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1.
Braz. j. infect. dis ; 25(2): 101548, 2021.
Artículo en Inglés | LILACS | ID: biblio-1278574

RESUMEN

ABSTRACT This report shows the contribution of next-generation metagenomic sequencing (mNGS) as an alternative to challenging diagnostic infection in immunosuppressed individuals. Herein, we report three acute leukemia patients who developed severe invasive infections due to different etiologies: fungi, viruses, and protozoa. mNGS improved the diagnosis of the infections and provided the opportunity for adequate therapy. The mNGS is a hypothesis-free diagnostic platform, increasing potential in challenging diseases in hematological patients due to the extended diagnostic panel and the expedite access to the result.


Asunto(s)
Humanos , Leucemia , Enfermedades Transmisibles , Metagenómica , Secuenciación de Nucleótidos de Alto Rendimiento , Hongos
2.
Hematol., Transfus. Cell Ther. (Impr.) ; 42(4): 293-299, Oct.-Dec. 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1142962

RESUMEN

ABSTRACT During the COVID-19 pandemic, special attention has been addressed in cancer care to mitigate the impact on the patient's prognosis. We addressed our preparation to face COVID-19 pandemic in a Hematological and Stem Cell Transplant Unit in Brazil during the first two months of COVID-19 pandemic and described COVID-19 cases in patients and health care workers (HCW). Modifications in daily routines included a separation of area and professionals, SARS-CoV-2 screening protocols, and others. A total of 47 patients and 54 HCW were tested for COVID-19, by PCR-SARS-CoV-2. We report 11 cases of COVID-19 in hematological patients (including 2 post stem cell transplant) and 28 cases in HCW. Hematological cases were most severe or moderate and presented with several poor risk factors. Among HCW, COVID-19 were mostly mild, and all recovered without hospitalization. A cluster was observed among HCW. Despite a decrease in the number of procedures, the Transplant Program performed 8 autologous and 4 allogeneic SCT during the period, and 49 onco-hematological patients were admitted to continuing their treatments. Although we observed a high frequency of COVID-19 among patients and HCW, showing that SARS-CoV-2 is disseminated in Brazil, hematological patients were safely treated during pandemic times.


Asunto(s)
Humanos , Transmisión de Enfermedad Infecciosa de Profesional a Paciente , Atención Médica , Trasplante de Células Madre , Pandemias , Paquetes de Atención al Paciente , SARS-CoV-2 , COVID-19 , Neoplasias , Atención a la Salud , Hematología
3.
Hematol., Transfus. Cell Ther. (Impr.) ; 42(3): 200-205, July-Sept. 2020.
Artículo en Inglés | LILACS | ID: biblio-1134043

RESUMEN

ABSTRACT Since the World has been facing the COVID-19 pandemic, special attention has been taken concerning cancer patients; related to their immunosuppression status, adding risk for more aggressive COVID-19 and mortality, but also concerns about the access and the quality of care in cancer therapy. The COVID-19 pandemic impacts the number of infected, its related mortality, as well as the care of cancer patients. Multiple myeloma patients are a particular group with several important aspects to be considered during pandemic times. In essence, they are immunosuppressed in different intensities during their treatment. Most of them are elderly and all of them require long-term therapy, with prolonged contact with the health care system, possibly including a stem cell transplant during the treatment. A panel of experts in multiple myeloma and infectious diseases discusses pieces of evidence and the lack of the same in the scenario of COVID-19 in myeloma patients, while also exposing what is expected for the next phases of the COVID-19 pandemic.


Asunto(s)
Paraproteinemias , Trasplante de Células Madre , SARS-CoV-2 , COVID-19 , Mieloma Múltiple/diagnóstico , Mieloma Múltiple/terapia
5.
Hematol., Transfus. Cell Ther. (Impr.) ; 41(4): 281-282, Oct.-Dec. 2019.
Artículo en Inglés | LILACS | ID: biblio-1056237
6.
Braz. j. infect. dis ; 20(4): 354-359, July-Aug. 2016. tab
Artículo en Inglés | LILACS | ID: biblio-828120

