Antibacterials/antineoplastics
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Reactions 1213 - 2 Aug 2008 Author comment: Predisposing factors to disseminated Candida infection in patients with leukaemia include younger S Antibacterials/antineoplastics age, prolonged neutropenia, prophylactic antibiotic use, severe mucositis and TPN. The predisposing factors for Invasive pulmonary aspergillosis and hepatosplenic invasive aspergillosis in immunocompromised patients candidiasis (one fatal): 2 case reports include cytotoxic chemotherapy, prolonged neutropenia, and Two boys, aged 15 and 16 years, developed combined corticosteroids or other immunosuppressive therapies. invasive pulmonary aspergillosis and hepatosplenic Neutropenic enterocolitis can be one of the predisposing candidiasis during treatment with antineoplastics [drugs, factors for development of hepatosplenic candidiasis. dosages and duration of treatment to reaction onset not clearly stated] and antibacterials. The 15-year-old boy subsequently Avci Z, et al. Double invasive fungal infection and typhlitis in children with acute died due to pulmonary haemorrhage. lymphoblastic leukemia. Pediatric Hematology and Oncology 25: 99-106, No. 2, 2008 - Turkey 801118344 The 15-year-old boy was diagnosed with acute lymphoblastic leukaemia (ALL) and started receiving induction chemotherapy according to St Jude Total XIII protocol. On day 15 of induction chemotherapy, he developed febrile neutropenia and oral mucositis. He had expiratory wheezing over both lung fields and a chest -x-ray showed hyperinflation in both lung fields. He received empirical antibacterial treatment with imipenem and amikacin [dosages not stated] along with nebulised salbutamol [albuterol] and beclometasone. Total parenteral nutrition (TPN) was started. On day 5 of antibacterial treatment, he developed abdominal pain and vomiting. He had tenderness in his right lower abdominal quadrant, which suggested neutropenic enterocolitis. Metronidazole was added and oral nutrition was stopped. On day 7, an abdominal CT scan showed thickening of the ascending colon and caecum, consistent with enterocolitis. Nodular hypodense areas in the liver and spleen parenchyma were observed, suggestive of hepatosplenic candidiasis. He started receiving liposomal amphotericin B and vancomycin and, 1 day later, developed haemoptysis and pleuritic chest pain. Examination showed fine rales in his right lung. A chest CT scan showed multiple nodular consolidation areas in the lung parenchyma, with some cavitations. Laboratory investigations showed the following: WBC count 0.232 × 10 9 /L, platelet count 17.5 × 10 9 /L, no neutrophils in a peripheral blood smear, and INR 1.7. He received vitamin K, fresh-frozen plasma and thrombocyte suspensions. Blood and sputum cultures revealed amphotericin B-sensitive Candida tropicalis and Aspergillus fumigatus, respectively. On day 14 after antibacterial initiation, his neutropenia, thrombocytopenia, coagulopathy and enterocolitis symptoms recovered but, 6 days later, he died due to massive pulmonary haemorrhage. Postmortem analysis showed lesions consistent with invasive candidiasis of the liver and invasive aspergillosis of the lungs. The 16-year-old boy, who had a history of a dairy product- rich diet, was diagnosed with ALL, and started receiving chemotherapy according to ALL-BFM 95 protocol. After receiving high-dose methotrexate and cytarabine during consolidation phase, he developed febrile neutropenia and oral mucositis. He then started receiving empirical antibacterial therapy with cefepime and amikacin [dosages not stated]. On day 2 of antibacterial treatment, he developed abdominal pain and tenderness in his right lower abdominal quadrant. Abdominal ultrasonography and CT scan showed neutropenic enterocolitis. He started receiving metronidazole and TPN. He had a WBC count of 0.02 × 10 9 /L with no neutrophils observed in the peripheral blood smear. On day 6 of antibacterial treatment, he started receiving empirical liposomal amphotericin B and a granulocyte colony- stimulating factor; at this time, he had normal chest CT scan findings. Febrile neutropenia showed improvement on day 11 of antibacterial treatment, but he had increased serum alkaline phosphatase (1710 U/L) and galactomannan (8.1) levels. Blood culture obtained before antifungal therapy initiation showed amphotericin B-sensitive Candida kefyr. Antibacterials were discontinued on day 14. After 2 days, he had recurrent fever. Repeat chest CT scan findings were consistent with invasive pulmonary aspergillosis. Abdominal CT scan was indicative of hepatosplenic candidiasis. His liposomal amphotericin B dose was increased. Antifungal therapy was stopped on day 42. He remained in complete remission and maintenance therapy was continued. 1 Reactions 2 Aug 2008 No. 1213 0114-9954/10/1213-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antibacterials/antineoplastics
