1/6. Uneventful outcome of unrelated hematopoietic stem cell transplantation in a patient with leukemic transformation of Kostmann syndrome and long-lasting invasive pulmonary mycosis.Kostmann syndrome (KS) is an inherited hematological disorder characterized by an absolute neutrophil count (ANC) <0.2 x 109/L and life-threatening bacterial infections. Granulocyte-colony stimulating factor (G-CSF) makes it possible to reach an ANC of 1.0 x 109/L and consequently to reduce significantly the occurrence of severe infections. Absence of response to G-CSF, G-CSF receptor mutation, and leukemic transformation are absolute indications to perform hematopoietic stem cell transplantation (HSCT). Pulmonary mycosis does not represent an absolute contraindication to bone marrow transplantation (BMT), although a relapse rate of 30-50% has been reported, despite adequate medical and surgical treatment. Mycotic pneumonia recurrence shows a mortality rate above 80%, especially in the presence of persisting immunosuppression. We report on a KS patient with long-lasting fungal pneumonia who developed myelodysplasia and subsequent acute myeliod leukemia (AML) conversion resistant to antiblastic therapy. Despite surgical excision and secondary prophylaxis, recurrence of the pulmonary lesion occurred prior to the unrelated HSCT. In spite of these poor prognostic characteristics, outcome was uneventful and the patient is alive and well in continuous complete remission with no signs of fungal infection.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
2/6. Pseudallescheriasis in northern Britain.Five cases of pseudallescheria boydii infection are reported from the northern part of the United Kingdom. None of the patients had travelled abroad. Three cases of otitis in which P. boydii was associated with bacterial infections were diagnosed within a 6-month period. A lady who had diabetes mellitus presented with a pulmonary fungus ball in a pre-existent cavity caused by a previous bacterial infection. After minor trauma at the site of an old skin graft, a farmer's wife developed an ulcer on the dorsum of the right ankle. Precipitating antibodies were demonstrated except in two of the cases of ear infection. The management of the individual cases is discussed.- - - - - - - - - - ranking = 2keywords = bacterial infection (Clic here for more details about this article) |
3/6. Chronic granulomatous disease of childhood: a changing pattern?We have followed nine male patients with Chronic Granulomatous disease at The Hospital for Sick Children, Toronto, since 1972. The diagnosis was established in each case by the failure of neutrophils to reduce nitroblue tetrazolium dye and to kill staphylococcus aureus normally in vitro. bacterial infections began between 6 months and 14 years of age. In five of the nine patients, infections began after 4 years of age. The first significant infection in five patients was a liver abscess(es), and one patient each had lymphadenitis, pulmonary aspergillosis, a parapharyngeal abscess, and a draining inguinal incision following surgery. Following diagnosis, all patients were started on trimethoprim-sulfamethoxazole at a dose of 2 mg/kg/day of trimethoprim. The patients have been followed for 50 patient-years. Five of nine patients have been free of infection during 16 years of observation. For the remaining four patients, there have been six infections during 34 years of observation. A possible infection-related death occurred in one patient. The patients reported here appear to differ from those in previous reports. They present later in life, often with a liver abscess. They have a low incidence of subsequent bacterial infections which may, in part, be due to trimethoprim-sulfamethoxazole prophylaxis. The patients with chronic granulomatous disease reported here appear to have a better prognosis than previously thought.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
4/6. Pulmonary oxalosis caused by aspergillus niger.A case report involving a pleuropulmonary mixed bacterial infection in association with aspergillus niger is described. The patient responded to a combination of antibiotics, aerosolized and intravenously administered amphotericin b, and surgery. aspergillus niger appeared to be a secondary invader and caused lung damage by the production of oxalic acid.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
5/6. Fungal pulmonary abscess in an adult secondary to hyperimmunoglobulin E (Job's) syndrome.Job's syndrome is characterized by recurring bacterial infections of the skin and sinopulmonary tract. Laboratory evaluation reveals consistent elevation of circulating immunoglobulin e levels. The syndrome has been reported as a rare cause of bacterial pulmonary abscess and pneumatocele formation in childhood; here we present a case of cavitating fungal abscess in an adult with Job's syndrome.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
6/6. Saprophytic fungal infections and lung transplantation--revisited.BACKGROUND: Fungal infections cause serious morbidity and death in lung transplant recipients. Some centers exclude and others will prophylactically treat patients with evidence of Aspergillus colonization. methods: Of 126 patients undergoing lung transplantation at the University of north carolina since January 1990, five patients have died because of invasive Aspergillus and other saprophytic fungal infections. Those cases are reviewed looking for common predisposing factors, including any evidence of prior colonization. In addition, all preoperative and postoperative culture data on all transplant recipients were retrospectively examined to define the prevalence of preoperative and postoperative Aspergillus colonization in 121 patients with and without cystic fibrosis, none of whom had development of significant fungal disease. RESULTS: Fifty-two percent of 65 patients with cystic fibrosis were colonized with Aspergillus before operation, and 40% after operation at some time. None had development of significant Aspergillus infections, and none received prophylactic antifungal therapy. Most of the deaths from deep-seated fungal infections have been in patients without cystic fibrosis with no evidence of preoperative colonization. These patients had evidence of severe obliterative bronchiolitis, bacterial infections, persisting cytomegalovirus disease, or other major organ failure. CONCLUSION: The rationale for excluding patients or for giving amphotericin in the perioperative period in those patients who are colonized before surgery is questioned.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |