceae , Hospitalization , Neoplasms
14.
Rev. chil. infectol ; 36(2): 167-178, abr. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1003665

ABSTRACT

Resumen Este documento incluye los recursos terapéuticos antiinfecciosos necesarios para pacientes inmunocomprometidos por terapia de cáncer o receptores de trasplante de precursores hematopoyéticos (TPH). Se aborda la terapia indicada para pacientes con las situaciones clínicas prevalentes en esta población y la terapia indicada para algunos microorganismos específicos. Según presentación clínica, se aborda el manejo de pacientes con: neutropenia febril sin foco, sepsis, infecciones del sistema nervioso central, neumonía, infecciones de piel y tejidos blandos, enterocolitis neutropénica e infección del tracto urinario. Se describe el arsenal terapéutico necesario, las dosis recomendadas y las precauciones especiales para el uso de antibacterianos, antivirales, antifúngicos y antiparasitarios en esta población, incluida la medición de concentraciones plasmáticas de ciertos fármacos en situaciones específicas.


This manuscript includes the antiinfective therapeutic resources for immunocompromised patients under chemotherapy by cancer or hematopoietic stem cells transplant (HSCT) receptors. The document presents the antimicrobial therapy indicated in the most prevalent clinical situations in this population and the primary and alternative therapy for some specific microorganisms. The clinical situations included in the analysis are: febrile neutropenia without focus, sepsis, infections of the central nervous system, pneumonia, skin and soft tissue infections, neutropenic enterocolitis and urinary tract infection. The therapeutic resources, recommended doses and special precautions for the use of antimicrobial recommended in bacterial, viral, fungal and parasitic infections in this population are described, including the measurement of plasma concentrations of certain drugs in specific situations.


Subject(s)
Humans , Hematopoietic Stem Cell Transplantation/adverse effects , Febrile Neutropenia/drug therapy , Infections/drug therapy , Anti-Infective Agents/administration & dosage , Neoplasms/complications , Neoplasms/therapy , Risk Factors , Treatment Outcome , Immunocompromised Host/drug effects , Practice Guidelines as Topic , Dose-Response Relationship, Drug , Immunocompetence/drug effects
16.
Article in English | WPRIM | ID: wpr-719585

ABSTRACT

We implemented a carbapenem-saving strategy in hemato-oncology patients from 2013, using an empirical combination of piperacillin-tazobactam and amikacin for high-risk hemato-oncology patients with febrile neutropenia, who remain hemodynamically unstable > 72 hours despite initial cefepime treatment. All-cause mortality was not different between the two periods (6.54 and 6.57 deaths per 1,000 person-day, P = 0.926). Group 2 carbapenem use significantly decreased after strategy implementation (78.43 vs. 67.43 monthly days of therapy, P = 0.018), while carbapenem-resistant gram-negative bacilli did not show meaningful changes during the study period. Our carbapenem-saving strategy could effectively suppress carbapenem use without an increase of overall mortality.


Subject(s)
Amikacin , Febrile Neutropenia , Humans , Mortality
17.
Article in English | WPRIM | ID: wpr-763115

ABSTRACT

PURPOSE: Dose-dense chemotherapy (DD-CT) is a preferred (neo)adjuvant regimen in early breast cancer (BC). Although the results of reported randomized trials are conflicting, a recent meta-analysis showed improved overall and disease-free survival with DD-CT compared to conventional schedules. However, no DD-CT safety data for Korean BC patients are available. This phase II study was conducted to evaluate the safety and efficacy of pegteograstim in Korean BC patients receiving DD-CT. MATERIALS AND METHODS: Patients with operable (stage I-III), histologically confirmed BC received four cycles of intravenous doxorubicin (60 mg/m2) and cyclophosphamide (600 mg/m2) on day 1 every 2 weeks as neoadjuvant or adjuvant therapy. Pegteograstim (6.0 mg) was administered subcutaneously on day 2 of each cycle. The primary endpoint was the incidence of febrile neutropenia (FN). The secondary endpoints were safety and tolerability. RESULTS: Of 63 patients, one (1.6%) developed FN during all cycles of DD-CT. Dose delay was observed in four patients (6.3%) and dose reduction in two (3.2%) during DD-CT. Frequent adverse events (AEs) were nausea, alopecia, generalized muscle weakness, myalgia, mucositis, anorexia, dyspepsia, and diarrhea; most AEs were related to chemotherapy. Grade 3-4 AEs were reported in five of 63 patients (7.9%), and all grade 3 and 4 AEs were related to chemotherapy. Adverse drug reactions possibly linked to pegteograstim were abdominal pain, bone pain, myalgia, generalized muscle weakness, and headache in five of 63 patients (7.9%). CONCLUSION: Dose-dense AC (doxorubicin/cyclophosphamide) chemotherapywith pegteograstim support is a tolerable and safe regimen in Korean early BC patients.


