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1.
Med. infant ; 27(2): 192-199, Diciembre 2020.
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1151212

ABSTRACT

Entre los años 2000 y 2016 en Argentina, se reportaron al Registro Oncopediátrico Hospitalario Argentino (ROHA) 22.450 casos de cáncer en niños menores de 15 años de edad. Las Leucemias constituyen la enfermedad oncológica más frecuente, seguida de los Tumores de Sistema Nervioso Central y los Linfomas. Esta distribución es similar a la descripta en los países desarrollados de Europa y Norteamérica. Su tasa de curación a nivel mundial, llega al 80% debido al uso de quimioterapia intensiva, situación que mejora la supervivencia pero que también aumenta la frecuencia de complicaciones. Estas complicaciones pueden ser debidas tanto al propio cáncer como al tratamiento y en ocasiones ser la primera manifestación de la enfermedad oncológica. Los eventos que amenazan la vida en pacientes inmunocomprometidos son mayores que en la población general, y cuando ocurren tienen una mortalidad elevada. El reconocimiento temprano es clave para el resultado en términos de sobrevida y disminución de la mortalidad. Las acciones deberán centrarse al reconocimiento temprano de eventos críticos en pacientes oncológicos. Los pacientes Hemato-Oncológicos constituyen un gran número de ingresos no planificados a las unidades de cuidados intensivos. Uno de cada 4 pacientes requerirá durante su evolución ingreso a Unidades de Cuidados Intensivos. El propósito de este artículo es describir tres de las urgencias oncológicas que requieren con mayor frecuencia admisión en UCI: la presentación y manejo del shock séptico, Shock Cardiogénico y las complicaciones neurológicas en los pacientes con leucemias agudas (AU)


Between 2000 and 2016, 22,450 cases of cancer in children younger than 15 years of age were reported to the Argentine Hospital Registry of Childhood Cancer (ROHA). Leukemia was the most common cancer reported, followed by central nervous system tumors and lymphoma. This distribution is similar to that described in the developed countries of Europe and North America. The worldwide cure rate is up to 80% due to the use of intensive chemotherapy, which improves survival but also increases the complication rate. These complications may be due both to the cancer itself and to the treatment and are sometimes the first manifestation of the disease. Life-threatening events are more common in immunocompromised patients than in the general population, and when they occur, the mortality rate is high. Early recognition is essential for the outcome in terms of survival and decreased mortality. Interventions should focus on early recognition of critical events in cancer patients. Patients with hematology-oncology diseases account for a large number of unplanned admissions to intensive care units (ICU), while one in four of these patients will require admission to the ICU in the course of their disease. The aim of this study was to describe three oncology emergencies that most frequently require ICU admission: septic shock and its management, cardiogenic shock, and neurological complications in patients with acute leukemia (AU)


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Shock, Septic/etiology , Shock, Septic/therapy , Intensive Care Units, Pediatric , Leukemia, Myeloid, Acute/complications , Central Nervous System Diseases/etiology , Central Nervous System Diseases/therapy , Hematologic Neoplasms/complications , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Survival Rate , Critical Illness/therapy
2.
Rev. cuba. reumatol ; 22(2): e719, mayo.-ago. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126813

ABSTRACT

La policondritis recurrente o recidivante es una enfermedad sistémica crónica autoinmune, caracterizada por la inflamación de tejidos cartilaginosos asociada en pocos casos a enfermedades malignas hematológicas. Presentamos el caso de una paciente femenina de 26 años que cursaba concomitantemente con leucemia mieloide aguda (LMA). La manifestación inicial fue una afección cutánea en forma de eritema nodoso, y posteriormente se diagnosticó LMA; durante la fase de aplasia posquimioterapia desarrolló inflamación bilateral del cartílago auricular (condritis auricular) y síndrome vertiginoso con evolución clínica satisfactoria al tratamiento inmunosupresor con glucocorticoides. Conclusiones: Es difícil definir si existe asociación entre la policondritis recidivante y la leucemia mieloide aguda, la quimioterapia o la sumatoria de las dos noxas. Una vez que se establece el diagnóstico se debe iniciar oportunamente la administración de glucocorticoide a altas dosis, ya que pudieran aparecer complicaciones como la necrosis del cartílago y la pérdida de la región afectada. En contraste, el uso de los glucocorticoides tiene una excelente respuesta con modulación completa de la enfermedad, tal como se muestra en el caso presentado(AU)


Relapsing polychondritis is a systemic, chronic and autoimmune disease characterized by the inflammation of cartilaginous tissues. This disease is associated in a few cases with malignant hematological diseases. We present a case of a patient with relapsing polychondritis and concomitantly with acute myeloid leukemia. A 26-year-old female patient, with cutaneous affection as initial manifestation categorized as erythema nodosum. Then she was diagnosed with acute myeloid leukemia. In the aplasia post-chemotherapy phase, the patient developed bilateral inflammation of the ear cartilage (auricular chondritis) and a vertiginous syndrome with satisfactory clinical evolution to immunosuppressive treatment with glucocorticoids. Conclusion: Relapsing polychondritis usually presents with cartilaginous involvement, such as bilateral atrial chondritis, as shown in the case. Early diagnosis and timely treatment are necessary to achieve a good clinical response. Subsequent studies are necessary to evaluate the association between relapsing polychondritis and hematological alterations such as acute myeloid leukemia and the use of chemotherapy(AU)


