Most of the studies about invasive Candida infections in cancer patients have focused on haematological patients. The aim of this study was to provide information about risk factors for candidaemia ...in patients with solid tumours.
Retrospective cohort study. During a 9-year period (1995-2003) we reviewed all cases of candidaemia that affected cancer patients in Santa Casa Complexo Hospitalar, Brazil.
During the period of study, 210 patients had the diagnosis of candidaemia in our medical centre, and 83 of these patients had cancer (39.5%). The majority of patients with cancer had solid tumours (77.1%), mostly in the alimentary tract. Most of solid cancers were non-metastatic (71.9%). Major diagnoses in patients with haematological neoplasia were acute leukaemia (n = 13), high grade non-Hodgkin lymphoma (n = 5) and Hodgkin's disease (n = 1). Non-Candida albicans species caused 57.8% of the episodes of candidaemia in patients with cancer, mainly in patients with haematological malignancies (p = 0.034). Neutropenia and treatment with corticosteroids were more frequent in the haematological group, in comparison with patients with solid tumours. Only 22.2% of patients with solid tumours were neutropenic before candidaemia. Nonetheless, the presence of ileus and the use of anaerobicides were independent risk factors for candidaemia in patients with solid cancers. The overall mortality in cancer patients with candidaemia was 49.4%. We then compared 2 groups of adult patients with candidaemia. The first was composed of non-neutropenic patients with solid tumours, and the second group included patients without cancer. We found that central venous catheters and gastrointestinal surgery were independently associated with candidaemia in patients with solid tumour.
Cancer patients with candidaemia seem to have very different predisposing factors to acquire the infection when stratified according to baseline diseases. This study provides some useful clinical information regarding risk for candidaemia in patients with solid tumours.
To report an outbreak of Pichia anomala fungemia that occurred in a Brazilian pediatric intensive care unit (ICU) from October 2002 to January 2004.
Unmatched case-control study.
We randomly selected ...four control-patients for each case-patient from a list of all patients admitted to the ICU for at least 48 hours during the outbreak. A second control group was composed of all consecutive patients with nosocomial candidemia in the ICU during the outbreak. An environmental study was performed, and genetic relatedness among the clinical isolates was characterized by randomly amplified polymorphic DNA assay.
During the study period, 1,046 children were admitted to the pediatric ICU, 17 of whom developed P. anomala fungemia (attack rate, 1.6%). The median age was 1.1 years, and the main underlying conditions were congenital malformations (35.3%) and neoplastic diseases (11.8%). The overall mortality rate was 41.2%. Two patients received no antifungal treatment; all of the others were treated with amphotericin B. On multivariate analysis, only the presence of a central venous catheter was significantly associated with P. anomala fungemia. The yeast was not found on healthcare workers' hands or in the environment. Molecular studies showed that the outbreak was caused by a single strain. The distribution of risk factors was similar between patients with P. anomala fungemia and control-patients with candidemia.
This study highlights the importance of P. anomala as an emerging nosocomial fungal pathogen. Patients with P. anomala fungemia seem to have risk factors in common with those who have candidemia.
Even though amphotericin B is associated with considerable hematological toxicity, this subject has been poorly studied. This retrospective cohort study assessed the incidence and predictors of ...hematological toxicity in patients treated with different amphotericin B formulations: amphotericin B deoxycholate (d-AmB), liposomal amphotericin B (L-AmB) and amphotericin B lipid complex (ABLC). A total of 497 patients were included. Severe anemia was independently associated with human immunodeficiency virus (HIV) infection (odds ratio OR 1.79; 95% confidence interval CI: 1.03-3.06). L-AmB use was marginally associated with reduced risk for severe anemia (OR 0.61; CI: 0.32-1.11). Severe leukopenia was associated with ABLC use (OR 2.58; CI: 1.05-6.21) and hematological cancer (OR 4.61; CI: 2.07-10.38). Hematological cancer (OR 5.00; CI 2.79-8.97) was independently associated with risk of severe thrombocytopenia. In this study, significant hematological toxicity was associated with amphotericin B treatment, along with previous hematological disease and use of myelotoxic drugs. Close monitoring is required when managing patients receiving amphotericin B formulations.
Invasive pulmonary aspergillosis is typically caused by a single Aspergillus species, most frequently Aspergillus fumigatus. Here we report that a lung transplant recipient developed invasive ...aspergillosis due to a mixed infection caused by Aspergillus flavus and A. fumigatus. The implications for this unusual finding are discussed.
Why don't we just do what we have to do? Pasqualotto, Alessandro Comarú; Severo, Luiz Carlos
The Journal of infection,
10/2005, Letnik:
51, Številka:
3
Journal Article
Clinical protocols of 28 cases of cryptococcemia studied between April 1995 and November 2002 were reviewed. The varieties of Cryptococcus neorformans, the underlying disease, and the severity and ...outcome of the disease were emphasized. Most patients were immunossupressed (89.3% with AIDS) and Cryptococcus neoformans var. grubii was the main recovered variety (92.8%). Regardless of antifungal treatment, in-hospital mortality was 41% strongly associated with APACHE II score, >14 (p<0.01).
Strongyloides stercoralis in the urine Pasqualotto, Alessandro C; Zborowski, Mirna F; dos Anjos, Mauro ...
Transactions of the Royal Society of Tropical Medicine and Hygiene,
01/2009, Letnik:
103, Številka:
1
Report
PDF
