Subject(s)
Breast Neoplasms , Drug-Related Side Effects and Adverse Reactions , Onychomycosis , Female , Humans , Nails , Pilot ProjectsABSTRACT
Invasive fusariosis (IF) is associated with severe neutropenia in patients with concurrent hematologic conditions. We conducted a retrospective observational study to characterize the epidemiology of IF in 18 Spanish hospitals during 2000-2015. In that time, the frequency of IF in nonneutropenic patients increased from 0.08 cases per 100,000 admissions in 2000-2009 to 0.22 cases per 100,000 admissions in 2010-2015. Nonneutropenic IF patients often had nonhematologic conditions, such as chronic cardiac or lung disease, rheumatoid arthritis, history of solid organ transplantation, or localized fusariosis. The 90-day death rate among nonneutropenic patients (28.6%) and patients with resolved neutropenia (38.1%) was similar. However, the death rate among patients with persistent neutropenia (91.3%) was significantly higher. We used a multivariate Cox regression analysis to characterize risk factors for death: persistent neutropenia was the only risk factor for death, regardless of antifungal therapy.
Subject(s)
Fusariosis , Fusarium , Neutropenia , Antifungal Agents/therapeutic use , Fusariosis/drug therapy , Fusariosis/epidemiology , Humans , Neutropenia/drug therapy , Neutropenia/epidemiology , Observational Studies as Topic , Spain/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Middle Aged , Anti-Infective Agents/therapeutic use , Clostridium Infections/drug therapy , Clostridioides difficile , Metronidazole/therapeutic use , Neoplasms/complications , Neoplasms/microbiology , Clostridium Infections/epidemiology , Clostridium Infections/etiology , Prospective Studies , Recurrence , Treatment OutcomeSubject(s)
Anti-Infective Agents/therapeutic use , Clostridioides difficile , Clostridium Infections/drug therapy , Metronidazole/therapeutic use , Neoplasms/complications , Neoplasms/microbiology , Adult , Aged , Aged, 80 and over , Clostridium Infections/epidemiology , Clostridium Infections/etiology , Female , Humans , Male , Middle Aged , Prospective Studies , Recurrence , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Adult , Female , Humans , Case Reports , Hemorrhagic Septicemia/blood , Hemorrhagic Septicemia/pathology , Neoplasms/chemically induced , Microbiology/standards , Hyperplasia/pathology , Endometrium/cytology , Hemoglobin A , Hemorrhagic Septicemia/complications , Hemorrhagic Septicemia/metabolism , Neoplasms/radiotherapy , Microbiology/classification , Hyperplasia/metabolism , Endometrium/abnormalities , Hemoglobin A/administration & dosageABSTRACT
No disponible
Subject(s)
Female , Humans , Male , Aged , Aged, 80 and over , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Methicillin-Resistant Staphylococcus aureus/pathogenicity , Communicable Diseases/drug therapy , Molecular Biology , Cross Infection , Cancer Care Facilities , Spain/epidemiologySubject(s)
Bacterial Proteins/genetics , Cross Infection/microbiology , Drug Resistance, Multiple, Bacterial/genetics , Methicillin-Resistant Staphylococcus aureus/pathogenicity , Penicillin-Binding Proteins/genetics , Staphylococcal Infections/microbiology , Aged , Aged, 80 and over , Female , Genetic Markers , Humans , Leukocidins/genetics , Male , Methicillin-Resistant Staphylococcus aureus/drug effects , Methicillin-Resistant Staphylococcus aureus/genetics , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Middle Aged , Retrospective Studies , SpainABSTRACT
INTRODUCCIÓN Y OBJETIVO: La neutropenia es un signo frecuente en los pacientes que van a ser sometidos a trasplante de progenitores hematopoyéticos (TPH). Una complicación importante es la infección favorecida por la inmunodepresión y el grado de neutropenia. El objetivo del estudio es evaluar la utilidad diagnóstica de la procalcitonina (PCT) y de la proteína C reactiva (PCR) en pacientes onco-hematológicos sometidos a quimioterapia y TPH para discriminar la etiología de la fiebre. PACIENTES Y MÉTODOS: Se midieron los valores de PCT y PCR en 30 episodios de neutropenia febril antes del inicio de la quimioterapia, el día de la neutropenia, el día del inicio de la fiebre y los días 1, 2, 3 y 6 postinicio de la fiebre y al fin del episodio. Los episodios fueron clasificados como 5 bacteriemias, 3 infecciones documentadas microbiológicamente, 10 infecciones clínicas y 12 fiebres de origen desconocido. RESULTADOS: Los valores medios de PCT más elevados correspondieron al grupo de pacientes con bacteriemia. Hubo diferencias estadísticamente significativas (p = 0,04) el segundo día tras el inicio de la fiebre. El punto de corte de 0,5 ng/ml mostró una sensibilidad del 66% y una especificidad del 75%. La PCR mostró diferencias estadísticamente significativas los días 1, 2 y 3 postinicio de la fiebre (p = 0,01; p = 0,003 y p = 0,002). El punto de corte de 7,5 mg/dl mostró una sensibilidad del 88% y una especificidad del 58%. CONCLUSIONES: La combinación de PCT y PCR es un método insuficiente para la detección de infección bacteriana y no puede sustituir el correcto diagnóstico clínico y microbiológico