Subject(s)
Humans , Female , Adult , Polychondritis, Relapsing/complications , Autoimmune Diseases , Leukemia, Myeloid, Acute/complications , Clinical Evolution , Erythema Nodosum/diagnosis , Glucocorticoids/therapeutic use , Early Diagnosis , Ear Cartilage/abnormalities
3.
Rev. chil. obstet. ginecol. (En línea) ; 85(2): 155-161, abr. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1115511

ABSTRACT

OBJETIVO: Remarcar la importancia de hacer un adecuado diagnóstico diferencial de la anemia y trombocitopenia en la gestante, ya que en ocasiones enmascaran cuadros tan graves como la leucemia. Presentar un caso de leucemia mieloide aguda con una preeclampsia sobreañadida y describir el proceso diagnóstico y terapéutico llevado a cabo. CASO CLÍNICO: Secundigesta, 25 años, gestante de 37 semanas, con antecedentes de preeclampsia, derivada desde atención primaria por alteración analítica y malestar general. A su llegada a urgencias el cuadro clínico es compatible con un Síndrome de HELLP. Tras el estudio del mismo se llega a la certeza de que se trata de una preeclampsia asociada a una leucemia mieloide aguda que ha simulado los parámetros analíticos de un Síndrome de HELLP. CONCLUSIONES: Es importante el adecuado estudio etiológico de la anemia y trombocitopenia en la gestación. La leucemia exige al clínico un abordaje precoz y multidisciplinar tanto diagnóstico como terapéutico.


OBJECTIVE: To emphasize on the importance of performing a precise differential diagnosis of anaemia and thrombocytopenia during pregnancy, as they can be due to important diseases as leukemia. A case of acute myeloid leukemia associated with preeclampsia is reported, describing the complexity of the diagnostic and therapeutic process. CLINICAL CASE: 25-year-old woman, gravida 2, para 1 (preeclampsia), at 36 weeks of gestation was referred to the emergency department by her primary care physician due to severe disturbance on the blood tests and general discomfort. Initially, a HELLP syndrome was suspected. However, after going in depth in the case, the final diagnosis was preeclampsia associated to acute myeloid leukemia, simulating blood parameters in HELLP syndrome. CONCLUSIONS: It is essential to study deeply and carry out a complete differential diagnosis process of anaemia and thrombocytopenia during pregnancy. Leukemia requires an early multidisciplinary management both for diagnosis and treatment.


Subject(s)
Humans , Female , Adult , Pre-Eclampsia/diagnosis , Pregnancy Complications, Neoplastic , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/diagnosis , Thrombocytopenia/etiology , HELLP Syndrome/diagnosis , Diagnosis, Differential , Anemia/etiology
4.
Med. infant ; 27(1): 3-9, Marzo de 2020. Tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1118423

ABSTRACT

Las infecciones bacterianas son una de las principales causas de morbimortalidad en los niños con cáncer. Nuestro objetivo fue describir y comparar las características clínicas y los microorganismos causantes de bacteriemias con su sensibilidad antimicrobiana en niños con diagnóstico de LLA y LMA. Se realizó un estudio observacional, descriptivo entre julio-2016 y junio-2018. Se incluyeron todos los episodios de bacteriemia (EpB) en pacientes de 0 a 18 años con diagnóstico de LLA y LMA. Se documentaron datos epidemiológicos y demográficos de los pacientes y datos microbiológicos de los aislamientos de hemocultivos positivos. Se utilizó stata13. Se incluyeron 258 EpB en 167 pacientes; el 55% eran varones. La mediana de edad fue 81 meses (RIC 39-130). En 215 EpB (83%) se registró la presencia de algún tipo de catéter; neutropenia en 193 EpB (75%), neutropenia severa en 98/258 EpB (38%). Se pudo determinar el foco clínico en 152 EpB (59%). Ciento diez pacientes tenían LLA y 57 LMA. En LLA predominaron las enterobacterias, en LMA los cocos gram positivos. Se observó asociación entre LMA y estreptococos del grupo Viridans (p<0,01) y entre LLA y P.aeruginosa (p 0,01). Con respecto a la sensibilidad hubo 11% y 17% de bacilos negativos multirresistentes en LLA y LMA respectivamente. Todos los estafilococos coagulasa negativos fueron meticilino resistentes. La mayoría de los pacientes tenía algún tipo de catéter y neutropenia. Se observó un predominio de enterobacterias con bajos niveles de resistencia antibiótica. Estos resultados son importantes para conocer la epidemiología local y establecer tratamientos empíricos adecuados (AU)


