Laura Cudillo

Mucormycosis in patients with haematological malignancies: a retrospective clinical study of 37 cases

A retrospective study of 37 patients with haematological malignancy (21 acute myeloid leukaemia, 11 acute lymphoid leukaemia, two lymphoma, two hairy cell leukaemia, one Hodgkins disease) and histologically documented mucormycosis was conducted to evaluate the clinical characteristics and ascertain the factors which influenced the outcome from mycotic infection. Patients were admitted to 18 haematology divisions in tertiary care or university hospitals in Italy between 1987 and 1995.

Fatal haemoptysis in pulmonary filamentous mycosis: An underevaluated cause of death in patients with acute leukaemia in haematological complete remission. A retrospective study and review of the literature

A retrospective study on a consecutive series of 116 patients affected by acute leukaemia with documented pulmonary filamentous mycosis (FM) admitted between 1987 and 1992 to 14 tertiary‐care hospitals in Italy was made in order to evaluate the characteristics of those patients who developed fatal massive haemoptysis.

Incidence and outcome of invasive fungal diseases after allogeneic stem cell transplantation: A prospective study of the gruppo italiano trapianto midollo osseo (GITMO)

Epidemiologic investigation of invasive fungal diseases (IFDs) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) may be useful to identify subpopulations who might benefit from targeted treatment strategies. The Gruppo Italiano Trapianto Midollo Osseo (GITMO) prospectively registered data on 1858 consecutive patients undergoing allo-HSCT between 2008 and 2010. Logistic regression analysis was performed to identify risk factors for proven/probable IFD (PP-IFD) during the early (days 0 to 40), late (days 41 to 100), and very late (days 101 to 365) phases after allo-HSCT and to evaluate the impact of PP-IFDs on 1-year overall survival. The cumulative incidence of PP-IFDs was 5.1% at 40 days, 6.7% at 100 days, and 8.8% at 12 months post-transplantation. Multivariate analysis identified the following variables as associated with PP-IFDs: transplant from an unrelated volunteer donor or cord blood, active acute leukemia at the time of transplantation, and an IFD before transplantation in the early phase; transplant from an unrelated volunteer donor or cord blood and grade II-IV acute graft-versus-host disease (GVHD) in the late phase; and grade II-IV acute GVHD and extensive chronic GVHD in the very late phase. The risk for PP-IFD was significantly higher when acute GVHD was followed by chronic GVHD and when acute GVHD occurred in patients undergoing transplantation with grafts from other than matched related donors. The presence of PP-IFD was an independent factor in long-term survival (hazard ratio, 2.90; 95% confidence interval, 2.32 to 3.62; P < .0001). Our findings indicate that tailored prevention strategies may be useful in subpopulations at differing levels of risk for PP-IFDs.

Characterization of coagulase-negative staphylococcal isolates from blood with reduced susceptibility to glycopeptides and therapeutic options

BackgroundCoagulase-negative staphylococci (CoNS) are a major cause of nosocomial blood stream infection, especially in critically ill and haematology patients. CoNS are usually multidrug-resistant and glycopeptide antibiotics have been to date considered the drugs of choice for treatment. The aim of this study was to characterize CoNS with reduced susceptibility to glycopeptides causing blood stream infection (BSI) in critically ill and haematology patients at the University Hospital Tor Vergata, Rome, Italy, in 2007.MethodsHospital microbiology records for transplant haematology and ICU were reviewed to identify CoNS with elevated MICs for glycopeptides, and isolates were matched to clinical records to determine whether the isolates caused a BSI. The isolates were tested for susceptibility to new drugs daptomicin and tigecycline and the genetic relationship was assessed using f-AFLP.ResultsOf a total of 17,418 blood cultures, 1,609 were positive for CoNS and of these, 87 (5.4%) displayed reduced susceptibility to glycopeptides. Clinical review revealed that in 13 cases (7 in haematology and 6 in ICU), CoNS with reduced susceptibility to glycopeptides were responsible for a BSI. Staphylococcus epidermidis was the causative organism in 11 instances and Staphylococcus haemolyticus in 2. The incidence of oxacillin resistance was high (77%), although all isolates remained susceptible to linezolid, daptomycin and tigecycline. Fingerprinting of CoNS identified one clonal relationship between two isolates.ConclusionMulti-resistant CoNS with reduced susceptibility to glycopeptides, although still relatively infrequent in our hospital, are emerging pathogens of clinical concern. Surveillance by antibiotyping with attention to multi-resistant profile, and warning to clinicians, is necessary.

A prospective study comparing quantitative Cytomegalovirus (CMV) polymerase chain reaction in plasma and pp65 antigenemia assay in monitoring patients after allogeneic stem cell transplantation

BackgroundLow levels of Cytomegalovirus (CMV) viral load are frequently detected following allogeneic stem cell transplantation (SCT) and CMV disease may still develop in some allogeneic SCT patients who have negative pp65-antigenemia (pp65-Ag) or undetectable DNA. Pp65Ag is a sensitive method to diagnose CMV infection. Quantitative CMV-DNA PCR assay in plasma has been proposed to monitor CMV infection in SCT patients. We evaluated the clinical utility of pp65Ag and PCR assay in plasma of SCT recipients.MethodsIn a prospective longitudinal study, 38 consecutive patients at risk of CMV infection (donor and/or recipient CMV seropositive) were weekly monitored for CMV infection by both quantitative CMV-PCR in plasma (COBAS AMPLICOR CMV MONITOR) and pp65 Ag, during the first 100 days after SCT.ResultsA total of 534 blood samples were simultaneously analysed for pp65Ag and PCR. Overall, 28/38 patients (74%) had active CMV infection within 100 days from SCT. In 16 patients, CMV was first detected by pp65 Ag alone; in 5 patients by both methods and in 6 by PCR assay alone; one patient had CMV biopsy-proven intestinal disease without pp65Ag and PCR assays positivity before CMV disease. Overall, three patients developed intestinal CMV disease (7.9%): one had negative both pp65Ag and PCR assays before CMV disease, one had disease and concomitant positivity of both methods, while in the remaining patient, only pp65Ag was positive before CMV disease.ConclusionPlasma PCR(COBAS AMPLICOR CMV MONITOR) and pp65Ag assays were effective in detecting CMV infection, however, discordance between both methods were frequently observed. Plasma PCR and pp65Ag assays may be complementary for diagnosis and management of CMV infection.