INTRODUCTION AND OBJECTIVE: Neutropenia is a frequent sign in patients who are going to have a haematopoietic stem cell transplant (HSCT).Infection is an important complication in these patients, which is favoured by immunosuppression and the degree of neutropenia. This study aims to evaluate the diagnostic usefulness of procalcitonin (PCT) and C-reactive protein (CRP) in onco-haematological patients undergoing chemotherapy and HSCT to determine the origin of the fever. PATIENTS AND METHODS:PCT and CRP values were measured in 30 episodes of febrile neutropenia: before starting chemotherapy, appearance of neutropenia, onset of fever, days 1, 2, 3 and 6 after the onset of fever, and when the febrile episode ended. The episodes were classified as 5 bacteraemia, 3 microbiologically documented infections, 10 clinical infections, and 12 fevers of unknown origin. RESULTS: The highest PCT mean values corresponded to the group of patients with bacteraemia. Statistically significant differences (P=.04) were found on the second day after the onset of fever. The cut-off point of 0.5ng/ml showed a sensitivity of 66% and a specificity of 75%. PCR results showed statistically significant differences on days 1, 2 and 3 after the onset of fever (P=.01, P=.003, and P=.002, respectively). The cut-off point of 7.5mg/L had a sensitivity of 88% and a specificity of 58%.CONCLUSIONS:The combination of PCT and CRP is an insufficient method to detect bacterial infections and may not replace the proper clinical and microbiological diagnosis (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Calcitonin/analysis , C-Reactive Protein/analysis , Infections/physiopathology , Neutropenia/diagnosis , Biomarkers/analysis , Hematopoietic Stem Cell Transplantation , Immunocompromised Host , Immunologic Deficiency Syndromes/complicationsSubject(s)
Humans , Female , Middle Aged , Seroma/complications , Seroma/diagnosis , Seroma/microbiology , Lymphopenia/complications , Lymphopenia/physiopathology , Lymphopenia , Geotrichum/isolation & purification , Geotrichum/pathogenicity , Abdominal Pain/etiology , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Seroma/physiopathology , Seroma , Geotrichum/radiation effects , Geotrichum/ultrastructure , Diagnosis, DifferentialABSTRACT
The aim of this study is to evaluate the diagnostic performance of human epididymis protein 4 (HE4), cancer antigen 125 (Ca125) and the risk of ovarian malignancy algorithm (ROMA) in discriminating ovarian cancer from other benign gynaecological diseases. Serum levels of HE4 and Ca125 were measured in 119 women with benign gynaecological diseases, 29 patients with primary ovarian cancer, 32 patients with ovarian cancer on chemotherapy treatment (18 of them with progressive disease), 6 patients treated and free of disease and 32 healthy women. Sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios (LR ±) were calculated. Receiver operator characteristic (ROC) curves were constructed, and the areas under the curve (AUC) were calculated. High serum levels for HE4, Ca125 and ROMA were observed in cancer patients. HE4 was elevated in 12.6 %, Ca125 in 21 % and ROMA in 9.2 % in the benign group, but HE4 was not elevated in endometriosis. The AUC values for HE4, Ca125 and ROMA were 0.92, 0.911 and 0.945 respectively. The sensitivity for discriminating ovarian cancer from benign gynaecological diseases was 86.2 % for HE4 and Ca125 and 93.1 % for ROMA. The specificity was 87.4, 78.9 and 90.7 % for HE4, Ca125 and ROMA. The overall positive likelihood ratio (LR+) was 6.84 for HE4, 4.1 for Ca125 and 10.01 for ROMA. In premenopausal women, LR + was 11.86 for HE4, 5.11 for ROMA and 2.02 for Ca125. HE4 might be significant in the differential diagnosis of ovarian cancer. HE4 seems to be superior to Ca125 in terms of diagnostic performance of all premenopausal women. ROMA could help to discriminate in cases with any doubt with a high diagnostic accuracy.