Bacterial infections are one of the main causes of morbidity and mortality in children with cancer. Our aim was to describe and compare the clinical features and bacteremia-causing microorganisms together with their antimicrobial sensitivity in acute lymphocytic (ALL) and acute myelocytic leukemia (AML). A descriptive observational study was conducted between July 2016 and June 2018. All episodes of bacteremia (EpB) in patients between 0 and 18 years of age with ALL and AML were included. All epidemiological and demographic data of the patients and microbiological information of the isolates of the positive blood cultures were recorded. For statistical analysis stata13 was used. Overall 258 EpB in 167 patients were included; 55% were boys. Median age was 81 months (IQR 39-130). In 215 EpB (83%) some type of catheter was involved; neutropenia was observed in 193 EpB (75%) and severe neutropenia in 98/258 EpB (38%). A clinical focus could be determined in 152 EpB (59%). Of all patients, 110 had ALL and 57 AML. The predominant micro-organisms were enterobacteria in ALL and gram-positive cocci in AML. An association was observed between AML and the viridans group of streptococci (p<0.01) and between ALL and P. aeruginosa (p 0.01). Regarding sensitivity, there were 11% and 17% of multiresistant negative bacilli in ALL and AML, respectively. All coagulase-negative staphylococci weer methicillin resistant. The majority of patients had some type of catheter and neutropenia. Predominance of enterobacteria with low levels of resistance to antibiotics was observed. These results are important to understand the local epidemiology and establish adequate empirical therapies (AU)


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Leukemia, Myeloid, Acute/complications , Microbial Sensitivity Tests , Bacteremia/microbiology , Bacteremia/epidemiology , Drug Resistance, Bacterial , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Blood Culture , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Argentina/epidemiology , Retrospective Studies , Cohort Studies
5.
Rev. chil. infectol ; 37(1): 77-81, feb. 2020. graf
Article in Spanish | LILACS | ID: biblio-1092725

ABSTRACT

Resumen Los episodios de neutropenia febril son cuadros graves, que requieren un estudio etiológico exhaustivo y un inicio rápido de antimicrobianos. Dentro de los posibles microorganismos causales se encuentran los de origen fúngico, los que, dependiendo de su grado de invasión tisular, pueden llegar a presentar una alta mortalidad. Presentamos el caso de un niño con una leucemia mieloide aguda, que tras su quimioterapia de inducción, presentó un episodio de neutropenia febril, con una infección rino-sinusal por Exserohilum rostratum, hongo filamentoso que raramente se asocia a cuadros patológicos. Se inició rápidamente terapia antifúngica, lo cual, asociado a un aseo quirúrgico precoz, lograron una respuesta clínica favorable, sin complicaciones. Luego del seguimiento, y tras recibir profilaxis secundaria durante los episodios de neutropenia, no ha vuelto a presentar nuevas lesiones ni compromiso rino-sinusal.


Abstract The episodes of febrile neutropenia are severe cases that require an exhaustive etiological study and a quick start of antimicrobial agents. Within the possible microorganisms, fungal origins are also found, and depending on its tissue invasion, they can reach a high mortality rate. A case of a pediatric patient who suffered from acute myeloid leukemia is reported, and after his induction chemotherapy, the patient showed an episode of febrile neutropenia, which matches a rhinosinusal infection caused by Exserohilum rostratum, a filamentous fungi that is uncommonly associated with pathological cases. An antifungal therapy and an early surgical treatment were started, which lead to a positive response, without complications to the patient. After the monitoring and receiving secondary prophylaxis during the episodes of neutropenia, the patient hasn't presented new injuries nor rhinosinusal damage.


Subject(s)
Humans , Child , Ascomycota/isolation & purification , Sinusitis/complications , Sinusitis/microbiology , Sinusitis/drug therapy , Leukemia, Myeloid, Acute/complications , Mycoses/complications , Mycoses/drug therapy , Antifungal Agents/therapeutic use , Treatment Outcome , Neutropenia/etiology
6.
Article in Chinese | WPRIM | ID: wpr-879493

ABSTRACT

OBJECTIVE@#To explore the genetic and clinical characteristics of near-tetraploidy/tetraploidy karyotype (NT/T) in patients with myelodysplastic syndrome (MDS).@*METHODS@#Cytogenetic findings of 1576 inpatients with primary MDS were retrospective analyzed, among which 9 were diagnosed with NT/T. Clinical data including gender, age, morphology, genetic feature and prognosis were analyzed.@*RESULTS@#The prevalence of MDS patients with NT/T (NT/T-MDS) among all cases was 0.57%. Karyotyping analysis suggested that eight MDS patients had sole NT/T, while the remainder one had a complex karyotype. In addition to the typical morphology of MDS, NT/T-MDS had unique morphology including huge blast, double-nuclear cell and irregular nuclear membrane. One NT/T-MDS patient gave up therapy, and the remaining eight underwent the first course of treatment, albeit with poor prognosis. Only one patient had complete remission, one had partial remission, three had no remission; and three had converted to acute myeloid leukemia.@*CONCLUSION@#NT/T-MDS is rare and has unique morphology. Generally, NT/T-MDS patients have poor prognosis. However, NT/T cannot be simply classified as high-risk group, but with consideration whether they have affected particular chromosomal structures as well as other clinical data.