RESUMEN

Abstract Introduction Invasive mold disease is an important complication of patients with hematologic malignancies, and is associated with high mortality. A diagnostic-driven approach has been an alternative to the classical empiric antifungal therapy. In the present study we tested an algorithm that incorporated risk stratification using the D-index, serial serum galactomannan and computed tomographic-scan to guide the decision to start antifungal therapy in neutropenic patients. Patients and methods Between May 2010 and August 2012, patients with acute leukemia in induction remission were prospectively monitored from day 1 of chemotherapy until discharge or death with the D-index and galactomannan. Patients were stratified in low, intermediate and high risk according to the D-index and an extensive workup for invasive mold disease was performed in case of positive galactomannan (≥0.5), persistent fever, or the appearance of clinical manifestations suggestive of invasive mold disease. Results Among 29 patients, 6 (21%), 11 (38%), and 12 (41%) were classified as high, intermediate, and low risk, respectively. Workup for invasive mold disease was undertaken in 67%, 73% and 58% (p = 0.77) of patients in each risk category, respectively, and antifungal therapy was given to 67%, 54.5%, and 17% (p = 0.07). Proven or probable invasive mold disease was diagnosed in 67%, 45.5%, and in none (p = 0.007) of high, intermediate, and low risk patients, respectively. All patients survived. Conclusion A risk stratification using D-index was a useful instrument to be incorporated in invasive mold disease diagnostic approach, resulting in a more comprehensive antifungal treatment strategy, and to guide an earlier start of treatment in afebrile patients under very high risk.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Aspergilosis/tratamiento farmacológico , Algoritmos , Fusariosis/tratamiento farmacológico , Mananos/sangre , Antifúngicos/uso terapéutico , Neutropenia/inmunología , Aspergilosis/diagnóstico , Aspergilosis/inmunología , Síndromes Mielodisplásicos/inmunología , Síndromes Mielodisplásicos/microbiología , Leucemia Mieloide Aguda/inmunología , Leucemia Mieloide Aguda/microbiología , Tomografía Computarizada por Rayos X , Estudios Prospectivos , Sensibilidad y Especificidad , Medición de Riesgo , Fusariosis/diagnóstico , Fusariosis/inmunología , Mananos/inmunología , Neutropenia/microbiología
7.
Rev. bras. hematol. hemoter ; 32(supl.1): 140-162, maio 2010. tab
Artículo en Portugués | LILACS | ID: lil-554167

RESUMEN

A infecção em receptores de transplante de células-tronco hematopoéticas (TCTH) está relacionada a altas taxas de morbidade e mortalidade. O tipo de transplante, a fonte de célula-tronco hematopoética, a utilização de doadores alternativos e outras medidas relacionadas ao procedimento influenciam diretamente no tipo e na intensidade da imunossupressão, modificando o risco de desenvolver uma infecção. Nesta seção são discutidas as estratégias para monitorização, diagnóstico e tratamento das infecções em receptores de TCTH em três fases: na fase pré-transplante, durante a fase de neutropenia, e na fase pós-pega do enxerto.


Infectious complications following stem cell transplantation are frequent and associated with high morbidity and mortality. Several factors related to the transplant procedure, such as type of transplant, the source of stem cells, the utilization of alternative donors are important determinants of the immune status of the host, and impact on the risk of infection. In this section we will discuss the different approaches for monitoring patients at risk and diagnosing and treating infectious complications in three time periods: before transplant, during neutropenia, and after engraftment.


Asunto(s)
Humanos , Trasplante de Células Madre Hematopoyéticas , Infecciones Bacterianas/complicaciones
8.
Rev. bras. hematol. hemoter ; 27(4): 290-300, out.-dez. 2005. tab
Artículo en Portugués | LILACS | ID: lil-450000

RESUMEN

Infecção é uma freqüente complicação em pacientes com leucemia linfocítica crônica (LLC). O risco de infecção é maior à medida que a doença avança, e guarda estreita correlação com a dosagem de imunoglobulinas no sangue. Embora o defeito imune primário na LLC seja deficiência de imunoglobulinas, as diversas modalidades de tratamento comprometem outros elementos do sistema imune, ampliando o espectro de agentes infecciosos. Este texto sumariza o conhecimento atual sobre os riscos de infecção com as diversas modalidades de tratamento e apresenta recomendações para o manejo destas infecções, seja na prevenção seja no tratamento. Tais recomendações são colocadas em graus de evidência tanto do ponto de vista de sua força quanto da qualidade da evidência.


Infection is a frequent complication in patients with chronic lymphocytic leukemia (CLL). The risk of infection is greater with advanced disease and with lower serum immunoglobulin levels. In newly diagnosed patients, the main immunodeficiency is hypogamaglobulinemia, but with different regimens of treatment, other immunodeficiencies occur and contribute to changing the spectrum and increasing the incidence of infection. This paper reviews the current knowledge of the risks and epidemiology of infection according to the different regimens given in the treatment of CLL, and presents recommendations for prophylaxis and treatment of these infections. Such recommendations are rated according to standard scoring schema used in other guidelines to illustrate the strength of the supporting evidence and the quality of the data.


Asunto(s)
Humanos , Infecciones , Leucemia Linfocítica Crónica de Células B , Leucemia Linfocítica Crónica de Células B/epidemiología , Leucemia Linfocítica Crónica de Células B/terapia
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