Subject(s)
Abdominal Pain , Alopecia , Anorexia , Appointments and Schedules , Breast Neoplasms , Breast , Cyclophosphamide , Diarrhea , Disease-Free Survival , Doxorubicin , Drug Therapy , Drug-Related Side Effects and Adverse Reactions , Dyspepsia , Febrile Neutropenia , Headache , Humans , Incidence , Mucositis , Muscle Weakness , Myalgia , Nausea
18.
Oncol. (Guayaquil) ; 28(2): 128-137, Ago. 30, 2018.
Article in Spanish | LILACS | ID: biblio-1000146

ABSTRACT

Introducción: La mortalidad relacionada a la neutropenia febril puede ser muy alta en ciertas poblaciones de alto riesgo. El objetivo del presente estudio fue identificar factores predictores tempranos de mortalidad en una cohorte de pacientes oncológicos con neutropenia febril admitidos en una unidad de cuidados intensivos (UCI). Métodos: Estudio observacional retrospectivo en pacientes con neutropenia febril mayores de 18 años ingresados en la UCI del Hospital Oncológico Solón Espinosa Ayala de Quito. Se recogieron variables sociodemográficas, clínicas, de laboratorio y microbiológicas de los registros clínicos al ingreso. Con dichas variables se construyeron modelos predictivos de mortalidad mediante análisis de regresión logística para identificar predictores de muerte. Resultados: Se registraron 107 pacientes con episodios de neutropenia febril, el 53.3 % de los casos presentaron neutropenia severa y en un 29.9 % de los casos la neutropenia duró más de 10 días. La prevalencia de bacteriemia fue del 34.6 %. El 34.6 % de los pacientes murieron (n=37), de estos el 22.4 % falleció en la UCI. Edad superior de 40 años, valores de procalcitonina superiores a 4 ng/ml, puntuaciones altas en APACHE II y la necesidad de apoyo ventilatorio se asociaron con mayor riesgo de muerte en el modelo multivariado; el valor predictivo en la validación interna tuvo una precisión de 81.3 %; sensibilidad de 63.6 %; especificidad de 90.5 %; valor predictivo positivo de 77.8 %; valor predictivo negativo de 82.6 %; área bajo la curva de 0.87. Conclusión: Factores como la edad mayor de 40 años, procalcitonina > 4 ug/ml al ingreso, valores de APACHE II y necesidad de ventilación mecánica están asociados con mayor riesgo de muerte.


Introduction: The mortality related to febrile neutropenia may be very high in certain populations. The aim of the present study was to identify early predictors of mortality in a cohort of oncologic patients with febrile neutropenia admitted to an intensive care unit (ICU). Methods: Retrospective observational study in patients with febrile neutropenia older than 18 years admitted to the intensive care unit of the "Solon Espinosa Ayala" Oncology Hospital in Quito. Sociodemographic, clinical, laboratory and microbiological variables were collected from clinical records at admission. With these variables, predictive mortality models were constructed usingclogistic regression analysis to identify predictors of death. Results: There were 107 episodes of febrile neutropenia, 53.3 % had severe neutropenia, and in 29.9 % of the cases neutropenia lasted more than 10 days. The prevalence of bacteremia was 34.6 %. 34.6 % of the patients died (n = 37), of which 22.4 % died in the ICU. A higher age of 40 years, procalcitonin values higher than 4 ng / ml, high APACHE II scores and the need for ventilatory support were associated with an increased risk of death in the multivariate model; The predictive value in the internal validation had an accuracy of 81.3 %; Sensitivity of 63.6 %; Specificity of 90.5 %; Positive predictive value of 77.8 %; Negative predictive value of 82.6 %; Area under the curve of 0.87. Conclusion: Factors such as age greater than 40 years, procalcitonin at admission > 4 ug/ml, APACHE II and requirement of mechanical ventilation support are associated with a higher risk of death.


Subject(s)
Humans , Acute-Phase Proteins , Sepsis , Febrile Neutropenia , Critical Care , Death , Neoplasms
19.
Actual. SIDA. infectol ; 26(97 Suplemento 1): 2-25, 20180000. tab, graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1355025

ABSTRACT

La leucemia aguda ha sido reconocida como una enfermedad compleja y rápidamente fatal desde su primera descripción hace 150 años. Librada a su historia natural, la leucemia mieloide aguda lleva a la muerte en pocos meses. Las infecciones son la principal causa de muerte, siendo la bacteriemia y la neumonía las más frecuentes.Los avances ocurridos en los últimos 50 años, como el advenimiento de quimioterapias efectivas, la mejor comprensión de la patogénesis de las complicaciones infecciosas en el paciente neutropénico, la disponibilidad de agentes anti infecciosos de amplio espectro y la mejoría en los cuidados de soporte contribuyeron a mejorar esta situación. En relación a otras enfermedades oncohematológicas, la leucemia mieloide aguda registra la mayor incidencia de eventos febriles, siendo el período de mayor riesgo el de la inducción a la remisión.La fiebre de origen desconocido, la multirresistencia bacteriana y las infecciones fúngicas invasivas constituyen un desafío para el equipo de trabajo.El uso de profilaxis antibacteriana y antifúngica no reemplaza a las medidas de prevención de carácter institucional


