ABSTRACT
BACKGROUND: Pneumocystis carinii pneumonia (PCP) is a potentially life-threatening but preventable infection that may occur after hematopoietic stem cell transplantation (HSCT). Intravenous pentamidine has been used in the prevention of PCP in the post-transplant period, although there are few trials published in the literature evaluating its safety and efficacy. METHODS: We retrospectively reviewed the medical records of children who underwent HSCT from January 1, 2005, to October 1, 2011, who received intravenous pentamidine as first-line PCP prophylaxis initiated at admission. Demographic, clinical, microbiologic, management and outcome data were collected. RESULTS: One hundred sixty-seven consecutive HSCTs in 137 pediatric patients were given intravenous pentamidine before myeloablation and then every 28 days until the subject was at least a minimum 30 days post-HSCT, had stable neutrophil engraftment (absolute neutrophil count >1000/mm for 3 days without growth factor support) and for allogeneic patients, no evidence of active graft versus host disease and weaning on their immunosuppressive therapy. No cases of PCP were seen in this cohort. Ten (7%) had a grade I side effect of nausea/vomiting requiring slower infusion time and 2 (2%) had a grade IV reaction with anaphylaxis (rash) and hypotension with 1 child requiring transfer to the intensive care unit. CONCLUSIONS: Intravenous pentamidine was safe and effective for the prevention of PCP in pediatric HSCT patients. Given the potential neutropenic effects of trimethoprim-sulfamethoxazole, compliance with drug administration and inferior efficacy of other PCP prophylactic medications, intravenous pentamidine should be considered as first-line therapy for the prevention of PCP in children undergoing HSCT.
Subject(s)
Antifungal Agents/administration & dosage , Chemoprevention/methods , Hematopoietic Stem Cell Transplantation , Immunocompromised Host , Pentamidine/administration & dosage , Pneumonia, Pneumocystis/prevention & control , Administration, Intravenous/adverse effects , Adolescent , Antifungal Agents/adverse effects , Chemoprevention/adverse effects , Child , Child, Preschool , Female , Humans , Male , Pentamidine/adverse effects , Pneumocystis carinii/drug effects , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: A routine chest radiograph is often performed to evaluate initial fever in patients undergoing hematopoietic stem cell transplantation (HSCT) given the signs and symptoms of infectious pulmonary pathology may be subtle or absent. Studies in patients receiving conventional chemotherapy have shown that chest radiographs do not appear to be helpful in the evaluation of asymptomatic patients with febrile neutropenia. We performed a retrospective review of pediatric stem cell transplant recipients to determine if chest radiographs are useful in the evaluation of initial fever. PROCEDURE: We retrospectively identified 81 consecutive pediatric hematopoietic stem transplant recipients who had a chest radiograph performed as a routine part of the evaluation of initial fever during stem cell transplantation. RESULTS: Seventy-six (94%) of the chest radiographs performed had no evidence of pulmonary infiltrate. Of the five children with positive radiographs, three had symptomatic respiratory infection and two (40%) were asymptomatic. One asymptomatic patient had a history of pulmonary infection with persistent stable infiltrates prior to transplantation. This patient did not have any evidence of pneumonia during the transplant. The second asymptomatic patient had subsequent resolution of the infiltrate with antibiotic administration. None of the patients had a change made in the empiric antibiotic regimen based upon the results of the chest film. CONCLUSIONS: Routine radiographs are not useful in the evaluation of asymptomatic children at the time of an initial febrile event while undergoing HSCT.
Subject(s)
Fever/diagnostic imaging , Hematopoietic Stem Cell Transplantation/adverse effects , Respiratory Tract Infections/diagnostic imaging , Adolescent , Child , Child, Preschool , Female , Fever/etiology , Humans , Infant , Male , Radiography, Thoracic , Respiratory Tract Infections/diagnosis , Retrospective Studies , Young AdultABSTRACT
Occupational asthma has been a recognized cause of respiratory disease for centuries, and bakers' asthma, in particular, has been well described. This case report identifies egg white protein as the trigger of asthma in an atopic baker. It highlights the clinical spectra of bakers' asthma, emphasizing the importance of occupational exposures in adult onset asthma.