Reactions 1213 - 2 Aug 2008
Author comment: Predisposing factors to disseminatedCandida infection in patients with leukaemia include younger SAntibacterials/antineoplastics age, prolonged neutropenia, prophylactic antibiotic use,severe mucositis and TPN. The predisposing factors forInvasive pulmonary aspergillosis and hepatosplenicinvasive aspergillosis in immunocompromised patientscandidiasis (one fatal): 2 case reportsinclude cytotoxic chemotherapy, prolonged neutropenia, andTwo boys, aged 15 and 16 years, developed combinedcorticosteroids or other immunosuppressive therapies.invasive pulmonary aspergillosis and hepatosplenicNeutropenic enterocolitis can be one of the predisposingcandidiasis during treatment with antineoplastics [drugs,factors for development of hepatosplenic candidiasis.dosages and duration of treatment to reaction onset not clearly
stated] and antibacterials. The 15-year-old boy subsequently Avci Z, et al. Double invasive fungal infection and typhlitis in children with acutedied due to pulmonary haemorrhage. lymphoblastic leukemia. Pediatric Hematology and Oncology 25: 99-106, No. 2,
2008 - Turkey 801118344The 15-year-old boy was diagnosed with acutelymphoblastic leukaemia (ALL) and started receiving inductionchemotherapy according to St Jude Total XIII protocol. Onday 15 of induction chemotherapy, he developed febrileneutropenia and oral mucositis. He had expiratory wheezingover both lung fields and a chest -x-ray showed hyperinflationin both lung fields. He received empirical antibacterialtreatment with imipenem and amikacin [dosages not stated]along with nebulised salbutamol [albuterol] andbeclometasone. Total parenteral nutrition (TPN) was started.On day 5 of antibacterial treatment, he developed abdominalpain and vomiting. He had tenderness in his right lowerabdominal quadrant, which suggested neutropenicenterocolitis. Metronidazole was added and oral nutrition wasstopped. On day 7, an abdominal CT scan showed thickeningof the ascending colon and caecum, consistent withenterocolitis. Nodular hypodense areas in the liver and spleenparenchyma were observed, suggestive of hepatospleniccandidiasis. He started receiving liposomal amphotericin Band vancomycin and, 1 day later, developed haemoptysis andpleuritic chest pain. Examination showed fine rales in his rightlung. A chest CT scan showed multiple nodular consolidationareas in the lung parenchyma, with some cavitations.Laboratory investigations showed the following: WBC count0.232 × 109/L, platelet count 17.5 × 109/L, no neutrophils in aperipheral blood smear, and INR 1.7. He received vitamin K,fresh-frozen plasma and thrombocyte suspensions. Blood andsputum cultures revealed amphotericin B-sensitive Candidatropicalis and Aspergillus fumigatus, respectively. On day 14after antibacterial initiation, his neutropenia,thrombocytopenia, coagulopathy and enterocolitis symptomsrecovered but, 6 days later, he died due to massive pulmonaryhaemorrhage. Postmortem analysis showed lesions consistentwith invasive candidiasis of the liver and invasive aspergillosisof the lungs.
The 16-year-old boy, who had a history of a dairy product-rich diet, was diagnosed with ALL, and started receivingchemotherapy according to ALL-BFM 95 protocol. Afterreceiving high-dose methotrexate and cytarabine duringconsolidation phase, he developed febrile neutropenia andoral mucositis. He then started receiving empiricalantibacterial therapy with cefepime and amikacin [dosages notstated]. On day 2 of antibacterial treatment, he developedabdominal pain and tenderness in his right lower abdominalquadrant. Abdominal ultrasonography and CT scan showedneutropenic enterocolitis. He started receiving metronidazoleand TPN. He had a WBC count of 0.02 × 109/L with noneutrophils observed in the peripheral blood smear. On day 6of antibacterial treatment, he started receiving empiricalliposomal amphotericin B and a granulocyte colony-stimulating factor; at this time, he had normal chest CT scanfindings. Febrile neutropenia showed improvement on day 11of antibacterial treatment, but he had increased serum alkalinephosphatase (1710 U/L) and galactomannan (8.1) levels. Bloodculture obtained before antifungal therapy initiation showedamphotericin B-sensitive Candida kefyr. Antibacterials werediscontinued on day 14. After 2 days, he had recurrent fever.Repeat chest CT scan findings were consistent with invasivepulmonary aspergillosis. Abdominal CT scan was indicative ofhepatosplenic candidiasis. His liposomal amphotericin B dosewas increased. Antifungal therapy was stopped on day 42. Heremained in complete remission and maintenance therapy wascontinued.
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Reactions 2 Aug 2008 No. 12130114-9954/10/1213-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