Acute leukemias have been recognized as complex and radiply fatal diseases since its first description 150 years ago. Delivered to its natural history, acute myeloid leukemia leads to death in a few months. Infections are the main cause of death, being bacteremia and pneumonia the most frequent. Advances in the last 50 years, such as the advent of effective chemotherapy, a best understanding of the pathogenesis of infectious complications in the neutropenic patient, the availability of broad-spectrum anti-infective agents and better supportive care helped improve this situation. Among other oncological diseases, acute myeloid leukemia has the highest incidence of febrile events, being induction to remission the period of greatest risk. Fever of unknown origin, bacterial multidrug resistance and invasive fungal infections are a challenge for the medical team. The use of antibacterial and antifungal prophylaxis does not replace institutional preventive measures


Subject(s)
Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications , Leukemia, Myeloid, Acute/diagnosis , Leukemia, Myeloid, Acute/mortality , Leukemia, Myeloid, Acute/therapy , Antibiotic Prophylaxis , Drug Therapy , Febrile Neutropenia/therapy
20.
Rev. bras. ginecol. obstet ; 40(6): 372-376, June 2018. tab
Article in English | LILACS | ID: biblio-959001

ABSTRACT

Abstract Parvovirus B19 has tropism for red line blood cells, causing immune hydrops during pregnancy. A positive anti-Kell Coombs reaction usually happens during pregnancy when there is production of antibodies that target Kell antigens, but cross reactions to other antigens may occur. A 24-year-old Gypsy primigravida, 0 Rhesus positive, presented with persistent isolated hyperthermia for 2 weeks and a positive indirect Coombs test result with anti-Kell antibodies at routine tests. She had a 19-week live fetus. The blood tests revealed bicytopenia with iron deficiency anemia, leucopoenia with neutropenia, and elevated C-reactive protein. She was medicated with imipenem, and had a slow clinical recovery. Blood, urine and sputum samples were taken to perform cultures and to exclude other systemic infections. Escherichia coli was isolated in the urine, which most probably caused a transient cross anti-Kell reaction. Haemophilus influenza in the sputum and seroconversion to parvovirus B19 was confirmed, causing unusual deficits in the white cells, culminating in febrile neutropenia. Despite the patient's lack of compliance to the medical care, both maternal and fetal/neonatal outcomes were good. This a rare case report of 2 rare phenomena, a cross anti-Kell reaction to E. coli and parvovirus B19 infection with tropism for white cells causing febrile neutropenia, both events occurring simultaneously during pregnancy.


Resumo O parvovírus B19 tem tropismo para as células sanguíneas da linha vermelha, causando hidropsia imune durante a gravidez. O teste Coombs anti-Kell positivo ocorre durante a gravidez quando há produção de anticorpos contra os antígenos de Kell, mas pode haver reações cruzadas para outros antígenos. Uma grávida primigesta de etnia cigana, de 24 anos, 0 Rhesus positivo, recorreu ao hospital às 19 semanas de gestação por hipertermia isolada persistente por 2 semanas e umteste Coombs indireto positivo por anticorpos anti-Kell em testes de rotina da gravidez. O estudo analítico revelou bicitopenia com anemia ferropênica, leucopenia com neutropenia, e elevação da proteína C-reativa. A paciente foi medicada com imipenem, e teve uma recuperação clínica lenta. Foram colhidas amostras de sangue, urina e expectoração para culturas bacterianas. Na urina, foi isolada Escherichia coli, o que provavelmente causou a reação anti-Kell cruzada transitória. Na expectoração, foi isolada Haemophilus influenza, e foi confirmada seroconversão para o parvovírus B19, que causou um déficit incomum na linhagem sanguínea branca, culminando com neutropenia febril. Apesar da má adesão aos cuidados médicos, os desfechos materno e fetal/neonatal foram bons. Este é um caso de 2 fenômenos raros, uma reação cruzada anti-Kell à infecção por E. coli, e parvovírus B19 comtropismo para células brancas causando neutropenia febril, ambos ocorrendo simultaneamente durante a gravidez.


Subject(s)
Humans , Female , Pregnancy , Young Adult , Pregnancy Complications, Infectious/immunology , Parvovirus B19, Human , Erythema Infectiosum/complications , Erythema Infectiosum/immunology , Escherichia coli/immunology , Febrile Neutropenia/immunology , Febrile Neutropenia/virology , Kell Blood-Group System/immunology , Cross Reactions
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