Subject(s)
Humans , Karyotype , Leukemia, Myeloid, Acute/complications , Myelodysplastic Syndromes/pathology , Prognosis , Retrospective Studies , Tetraploidy
8.
Rev. chil. obstet. ginecol. (En línea) ; 84(4): 332-336, 2019. graf, ilus
Article in Spanish | LILACS | ID: biblio-1058156

ABSTRACT

RESUMEN Introducción y objetivos: El sarcoma mieloide puede ser la primera manifestación de la leucemia mieloide aguda (LMA), presentarse simultáneamente o constituir una forma de recaída. Material y métodos: Presentamos el caso de una paciente con sarcoma mieloide uterino, como forma de recaída de LMA. Resultados: El diagnóstico se basa en los hallazgos histopatológicos, la inmunohistoquímica y el inmunofenotipo. El tratamiento y el pronóstico son similares a LMA. Conclusión: La afectación uterina por leucemia mieloide extramedular es rara pero debe tenerse en cuenta en el diagnostico diferencial de una masa uterina en aquellas pacientes con antecedentes de LMA.


ABSTRACT Introduction and objectives: Myeloid Sarcoma can present as a first MLA sign, concurrently with or at relapse form. Materials and methods: We present the case of a patient with uterine myeloid sarcoma, as a form of relapse of MLA. Results: The diagnostic is based on the histopathology findings along with immunohistochemistry and immunophenotyping. Conclusion: Uterine involvement due to extramedullary myeloid leukemia is rare but it should be taken into account in the differential diagnosis of a uterine mass in those patients with a history of MLA.


Subject(s)
Humans , Female , Aged , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/therapy , Sarcoma, Myeloid/diagnostic imaging , Thrombosis , Immunohistochemistry , Magnetic Resonance Spectroscopy , Leukemia, Myeloid, Acute/pathology
9.
Rev. chil. infectol ; 35(3): 233-238, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-959436

ABSTRACT

Resumen Introducción: La bacteriemia constituye una complicacion frecuente en los niños con cáncer, que se asocia a mayor gravedad, internación prolongada y mortalidad. La internación prolongada condiciona mayor morbilidad y riesgo de adquisición de infecciones intranosocomiales. Objetivo: Analizar factores de riesgo de internación prolongada en niños con leucemia y bacteriemia. Pacientes y Métodos: Cohorte retrospectiva. Se incluyeron niños con leucemia internados en el Hospital Garrahan entre 1/1/2015 y 31/12/2016 con bacteriemia. Se compararon características de pacientes con internaciones menores o mayores a 14 días. Se realizó un análisis bivariado y modelo de regresión logística. Se utilizó Stata 13. Resultados: n = 121. Mediana de edad 59 meses. Tenían leucemia linfoblastica 81 pacientes (67%) y leucemia mieloblástica 40 (33%). Tenían catéter venoso central (CVC) 96 de los niños (79%), neutropenia 94 (78%), neutropenia menor a 100 neutrófilos 79 (65%). La identificación en hemocultivos fue: 55 casos (45%) enterobacterias, 28 (23%) Staphylococcus coagulasa negativa, Streptococcus spp grupo viridans 19 (16%), Pseudomonas aeruginosa 8 (7%). Huo co-infección viral en 14 pacientes (12%).Tuvieron menos de 14 días de internación 71 pacientes (59%) y mayor período 50 (41%). En el análisis multivariado la bacteriemia asociada a CVC (OR 21,73; IC95% 1,2-43,20; p 0,04), neutropenia profunda al ingreso (OR 1,75; IC95% 1,82-1,28; p 0,03) y co-infección viral (OR 27,42; IC95% 2,88-260,83; p 0,004) fueron factores de riesgo de internación > 14 días. Conclusiones: La bacteriemia asociada a CVC, la neutropenia profunda al ingreso y la co-infección se asociaron con una internación igual o mayor a 14 días.


ABSTRACT Introduction: Bacteremia is a frequent complication in children with cancer, which is associated with greater severity, prolonged hospitalization and mortality. Prolonged hospitalization conditions greater morbidity and risk of acquisition of intranosocomial infections. Aim: To describe risk factors for prolonged hospital length of stay in children with leukemia and bacteremia. Methods: Cohort study. Episodes of bacteremia in patients with leukemia at Garrahan Hospital from 1/1/2015 to 31/12/2016 were reviewed. We compared data from patients with a LOS of 14 days or more with those admitted for less than 14 days. Bivariate and logistic regression analysis was performed. We used Stata 13 statistical package. Results: n = 121. Median age 59 months.81 patients (67%) had a diagnosis of acute lymphoblastic leukemia, followed by acute myeloid leukemia in 40 (33%). 96 patients (79%) had a central venous catheter (CVC), 94 patients (78%) were neutropenic. Blood cultures were positive for Enterobacteriaceae in 55 cases (45%), coagulase-negative staphylococci in 28 cases (23%), Group viridans Streptococcus in 19 (16%), Pseudomonas aeruginosa in 8 (7%). (9%). By the multivariate analysis, three factors remained significantly associated with length of stay of more than 14 days: CVC associated bacteremia (OR 21,73; CI95% 1.2-43.2; p 0.04), severe neutropenia (OR 1.75; CI95% 1.82-1.28; p 0.03) and coinfection (OR 27.4; CI95% 2.8-260.8; p 0.004). Conclusion: CVC associated bacteremia, severe neutropenia and viral coinfection were associated with hospital LOS of more than 14 days.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Leukemia, Myeloid, Acute/complications , Bacteremia/etiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Neutropenia/etiology , Leukemia, Myeloid, Acute/microbiology , Retrospective Studies , Risk Factors , Cohort Studies , Bacteremia/microbiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/microbiology , Length of Stay , Neutropenia/microbiology
10.
Rev. Hosp. Ital. B. Aires (2004) ; 37(4): 142-145, dic. 2017. ilus
Article in Spanish | LILACS | ID: biblio-1095740

