Antineoplastics
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Reactions 1240 - 21 Feb 2009 ★ S Antineoplastics Bacillus infection (first report with cisplatin and vinblastine): 2 case reports Two men, who had received antineoplastic therapy, developed Bacillus infections and subsequently died. The first man, aged 52 years, was hospitalised with fever and acute respiratory distress 10 days after his first cycle of antineoplastic therapy comprising cisplatin, vinblastine and methotrexate [dosages not stated] for bladder cancer. Physical examination revealed a lung disorder and a chest x-ray showed a localised area of alveolar consolidation affecting the middle lobe. Blood tests showed the following; bicytopenia, anaemia (5.1 g/dL), neutropenia (400 polynuclear neutrophils/mm 3 ), plasma fibrinogen 7.5 g/L, CRP 200 IU/L, severe hypoxaemia (50mm Hg at room air), creatinine 270 µmol/L, plasma urea 16.4 mmol/L. He was treated with ceftriaxone and ciprofloxacin. During the following few hours, he developed septic shock and was mechanically ventilated. He was administered catecholamines. Blood cultures were positive within 24 hours and Gram-positive motile bacilli were identified. The pathogen was subsequently identified as B. macerans. His condition deteriorated and he died five days after his admission. The second man, who was aged 53 years and had adenocarcinoma of the colon, was hospitalised following partial hepatectomy. He had been treated with antineoplastics [specific agents, dosages and duration of therapy not stated] and had received his last cycle over a month ago. He exhibited signs of septic shock with fever and was treated with catecholamines. Blood tests revealed the following; WBC count 20 000/mm 3 , CRP 175 IU/L, plasma fibrinogen 0.45 g/L. His subclavicular central venous catheter, which had been placed more than 6 months earlier, was removed and he was started on ceftriaxone and ciprofloxacin. Blood cultures were positive in less than 24 hours and Gram-positive motile bacilli were identified. Culture of his central catheter revealed Gram- positive bacillus (10 3 CFU/mL). The pathogen was subsequently identified as B. pumilus. His condition deteriorated, despite a change in antibacterials to amoxicillin-clavulanic acid and gentamicin, and he died 5 days after admission. Author comment: Infections caused by Bacillus species are usually described in patients with immunosuppression. Nevertheless, B. macerans and B. pumilus are rarely isolated. Farhat H, et al. Two cases of Bacillus infection and immunodepression. Medecine et Maladies Infectieuses 38: 612-614, No. 11, Nov 2008 [French; summarised from a translation] - France 801135436 » Editorial comment: A search of AdisBase, Medline, Embase and the WHO ADR database did not reveal any previous case reports of Bacillus infection associated with cisplatin or vinblastine. 1 Reactions 21 Feb 2009 No. 1240 0114-9954/10/1240-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1240 - 21 Feb 2009
★ SAntineoplastics
Bacillus infection (first report with cisplatin andvinblastine): 2 case reports
Two men, who had received antineoplastic therapy,developed Bacillus infections and subsequently died.
The first man, aged 52 years, was hospitalised with feverand acute respiratory distress 10 days after his first cycle ofantineoplastic therapy comprising cisplatin, vinblastine andmethotrexate [dosages not stated] for bladder cancer.Physical examination revealed a lung disorder and a chestx-ray showed a localised area of alveolar consolidationaffecting the middle lobe. Blood tests showed thefollowing; bicytopenia, anaemia (5.1 g/dL), neutropenia(400 polynuclear neutrophils/mm3), plasma fibrinogen7.5 g/L, CRP 200 IU/L, severe hypoxaemia (50mm Hg atroom air), creatinine 270 µmol/L, plasmaurea 16.4 mmol/L. He was treated with ceftriaxone andciprofloxacin. During the following few hours, hedeveloped septic shock and was mechanically ventilated.He was administered catecholamines. Blood cultures werepositive within 24 hours and Gram-positive motile bacilliwere identified. The pathogen was subsequently identifiedas B. macerans. His condition deteriorated and he died fivedays after his admission.
The second man, who was aged 53 years and hadadenocarcinoma of the colon, was hospitalised followingpartial hepatectomy. He had been treated withantineoplastics [specific agents, dosages and duration oftherapy not stated] and had received his last cycle over amonth ago. He exhibited signs of septic shock with feverand was treated with catecholamines. Blood tests revealedthe following; WBC count 20 000/mm3, CRP 175 IU/L,plasma fibrinogen 0.45 g/L. His subclavicular centralvenous catheter, which had been placed more than6 months earlier, was removed and he was started onceftriaxone and ciprofloxacin. Blood cultures were positivein less than 24 hours and Gram-positive motile bacilli wereidentified. Culture of his central catheter revealed Gram-positive bacillus (103 CFU/mL). The pathogen wassubsequently identified as B. pumilus. His conditiondeteriorated, despite a change in antibacterials toamoxicillin-clavulanic acid and gentamicin, and he died5 days after admission.
Author comment: Infections caused by Bacillus speciesare usually described in patients with immunosuppression.Nevertheless, B. macerans and B. pumilus are rarely isolated.Farhat H, et al. Two cases of Bacillus infection and immunodepression. Medecineet Maladies Infectieuses 38: 612-614, No. 11, Nov 2008 [French; summarised froma translation] - France 801135436
» Editorial comment: A search of AdisBase, Medline,Embase and the WHO ADR database did not reveal anyprevious case reports of Bacillus infection associated withcisplatin or vinblastine.
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Reactions 21 Feb 2009 No. 12400114-9954/10/1240-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