Subject(s)
CA-125 Antigen/blood , Diagnosis, Differential , Genital Diseases, Female/blood , Membrane Proteins/blood , Ovarian Neoplasms/blood , Proteins/metabolism , Aged , Algorithms , Biomarkers, Tumor/blood , Female , Genital Diseases, Female/pathology , Humans , Middle Aged , Ovarian Neoplasms/pathology , Risk Factors , WAP Four-Disulfide Core Domain Protein 2Subject(s)
Geotrichosis/etiology , Geotrichum/isolation & purification , Intestinal Obstruction/surgery , Laparotomy , Lymphopenia/etiology , Postoperative Complications/microbiology , Seroma/etiology , Surgical Wound Infection/microbiology , Anastomosis, Surgical , Carcinoma, Endometrioid/surgery , Colon/surgery , Endometrial Neoplasms/surgery , Female , Geotrichosis/microbiology , Geotrichum/metabolism , Geotrichum/pathogenicity , Hemangioma , Humans , Hysterectomy , Jejunal Diseases/surgery , Jejunum/surgery , Liver Neoplasms , Middle Aged , Neoplasms, Multiple Primary , Postoperative Complications/surgery , Seroma/microbiology , Surgical Wound Infection/etiologyABSTRACT
INTRODUCTION AND OBJECTIVE: Neutropenia is a frequent sign in patients who are going to have a haematopoietic stem cell transplant (HSCT). Infection is an important complication in these patients, which is favoured by immunosuppression and the degree of neutropenia. This study aims to evaluate the diagnostic usefulness of procalcitonin (PCT) and C-reactive protein (CRP) in onco-haematological patients undergoing chemotherapy and HSCT to determine the origin of the fever. PATIENTS AND METHODS: PCT and CRP values were measured in 30 episodes of febrile neutropenia: before starting chemotherapy, appearance of neutropenia, onset of fever, days 1, 2, 3 and 6 after the onset of fever, and when the febrile episode ended. The episodes were classified as 5 bacteraemia, 3 microbiologically documented infections, 10 clinical infections, and 12 fevers of unknown origin. RESULTS: The highest PCT mean values corresponded to the group of patients with bacteraemia. Statistically significant differences (P=.04) were found on the second day after the onset of fever. The cut-off point of 0.5ng/ml showed a sensitivity of 66% and a specificity of 75%. PCR results showed statistically significant differences on days 1, 2 and 3 after the onset of fever (P=.01, P=.003, and P=.002, respectively). The cut-off point of 7.5mg/L had a sensitivity of 88% and a specificity of 58%. CONCLUSIONS: The combination of PCT and CRP is an insufficient method to detect bacterial infections and may not replace the proper clinical and microbiological diagnosis.
Subject(s)
C-Reactive Protein/analysis , Calcitonin/blood , Fever/blood , Hematopoietic Stem Cell Transplantation , Neutropenia/blood , Protein Precursors/blood , Adult , Aged , Biomarkers/blood , Calcitonin Gene-Related Peptide , Female , Fever/complications , Humans , Male , Middle Aged , Neutropenia/complications , Predictive Value of TestsSubject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Antineoplastic Agents/therapeutic use , Hepatitis B virus/physiology , Hepatitis B/drug therapy , Aged , Aged, 80 and over , Alemtuzumab , Antibodies, Monoclonal, Humanized/metabolism , Antigens, CD/metabolism , Antigens, Neoplasm/metabolism , Antineoplastic Agents/metabolism , CD52 Antigen , Carrier State , DNA, Viral/genetics , Female , Glycoproteins/metabolism , Hepatitis Antibodies/analysis , Hepatitis B/immunology , Hepatitis B Surface Antigens/analysis , Hepatitis B virus/genetics , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Lymphoma, Non-Hodgkin/complications , Mutation/genetics , Virus Activation/drug effectsSubject(s)
Humans , Female , Aged , Aged, 80 and over , Hepatitis B virus , Hepatitis B virus/isolation & purification , Hepatitis B virus/metabolism , Hepatitis B/diagnosis , Hepatitis B/drug therapy , Flow Cytometry/methods , Flow Cytometry , Hepatitis B virus/pathogenicity , Hepadnaviridae , Hepadnaviridae/isolation & purification , Hepadnaviridae Infections/drug therapyABSTRACT
No disponible