ABSTRACT

La infección diseminada por Fusarium se ha convertido en un problema creciente en las personas con neoplasias hematológicas malignas, principalmente en pacientes con leucemias agudas; se describen cada vez más casos en aquellos sometidos a un trasplante de médula ósea. No existe un tratamiento óptimo establecido para la fusariosis diseminada. La mortalidad global comunicada de esta infección oscila entre el 50 y el 80%. Se presenta a continuación el caso de un paciente de sexo masculino de 29 años, con diagnóstico de leucemia mieloide aguda, que presenta como complicación una fusariosis diseminada, y logra sobrellevar un trasplante alogénico de médula ósea en el Hospital Italiano de San Justo (Argentina) de forma exitosa. (AU)


Disseminated fusariosis has become an increasing problem in people with hematopoietic neoplasms, mainly in patients affected by acute leukemias, and even more in those who undergo hematopoietic cell transplantation. There is not an optimal treatment for disseminated fusariosis. The global mortality described in the literature is between 50% and 80%. We introduce a case of a 29 year old patient with diagnosis of acute myeloid leukemia complicated with disseminated fusariosis, who copes with an allogeneic hematopoietic cell transplantation with a successful outcome in the "Hospital Italiano de San Justo" (Argentina). (AU)


Subject(s)
Humans , Male , Adult , Leukemia, Myeloid, Acute/surgery , Bone Marrow Transplantation/trends , Fusariosis/therapy , Azacitidine/adverse effects , Tobacco Use Disorder , Transplantation, Homologous , Leukemia, Myeloid, Acute/complications , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Mitoxantrone/administration & dosage , Mitoxantrone/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Cytarabine/administration & dosage , Cytarabine/therapeutic use , Positron-Emission Tomography , Drug Therapy , Fever , Fusariosis/microbiology , Fusariosis/mortality , Fusariosis/epidemiology , Fusariosis/diagnostic imaging , Myalgia , Voriconazole/administration & dosage , Voriconazole/therapeutic use , Filgrastim/therapeutic use , Marijuana Use , Cocaine Smoking , Terbinafine/therapeutic use , Melphalan/administration & dosage , Melphalan/therapeutic use , Anti-Bacterial Agents/therapeutic use
11.
Rev. chil. infectol ; 34(3): 280-286, jun. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-899713

ABSTRACT

There are very few reports of pediatric patients with infections by dematiaceous filamentous fungi. In this publication we report a case of invasive fungal infection of the nasal septum by Curvularia spicifera in a pediatric patient with acute myeloid leukemia. The patient presented with a painful scabby wound in the nasal vestibule. Culture and universal PCR were consistent with Curvularia spicifera. Early management with surgical debridement and bi-associated antifungal therapy achieved complete resolution of the lesions, with no evidence of dissemination and relapses. Clinical management of these fungal infections represents a challenge as the antifungal selection and duration of therapy is not yet well stablished.


Existen pocos reportes de infecciones por hongos dematiáceos en pediatría. Comunicamos el caso de una infección fúngica invasora del tabique nasal en un niño con una leucemia mieloide aguda, que se presentó como una lesión costrosa dolorosa en el vestíbulo nasal. Se realizó desbridamiento quirúrgico precoz y recibió tratamiento antifúngico biasociado, lográndose resolución completa de las lesiones, sin diseminación ni recaídas. El cultivo y la RPC universal fueron compatibles con Curvularia spicifera. El manejo de estas infecciones fúngicas representa un desafío, considerando que la elección del agente antifúngico y la duración de la terapia no están completamente establecidas.


Subject(s)
Humans , Male , Child , Ascomycota/isolation & purification , Opportunistic Infections/complications , Leukemia, Myeloid, Acute/complications , Nose Diseases/complications , Phaeohyphomycosis/complications , Neutropenia/complications , Opportunistic Infections/microbiology , Leukemia, Myeloid, Acute/microbiology , Nose Diseases/microbiology , Phaeohyphomycosis/microbiology , Neutropenia/microbiology
12.
Clin. biomed. res ; 37(1): 55-58, 2017. ilus
Article in Portuguese | LILACS | ID: biblio-833309

ABSTRACT

O diabetes insipidus (DI) central é uma síndrome caracterizada pela incapacidade de concentração urinária devido à deficiência do hormônio antidiurético. O envolvimento do sistema nervoso central é frequente nas leucemias, mas a ocorrência de DI é rara e confere pior prognóstico. A patogênese do DI na leucemia não é totalmente conhecida, mas a infiltração do eixo hipotálamo-hipofisário por células leucêmicas parece ser um fator responsável. O presente relato descreve o caso de um paciente que apresentou DI como primeira manifestação de leucemia mieloide aguda e que evoluiu com dificuldades de ajustes do sódio sérico, da poliúria e da reposição volêmica, necessitando de permanência prolongada em unidade de cuidados intensivos(AU)


