Clinical characteristics of invasive pulmonary aspergillosis in non-neutropenic patients / 医学研究生学报

Objective In recent years, the incidence of invasive pulmonary aspergillosis (IPA) in non-neutropenic patients has been increasing. Most previous studies have focused on the diagnosis and treatment of IPA in severely immunocompromised patients. The purpose of this study was to investigate the clinical characteristics of IPA in non-neutropenic patients. Methods We enrolled 183 IPA patients (including 46 proven IPA cases and 137probable IPA cases) admitted to our hospital from 2008 to 2018, after excluding possible IPA cases and neutropenic cases. The clinical and laboratory data were collected and analyzed. Results In this study, 164 (89.6%) patients had underlying diseases and risk factors, among which chronic obstructive pulmonary disease and prolonged steroid treatment were the most common. Cough (79.8%), dyspnea (71.0%), sputum (68.9%)and fever (61.2%) were the common symptoms. Chest CT findings were mainly consolidation (45.9%), nodule (32.8%), ground-glass opacity (29.0%) and cavity (26.8%). The halo sign (8.2%) and air crescent sign (7.1%) were relatively rare. The mean numbers of leucocyte and neutrophils were 14.6×109/L and 10.2×109/L, respectively. Positive rates of sputum culture and bronchoalveolar lavage fluid culture were 32.5% and 35.1%, respectively. Positive rates of galactomannan (GM) antigen test in serum and bronchoalveolar lavage fluid samples were 55.2% and 77.1%, respectively. Transthoracic needle biopsy and transbronchial lung biopsy were associated with positive rates of 45.3% and 20.6%, respectively. Conclusion The clinical and imaging features of IPA in non-neutropenic patients are atypical. Compared with sputum culture and GM antigen test in serum, alveolar lavage fluid GM test has higher sensitivity which can assist in definitive diagnosis.

A Case of Appendicitis with Liver Abscesses Developed during Allogeneic Hematopoietic Stem Cell Transplantation / 임상소아혈액종양

A 10-year-old boy with severe aplastic anemia was admitted for allogeneic hematopoietic stem cell transplantation. After conditioning chemotherapy using cyclophosphamide, fludarabine, and antithymocyte immunoglobulin, he presented with fever and abdominal pain on day 0 of stem cell transplantation. After diagnosis of acute appendicitis with minor perforation, appendectomy was performed just after cell infusion. A week after the procedure, he showed two huge liver abscesses in S4 and S6 segments. We used broad spectrum antibiotics along with antifungal agents. Percutaneous drainage was attempted, but no fluid was removed and no microorganisms were isolated. After 7 weeks of antibiotics and antifungal therapy, liver abscesses showed improvement. We report a case of successfully treated appendicitis with liver abscesses in a severely neutropenic patient during allogeneic hematopoietic stem cell transplantation.

A Case of Appendicitis with Liver Abscesses Developed during Allogeneic Hematopoietic Stem Cell Transplantation / 임상소아혈액종양

A 10-year-old boy with severe aplastic anemia was admitted for allogeneic hematopoietic stem cell transplantation. After conditioning chemotherapy using cyclophosphamide, fludarabine, and antithymocyte immunoglobulin, he presented with fever and abdominal pain on day 0 of stem cell transplantation. After diagnosis of acute appendicitis with minor perforation, appendectomy was performed just after cell infusion. A week after the procedure, he showed two huge liver abscesses in S4 and S6 segments. We used broad spectrum antibiotics along with antifungal agents. Percutaneous drainage was attempted, but no fluid was removed and no microorganisms were isolated. After 7 weeks of antibiotics and antifungal therapy, liver abscesses showed improvement. We report a case of successfully treated appendicitis with liver abscesses in a severely neutropenic patient during allogeneic hematopoietic stem cell transplantation.

Significance of Aseptic Room Reverse Isolation in Febrile Neutropenic Cancer Patients / 대한소아혈액종양학회지

PURPOSE: The aim of this study is to find out the role of HEPA filter equipped lamina air flow room reverse isolation for the treatment of anticancer drug induced febrile neutropenic patients. METHODS: Antibiotics and antifungal agents were promptly administered to twenty six patients with febrile neutropenic following chemotherapy from January 2003 to July 2005 at the Department of Pediatrics, Kyungpook National University Hospital, Daegu, Korea. And if possible, they were treated in the aseptic room. RESULTS: Nineteen patients recovered and seven patients died of infectious causes among twenty six patients. Fourteen patients had microbiologically defined infection, seven patients had clinically defined infection, and five patients had unexplained fever. The causes of infection were sepsis, pneumonia and urinary tract infection. The etiologic pathogens were Gram negative bacilli, 6 (42.9%) ; Gram positive cocci, 3 (21.4%) ; and fungus, 5 (35.7%). The dead group showed lower leukocyte count and higher CRP than the survived group. All dead patients showed disseminated intravascular coagulation syndrome (DIC). Nine of the ten patients (90%) who were treated in the aseptic room survived and ten of the sixteen patients (62.5%) in the general ward survived. CONCLUSION: The infection-related mortality of febrile neutropenic patients following chemotherapy is influenced by the early and adequate use of antimicrobial agents, DIC, neutrophil count and CRP. The isolation in the aseptic room increased the survival rate, but it was not statistically significant.