ABSTRACT
A 5-year-old patient treated for acute lymphoblastic leukaemia (ALL) developed proven pulmonary invasive fungal disease (IFD) due to Actinomucor elegans. While completing ALL treatment according to AIEOP ALL protocol 2009 for further 15 months, antifungal treatment with liposomal amphotericin B and intermittent additional posaconazole was continued until immune reconstitution 7 months after the end of ALL treatment. Repeated imaging guided treatment decisions. Twenty-six and 19 months after the end of ALL treatment and antifungal treatment, respectively, the patient is still in the first complete remission and shows no signs of active invasive fungal disease (IFD).
Subject(s)
Amphotericin B/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Invasive Fungal Infections/drug therapy , Lung Diseases, Fungal/drug therapy , Mucormycosis/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Antifungal Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Asparaginase/administration & dosage , Child, Preschool , Cyclophosphamide/administration & dosage , Cytarabine/administration & dosage , Daunorubicin/administration & dosage , Humans , Lung Diseases, Fungal/microbiology , Male , Mercaptopurine/administration & dosage , Methotrexate/administration & dosage , Mucorales/isolation & purification , Precursor Cell Lymphoblastic Leukemia-Lymphoma/microbiology , Prednisone/administration & dosage , Remission Induction , Triazoles/therapeutic use , Vincristine/administration & dosageABSTRACT
UNLABELLED: Procalcitonin /PCT/ is a reliable marker for the diagnosis of early onset neonatal sepsis but its sensitivity and specificity in literature vary widely mostly due to existing unclarity on its normal values and kinetics in the postnatal period. Aim of our research is to study the normal values of PCT and its dynamics during the first 24 hours of life for the Bulgarian population. MATERIALS & METHODS: 70 healthy neonates were prospectively enrolled and separated in the following 3 groups (Group 1- immediately afterbirth; Group 2- 0-12 h afterbirth; Group 3- 12-24 h afterbirth) regarding the age at the time of PCT testing. The selected method of PCT testing is direct chemiluminescence. Results were analyzed with Statistical Package for Social Science (SPSS). RESULTS: For group 1 and group 2 the mean PCT level was 0.06 and 0.59 ng/ml respectively. In group 3 PCT concentrations reached peak mean values of 3.35ng/ml. In the last group also the greatest variations were observed PCTmin - 0.31 ng/ml, PCTmax - 23.81 ng/ml. No correlation between PCT concentrations, sex, mode of delivery and parity was found. CONCLUSION: During the first 24 hours of life PCT values in healthy term neonates show broad variations, most marked in the interval 12-24 h. The dynamics of PCT concentrations is characterized by a gradual increase from birth reaching peak levels approximately 24 hours later.
