ABSTRACT
<p><b>BACKGROUND</b>Acute leukemia is the most common pediatric hematological malignancy. Bloodstream infections (BSIs) are severe complications in these patients during chemotherapy. This study aimed to explore the clinical presentation and etiology of BSI, as well as the common sites of infection, and to provide a basis for the rational regarding antibiotic use.</p><p><b>METHODS</b>We performed a retrospective chart review of all pediatric patients who had acute leukemia accompanied by a BSI in our hospital from December 2011 to September 2015. All patients were selected based on clinical presentation and had to have at least one positive blood culture for inclusion. The basic clinical characteristics, blood culture results, and antimicrobial susceptibilities were analyzed.</p><p><b>RESULTS</b>All 231 patients had a fever; of them, 12 patients continued to have a fever. Twenty-five patients had nonremitting (NR) leukemia, and 206 patients achieved complete remission (CR). Differences in the duration of fever between the NR and CR groups were significant (9.6 ± 7.9 vs. 5.1 ± 3.8 days, P= 0.016). One hundred and eighty patients had agranulocytosis. Differences in fever duration between the agranulocytosis and nonagranulocytosis groups were significant (6.2 ± 5.1 vs. 4.1 ± 2.6 days, P= 0.001). The other sites of infection in these 231 patients were the lung, mouth, digestive tract, and rectum. Blood culture comprised 2635 samples. There were 619 samples, which were positive. Of the 619 positive blood culture samples, 59.9% had Gram-negative bacteria, 39.3% had Gram-positive bacteria, and 0.8% had fungus. The primary pathogens were Pseudomonas aeruginosa, Enterobactercloacae, Escherichia coli, and Klebsiella pneumoniae. Of these 231 patients, 217 patients were cured. The effective treatment ratio was 94%.</p><p><b>CONCLUSIONS</b>Gram-negative bacteria were the main pathogenic bacteria in patients with acute leukemia in our center. NR primary illness, agranulocytosis, and drug-resistant pathogenic bacteria were all risk factors for poor prognosis.</p>
ABSTRACT
The objective of this study was to explore the useful value of circulating galactomannan (GM) for early diagnosis of invasive aspergillosis. All 141 patients were classified as 103 patients of clinical and possible diagnosis, and 38 non-Aspergillus patients. 209 serum samples for the detection of GM by Platelia Aspergillus were collected before anti-fungal vaccine therapy. ELISA method was used in detection of GM. The results showed that (1) the sensitivity of 87.5%, specificity of 81.6%, positive prediction of 66.7% and negative prediction of 93.9% were determined by using cut-off value. According to the result of ELISA, the clinical diagnosed patients was up to 48, while the possible diagnosed patients were 55. (2) Among 62 patients with consecutive examinations of serum samples, 50 patients were successfully diagnosed and treated, while 12 patients died. A progressive reduction of GM level was found in survivors, however, the patients of poor prognosis showed higher antigen titres. It is concluded that GM test has more significance for earlier diagnosis of aspergillosis, the concentration of GM is related to prognosis of disease.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Aspergillosis , Diagnosis , Aspergillus , Enzyme-Linked Immunosorbent Assay , Hematologic Diseases , Diagnosis , Microbiology , Mannans , Blood , Predictive Value of Tests , Sensitivity and SpecificityABSTRACT
<p><b>OBJECTIVE</b>To explore the value of circulating galactomannan (GM) screening for early diagnosis and treatment monitoring of invasive aspergillosis (IA).</p><p><b>METHODS</b>Serum samples from 141 IA patients for the detection of GM by Platelia Aspergillus (Bia-Rad) were collected before and after systematic anti-fungal therapy.</p><p><b>RESULTS</b>(1) An increase in the clinical diagnosis rate of IA was obtained on the result of GM detection. The GM positivity appeared (10+/-4.1) (8-15) d before positive sputum culture, while (12.6+/-5.7) (6-22) d before the CT positive image. (2) Among the 62 patients with consecutive serum samples, 50 were success in treatment and 12 died. A progressive decrease of GM level was found in the former group, while the rising antigen titres were found in the latter.</p><p><b>CONCLUSION</b>Compared with other diagnostic test, GM test has an obvious advantage of higher positivity and earlier result. The anti-fungal effectiveness can be estimated by dynamic detection of serum GM.</p>