Breakthrough fusariosis in a patient with acute lymphoblastic leukemia receiving voriconazole prophylaxis.

nema pallidum antibody, and a diagnosis of relapsed secondary syphilis was made. Syphilitic hepatitis was suspected on the basis of a 2-fold increase in the level of alkaline phosphatase from previously normal levels, a 2-fold increase in the level of liver enzymes from baseline, a 5-fold increase in total bilirubin to 1200 mmol/L, and the exclusion of other etiologies, including viral hepatitis (A and B) and alcohol abuse. Two hours after the patient received intramuscular penicillin V, his temperature increased to 39.0ЊC. Within 24 h, the AST and ALT levels had increased to 1331 U/L and 328 U/L, respectively, and by 36 h, the patient was encephalopathic, with an international normalized ratio of 2.16, a total bilirubin of 364 mmol/L (direct bilirubin, 197 mmol/L). A diagnosis of Jarisch-Herxheimer reaction was made. Over the next week in the intensive care unit, the patients condition and liver status stabilized. Further antibiotic therapy for syphilis was administered without incident. The patient was eventually discharged but died of decompensated liver disease 6 months later. Syphilitic infection of the liver is well documented [4–6]. This case illustrates the potential for hepatic complications resulting from syphilitic infection and its treatment in cases of HIV-HCV coinfec-tion. Liver injury due to syphilis is thought to be immune mediated, although obstruction of portal lymph nodes by syph-ilitic adenitis has been proposed. The histological findings are variable and non-specific and include portal inflammatory infiltrates, hepatocellular necrosis, granu-loma, and cholestatis. There is insufficient knowledge of the effects of HIV infection, if any, on the histological manifestations of syphilitic hepatitis. The Jarisch-Herxheimer reaction is clearly life-threatening in patients with preexisting cirrhosis and limited hepatic synthetic reserve. The rapid lysis of spi-rochetes releases heat-stable pyrogen, which produces this febrile illness. It is unclear what influence HIV-related immune suppression has on the severity of this reaction. It is noteworthy that among an HIV-seropositive cohort with syphilitic hepatitis (), no one developed a Jar-n p 7 isch-Herxheimer reaction [7]. Acute hepatitis C in HIV-infected men who have sex with men. HIV Med 2004; 5:303–6. 4. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 27-1983: a 25-year-old homosexual man with persistent fever and liver disease. Sir—Voriconazole is a broad-spectrum triazole antifungal drug with excellent activity against Aspergillus species, most Candida species, and several less-common invasive fungi but with limited activity against pathogenic Zygomycetes. Reports on the successful use of voriconazole therapy for patients …

Management of carbapenem resistant Klebsiella pneumoniae infections in stem cell transplant recipients: An italian multidisciplinary consensus statement

The increasing incidence of infections by carbapenem-resistant enterobacteria (CRE), in particular carbapenem-resistant Klebsiella pneumoniae (CRKp), is a significant public health challenge worldwide.[1][1] The interim results of the last European survey on CRE (EuSCAPE project 2013) indicate that

Fibrin glue for refractory hemorrhagic cystitis after unrelated marrow, cord blood, and haploidentical hematopoietic stem cell transplantation.

BACKGROUND: Patients undergoing hematopoietic stem cell transplant (HSCT) are particularly exposed to the risk of developing hemorrhagic cystitis (HC), which is characterized by symptoms ranging from macroscopic hematuria to renal failure. Although HC significantly affects the quality of life and in a few cases becomes intractable leading to patient death, its therapeutic management has not been established. Fibrin glue (FG), a hemostatic agent derived from human plasma, has been largely employed in different surgical settings including urologic procedures.

Platelet gel for treatment of mucocutaneous lesions related to graft-versus-host disease after allogeneic hematopoietic stem cell transplant.

BACKGROUND: Platelet (PLT) gel has been successfully used in tissue regeneration of diabetic/surgical wounds through the releasing of growth factors such as basic fibroblast growth factor and PLT‐derived growth factor. Therefore, the PLT gel could represent a therapeutic tool in treating the deep and painful wounds sometimes occurring during graft‐versus‐host disease (GVHD).

Procalcitonin is a reliable marker of severe systemic infection in neutropenic haematological patients with mucositis

Patients with neutropenia are exposed to a high risk for infections in which fever is often the unique symptom [1]. Systemic infections remain the main cause of mortality in these patients therefore, the policy for infection management is to promptly administer empirical antibiotic therapy in order to avoid the increased risk of mortality related to the treatment delay [2]. However, microbiological diagnostic tests are not sufficiently rapid, sensitive or specific to indentify the microbial causes of fever, and a considerable number of patients suffer febrile episodes over a prolonged period without a definite microbiological etiology.