Central diabetes insipidus (DI) is a syndrome characterized by the inability to concentrate urine due to a lack of antidiuretic hormone. Involvement of the central nervous system is common in acute leukemia, but the occurrence of DI is rare and determines a worse prognosis. The pathogenesis of DI in leukemia has not been fully understood yet, but infiltration of the hypothalamic-pituitary axis by leukemic cells seems to be involved. This report describes a case of a patient who presented with DI as the first manifestation of acute myeloid leukemia. Difficulties in the management of serum sodium, fluid replacement and polyuria led to prolonged length of stay in an intensive care unit(AU)


Subject(s)
Humans , Male , Aged , Acute Kidney Injury , Anuria , Diabetes Insipidus/diagnosis , Diabetes Insipidus/drug therapy , Leukemia, Myeloid, Acute/complications , Chromosomes, Human, Pair 7 , Leukemia, Myeloid, Acute/genetics , Monosomy
13.
Bol. micol. (Valparaiso En linea) ; 31(2): 51-58, dic. 2016. ilus
Article in Spanish | LILACS | ID: biblio-868816

ABSTRACT

Se reporta un caso clínico de una paciente femenina de 41 años, con antecedentes de leucemia mieloide aguda (LMA) en remisión. Estudiada por hematología, se confirmó recaída de LMA M4. Se inició quimioterapia. La paciente evolucionó con pancitopenia severa. Presentó dos episodios de neutropenia febril, el primero fue asociado a un absceso glúteo que se trató con antibacterianos, y el segundo a compromiso rinosinusal y úlcera necrótica de punta nasal, columela, tabique, cornete inferior izquierdo y paladar duro. Debido a la clínica e imá- genes radiológicas, se sospechó mucormicosis, por lo que se realizó cirugía con debridación extensa y se inició tratamiento antimicótico con anfotericina B desoxicolato. El cultivo de tejido informó abundante desarrollo de Mucor hiemalis. Se mantuvo pancitopénica durante aproximadamente un mes, siendo diariamente evaluada por un equipo multidisciplinario. Se hicieron varios aseos quirúrgicos, en el último se encontró tejido vital. La paciente completó diez días con anfotericina B desoxicolato y posteriormente se hizo traslape a posaconazol oral. Se realizó mielograma de control que evidenció remisión completa de recaída de LMA. Se dio de alta a su domicilio al día 40 de hospitalización, con hemograma adecuado y tratamiento oral con posaconazol para completar 6 semanas en total.


We report a case of a 41-years-old female patient with a history of acute myeloid leukemia (AML) in remission. Hematology studies confirmed relapse of AML M4. Chemotherapy was started. The patient developed severe pancytopenia. She presented two episodes of febrile neutropenia, the first one was associated with a gluteal abscess that was treated with antibacterials, and the second to rhinosinusal involvement and necrotic ulcer of nasal tip, columella, septum, left inferior turbinate and hard palate. Due to clinical and radiological imaging, mucormycosis was suspected, so surgery was performed with extensive debridement and antifungal treatment with amphotericin B deoxicholate was initiated. Tissue culture reported abundant development of Mucor hiemalis. She remained pancytopenic for approximately one month, being evaluated daily by a multidisciplinary team. Several surgical were made, finding vital tissue in the last perform. The patient completed ten days with amphotericin B deoxicholate and later was overlapped to oral posaconazole. A control myelogram was performed, showing complete remission of AML. She was discharged to her home at day 40 of hospitalization, with adequate blood count and oral treatment with posaconazole to complete 6 weeks in total.


Subject(s)
Humans , Adult , Female , Amphotericin B , Chemotherapy-Induced Febrile Neutropenia , Leukemia, Myeloid, Acute/complications , Mucor/pathogenicity , Mucormycosis/surgery , Mucormycosis/diagnostic imaging , Mucormycosis/drug therapy , Paranasal Sinuses/surgery , Paranasal Sinuses/microbiology , Antifungal Agents , Debridement/methods , Magnetic Resonance Spectroscopy/methods , Hematologic Diseases , Fungi/pathogenicity , Risk Factors , Tomography, Spiral Computed/methods
14.
Bol. micol. (Valparaiso En linea) ; 31(1): 36-41, jun. 2016. ilus
Article in Spanish | LILACS | ID: biblio-868809

ABSTRACT

Se reporta un caso clínico de un paciente masculino de 65 años, que ingresó al hospital por cuadro de 10 días de evolución, con sospecha clí- nica y de laboratorio de un síndrome mieloproliferativo. Estudiado por hematología, se confirmó Leucemia Mieloide Aguda M5. Se inició quimioterapia de inducción. El paciente evolucionó con pancitopenia, destacando neutropenia severa hasta 200 /mm3, febril y sin foco precisado. Se trató con antibióticos de amplio espectro por 10 días con buena respuesta. Cinco días después de finalizar su tratamiento antibiótico, nuevamente comenzó con fiebre, alza de parámetros inflamatorios, neutropenia severa y clínica de foco respiratorio. Se realizó Tomografía Computada (TC) de tórax y galactomanano en sangre, ambos compatibles con aspergilosis pulmonar, por lo que se inició tratamiento con voriconazol. El paciente evolucionó con buena respuesta clínica y de laboratorio, mejoría de imá- genes del TC de tórax y negativización de galactomanano. Al mes cedió la pancitopenia. Fue dado de alta en buenas condiciones generales, con indicación de volver a hospitalizar para quimioterapia de consolidación.


