Arpita Bhattacharyya

Extraintestinal Infections Caused by Non-toxigenic Vibrio cholerae non-O1/non-O139

Vibrio cholerae is an aerobic, sucrose fermentative Gram-negative bacterium that generally prevails in the environment. Pathogenic V. cholerae is well-known as causative agent of acute diarrhea. Apart from enteric infections, V. cholerae may also cause other diseases. However, their role in causing extraintestinal infections is not fully known as it needs proper identification and evaluation. Four cases of extraintestinal infections due to V. cholerae non-O1/non-O139 have been investigated. The isolates were screened for phenotypic and genetic characteristics with reference to their major virulence genes. Serologically distinct isolates harbored rtx, msh, and hly but lacked enteric toxin encoding genes that are generally present in toxigenic V. cholerae. Timely detection of this organism can prevent fatalities in hospital settings. The underlying virulence potential of V. cholerae needs appropriate testing and intervention.

Jumping translocation in a case of de novo infant acute myeloid leukemia.

An infant presented with fever and purulent discharge from the left ear, proptosis of the right eye, and hepatosplenomegaly. She was diagnosed with acute monoblastic leukemia on morphological and flowcytometric analysis of the bone marrow. Karyotyping showed a jumping translocation (JT) involving the long arm of chromosome 1 as the sole cytogenetic abnormality in 29 metaphases. The patient died within 2 months of diagnosis. The presence of JT in a de novo infant AML as a sole cytogenetic abnormality indicates its possible role in leukemogenesis unlike previous reports that have implicated its role in tumor progression only. Pediatr Blood Cancer 2014;61:387–389.

Novel t(2;12)(q31;p13) in a case of pediatric T-cell acute lymphoblastic leukemia.

Background: The role of ETV6 in B-cell acute lymphoblastic leukemia (ALL) has been extensively studied, whereas only rare cases of ETV6 involvement in pediatric T-cell ALL have been described. Observation: We report a case of T-cell ALL in a 13-year-old boy with t(2;12)(q31;p13) involving ETV6, resulting in the relocation of the ETV6 from 12p13 to 2q31 locus that harbors the class 1 homeobox gene (HOX) cluster D, which is expressed during the early stages of T-cell development. Conclusions: We report a novel translocation in T-cell ALL highlighting the involvement of ETV6 and potentially the HOXD gene cluster in a case of T-cell ALL.

Clinical outcome, healthcare cost and length of hospital stay among patients with bloodstream infections and acute leukemia in a cancer center in eastern india

Chelsea Elizabeth Muennichow, Gaurav Goel MD, DNB, MNAMS, Arpita Bhattacharyya FRCP, Reena Nair MD, Mammen Chandy MD, FRACP, FRCPA, FRCP and Sanjay Bhattacharya MD, DNB, FRCPath Department of Molecular and Cell Biology, Neurobiology, University of California at Berkeley, Berkeley, California, Department of Microbiology, Tata Medical Center, Kolkata, India, Department of Pediatric Oncology, Tata Medical Center, Kolkata, India and Department of Clinical Hematology, Tata Medical Center, Kolkata, India

Undernutrition in Pediatric Malignancy

To the Editor:Undernutrition, prevalent in 8–60%, results in delay in treatment, dose-reductions, complications, and prolonged hospital-stay in children with cancer [1]. We performed a retrospective audit from the first anthropometric records for children <18 y, diagnosed with malignancy between January–December 2016, after ethical approval by the hospital committee. Weight-forheight/length for ≤5 y old, and body-mass-index for >5 y old children were calculated. Z-score < −2SD was classified as ‘undernutrition,’ < −3SD as ‘severe undernutrition,’ and > + 2SD as ‘overweight’. Three hundred and eighty one children were enrolled (hematological malignancies: 59%, solid tumours: 41%). Median age was 6 y (range: 15 d to 18 y). Male:female ratio was 1.4:1. Anthropometric data was available in 303. Sixty one (20%) children had undernutrition (severely undernourished: 22), 221 (73%) were normal and 21 (7%) were over-weight. Comparison between children with undernutrition (n = 61) and normal nutritional status (n = 221) demonstrated that those >5 y, and those with solid tumours, were likely to be undernourished (p = 0.03 and p = 0.004, respectively). The gender difference failed to reach statistical significance (p = 0.052). Children who defaulted from follow-up were more likely to have had undernutrition at diagnosis (p = 0.004) (Table 1). Consultation with the nutritionist was advised for children with, and, at-risk of malnutrition. Four hundred consultations were provided for 123 children. Routes of intervention included oral (58.5%), nasogastric (26.8%), mixed (11%) and parenteral (3.8%). At the last follow-up of children treated at our centre (n = 161), there was no significant difference between the initially under-nourished and normal children with respect to adverse outcomes (death/relapse/ progression) (p = 0.3) (Table 1). Kumar et al. had reported malnutrition in 52% among children with lymphoblastic leukaemia, with 36% losing weight in induction [2]. Prevalence was 30% in Delhi, and was frequent in solid tumours and those from rural background [3]. Delayed presentation and disease biology plausibly result in higher prevalence of under-nutrition in solid tumours [3, 4]. Children >5 y, who have completed their routine immunization, have infrequent contact with the healthcare system and could also have presented late, with undernutrition. The association between treatmentdefault and undernutrition was striking in our audit. Poverty and lack of education could provide the possible links. Regular review by nutritionists and limited follow-up would explain lack of effect of under-nutrition at diagnosis on treatment outcomes. Limitations of the study include lack of measurement of mid-upper-arm circumference and biochemical parameters, restriction to a single centre, and limited follow-up. Awareness and use of screening tools could lead to early diagnosis of cancer-related under-nutrition in children [5]. * Anirban Das anirban.das13@gmail.com; anirban.das@tmckolkata.com