A report of a clinical case of a male patient aged 65 is presented. He entered to the hospital for 10 days evolution box with clinical and laboratory suspicion of a myeloproliferative syndrome. Studied by hematology, acute myeloid leukemia M5 was confirmed. induction chemotherapy began. The patient developed pancytopenia, highlighting severe neutropenia up to 200 / mm3, fever and without pointed focus. He was treated with broadspectrum antibiotics for 10 days with good response. Five days after finishing his antibiotic treatment began with fever again, rising inflammatory parameters, neutropenia and severe respiratory clinical focus. Computed Tomography (CT) of the chest and blood galactomannan was realized, both were compatible with pulmonary aspergillosis, starting treatment with voriconazole. The patient developed good both clinical and laboratory, improvement in chest CT images and negativization galactomannan response. Month later yielded pancytopenia. He was discharged in good general condition, indicating again been hospitalized for consolidation chemotherapy.


Subject(s)
Humans , Male , Aged , Aspergillus/pathogenicity , Invasive Pulmonary Aspergillosis/diagnostic imaging , Invasive Pulmonary Aspergillosis/etiology , Invasive Pulmonary Aspergillosis/blood , Invasive Pulmonary Aspergillosis/drug therapy , Leukemia, Myeloid, Acute/complications , Leukemia, Monocytic, Acute/complications , Neutropenia , Tomography, X-Ray Computed/methods
16.
Rev. chil. infectol ; 32(4): 393-398, ago. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-762636

ABSTRACT

Background: The isolation of vancomycin-resistant Enterococcus spp (ERV) has increased significantly within the last few years, along with the risk of infection and dissemination of these bacteria. Our aim was to determine risk factors (RF) for intestinal colonization in hospitalized pediatric patients with oncological disease at Hospital de Niños Roberto del Río. Methods: Between January 2012 and December 2013 a transversal study was performed with 107 rectal swabs and processed with a PCR for ERV. The patients were classified as "colonized with ERV" and "not colonized with ERV" and we evaluated possible RF for intestinal colonization in both groups. Results: VRE colonization was found in 51 patients (52%). The median of time elapsed between oncological diagnosis and VRE colonization was 35 days. The significant RF associated with VRE colonization were days of hospitalization prior to study, neutropenia and treatment with antibiotics within 30 days prior to study and mucositis. Conclusions: According to the RF revealed in this study we may suggest prevention standards to avoid ERV colonization. This is the first investigation in our country in hospitalized pediatric patients with oncological disease and processed with a multiplex PCR for ERV, therefore it is a great contribution about this subject in Chile.


Introducción: El aislamiento de Enterococcus spp resistentes a vancomicina (ERV) ha presentado un incremento significativo en los últimos años, aumentando el riesgo de infección por esta bacteria y favoreciendo su diseminación. Nuestro objetivo es determinar los factores de riesgo (FR) de colonización intestinal de ERV en pacientes oncológicos internados en el Hospital de Niños Roberto del Río. Método: Entre enero de 2012 y diciembre de 2013 se realizó un estudio transversal de colonización rectal por ERV mediante muestras de hisopado rectal obtenidas en 107 pacientes efectuando RPC múltiple para ERV. Se dividió en grupo "portador" y "no portador" y se evaluó los posibles FR para colonización por ERV. Resultados: Se encontró colonización por ERV en 51 pacientes (52%). El tiempo transcurrido desde el diagnóstico oncológico y la colonización presentó una mediana de 35 días. Los FR encontrados con asociación significativa fueron el número de días de hospitalización previa, neutropenia, uso de antimicrobianos 30 días previos y mucositis. Conclusión: De acuerdo a los FR encontrados podemos sugerir medidas de prevención para colonización por ERV. Esta es la primera investigación realizada en nuestro país en pacientes oncológicos pediátricos y que utiliza la técnica de RPC múltiple para ERV, lo que permite un aporte significativo sobre este tema en Chile.


Subject(s)
Child , Child, Preschool , Female , Humans , Male , Hospitalization , Intestines/microbiology , Leukemia, Myeloid, Acute/microbiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/microbiology , Rectum/microbiology , Vancomycin-Resistant Enterococci/isolation & purification , Case-Control Studies , Cross-Sectional Studies , Cross Infection/microbiology , Length of Stay , Leukemia, Myeloid, Acute/complications , Multiplex Polymerase Chain Reaction , Mucositis/complications , Mucositis/microbiology , Neutropenia/complications , Neutropenia/microbiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Risk Factors , Vancomycin Resistance , Vancomycin-Resistant Enterococci/classification
17.
Rev. cuba. hematol. inmunol. hemoter ; 31(1): 79-85, ene.-mar. 2015.
Article in Spanish | LILACS | ID: lil-743987

ABSTRACT

La leucemia congénita es una entidad rara que se diagnostica entre el momento del nacimiento y los primeros 30 días de vida. Menos del 1 % de las leucemias de la infancia se diagnostican en el neonato. La hipoplasia severa o aplasia del timo se observa en el síndrome de Di George, que incluye varias malformaciones congénitas y déficit inmunológico, principalmente de células T por hipoplasia del timo, aunque se puede observar aplasia del timo en pacientes sin diagnóstico de Di George. Se presenta un caso diagnosticado como leucemia mieloide aguda congénita. En el momento del nacimiento presentó palidez mucocutánea intensa, petequias, equímosis generalizadas y hepatoesplenomegalia. El diagnóstico se confirmó por la presencia de blastos mieloides en periferia y médula ósea y por la caracterización inmunofenotípica de estas células. La necropsia confirmó la aplasia del timo.


Congenital leukemia is a rare disease in which a leukemic process is presented at birth or during the first 30 days of life. Less than 1 % of childhood leukemia is diagnosed in newborns. The severe hypoplasia or total thymic aplasia is seen at Di George syndrome which includes several birth defects and immune deficit, mainly of T cells by thymic hypoplasia; nevertheless, severe thymic hypoplasia can be observed in patients without diagnosis of Di George. We report a case of congenital acute myeloid leukemia who presented intense paleness generalized petechiae and ecchymoses as well as hepatosplenomegaly. The diagnosis was confirmed by the presence of blasts in peripheral blood smear and bone marrow aspirate. Immunophenotyping was performed and contributed to a definitive diagnosis. The autopsy confirmed the thymic aplasia.


Subject(s)
Humans , Female , Infant, Newborn , DiGeorge Syndrome/mortality , Leukemia, Myeloid, Acute/complications , DiGeorge Syndrome/pathology
19.
Rev. chil. infectol ; 31(3): 333-338, jun. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-716985

ABSTRACT

Introduction: Leukemia is the most common cancer in Chilean children. Acute lymphoblastic leukemia (ALL) is more prevalent and longer survival compared to acute myeloid leukemia (AML). Aims: To describe episodes of febrile neutropenia (FN) in children with AML, determining frequency of infections as agent, focus and evolution, comparing children with ALL episodes. Method: A prospective multicenter study. Children presenting with FN at six hospitals in Santiago, Chile, were invited to participate in two consecutive FONDECYT projects, from April 2004 to June 2011. All patients were uniformly evaluated, recording epidemiological, clinical and laboratory variables. Information regarding FN episodes of children with LMA and LLA was used to this study. Results: We evaluated 506 episodes of FN in children with leukemia: 173 children with AML and 333 in children with ALL. NF episodes in children with ALML showed significantly greater depth and duration of neutropenia, febrile remained a > period of time and had a worse clinical outcome, as evidenced by > hemodynamic instability, > sepsis, CRP > 90 mg/L for a longer time, more days of hospitalization, > frequency of hospitalization in ICU, > bacteremia, mainly by Streptococcus viridans group, > change of antimicrobial treatment, > use of antifungal therapy. Conclusions: This study demonstrates that FN episodes in children with ALML further evolve unfavorably, compared with episodes of FN in children with ALL. FN episodes in children with ALML require a more aggressive diagnostic and therapeutic approach, related to its severity.


Introducción: En Chile, la leucemia es el cáncer más frecuente en niños, siendo las dos principales leucemia linfoblástica aguda (LLA) y leucemia mieloide aguda (LMA). Objetivo: Describir los episodios de neutropenia febril (NF) observados en niños con LMA, determinando la frecuencia de infecciones según agente, foco y evolución, comparándolos con episodios de niños con LLA. Método: Estudio prospectivo, multicéntrico. Pacientes < de 18 años con NF que consultaron en uno de los seis hospitales del grupo PINDA de Santiago, Chile (abril de 2004-junio de 2011), enrolados en dos sucesivos proyectos FONDECYT. Se recogió de manera sistemática la información epidemiológica, clínica y de laboratorio relativa a cada episodio de NF; posteriormente se extrajo de la base de datos la información correspondiente a los pacientes con LMA y LLA. Resultados: Se evaluaron 506 episodios de NF en niños con leucemia: 173 en niños con LMA y 333 en niños con LLA. Los episodios de NF en niños con LMA presentaron significativamente mayor duración e intensidad de la neutropenia, se mantuvieron febriles por un mayor período de tiempo y presentaron una peor evolución clínica, evidenciada por mayor inestabilidad hemodinámica, mayor frecuencia de sepsis, PCR > 90 mg/L por un período más prolongado, más días de hospitalización, mayor frecuencia de hospitalización en UCI, mayor presencia de bacteriemia, principalmente por Streptococcus grupo viridans, mayor número de cambio de esquemas antimicrobianos y mayor uso de antifúngicos, particularmente de tipo empírico. Conclusiones: Este estudio demuestra que los episodios de NF en niños con LMA evolucionan en mayor medida en forma desfavorable, comparado con episodios de NF en niños con LLA. Los episodios de NF en niños con LMA requieren un enfoque diagnóstico y terapéutico más agresivo, relacionado a su gravedad.


Subject(s)
Child , Humans , Febrile Neutropenia/etiology , Leukemia, Myeloid, Acute/complications , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Febrile Neutropenia/drug therapy , Prospective Studies , Severity of Illness Index
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