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Query: UMLS:C0023418 (leukemia)
 93,477 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To determine the incidence and types of infections in Hodgkin's disease, particularly those related to the overwhelming pneumococcal sepsis syndrome, 210 consecutive patients with previously untreated Hodgkin's disease who underwent staging laparotomy with splenectomy from March 1968 to October 1979 were reviewed. For 178 patients (85 percent) alive at the end of the study, the mean follow-up time was 68.1 months. Eighty-two serious infections occurred among 59 (28 percent) of the patients; 47 (57 percent) serious infections were microbiologically documented and 35 (43 percent) were clinically documented. Forty-seven microbiologically documented serious infections occurred in 34 patients and consisted of 23 episodes of pneumonia, 10 cases of bacteremia, seven wound infections, two cases of disseminated herpes zoster, one subphrenic abscess, and four miscellaneous infections. Microbiologically documented serious infections occurring during initial treatment or remission had lower incidences of leukopenia (29 versus 58 percent) (p = 0.09) and death (11 versus 53 percent) (p = 0.005) than those occurring after relapse of Hodgkin's disease. Of the microbiologically documented serious infections, 76 percent were associated with a predisposing factor(s) (leukopenia, postoperative state, steroids, peripheral neuropathy, leukemia), of which 34 percent were fatal. Microbiologically documented serious infections unassociated with a predisposing factor were never fatal, including the only episode of pneumococcal sepsis in the series. In contrast to microbiologically documented serious infections, only 14 percent of clinically documented serious infections (versus 38 percent) were fatal. The overwhelming pneumococcal sepsis syndrome and other infections thought to be associated with the asplenic state are uncommon problems in patients with Hodgkin's disease after splenectomy.
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PMID:Infection among 210 patients with surgically staged Hodgkin's disease. 685 90

In Omaha, from 1974 to 79, 30 (12.5%) of 240 patients with Haemophilus influenzae bacteremia or meningitis had a wide variety of conditions known to be associated with increased susceptibility to bacterial infection. Neonates and adults accounted for 47 per cent of the infections. Non-type b and non-typable strains caused 41 per cent of the episodes. Forty-one per cent of patients had bacteremia with no detectable focus of infection. The incidence of meningitis was low. Mortality was 28 per cent, considerably higher than in patients who were previously healthy. A review of the medical literature indicated that low-birth weight infants and patients with leukemia and other malignancies undergoing chemotherapy, splenectomy, congenital asplenia, sickle cell anemia, immunoglobulin deficiency diseases, cerebrospinal fluid shunts, and skull defects are at greater risk for systemic H. influenzae disease than the general population.
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PMID:Systemic Hemophilus influenzae infection. A study of risk factors. 697 94

Prospective surveillance of hospitalized patients with leukemia or solid tumors was performed in order to define the rate of nosocomial bloodstream infection according to specific diagnosis. During the 38-month study, there were 842 nosocomial blood stream infections in 704 patients, 22% of whom had leukemia or solid tumors. In the patients with malignancy, the diagnoses associated with the highest rate of bloodstream infections were chronic myeloid leukemia (18.4/100 patients), acute lymphocyte leukemia (17.7/100), promyelocytic and undifferentiated leukemia (16.1/100) and acute monocytic/myelomonocyte (13.8/100). In 76% of patients with chronic lymphocytic, chronic myeloid, or undifferentiated leukemia, the peripheral blood polymorphonuclear leukocyte count at the time of bacteremia was less than 100 cells/mm-3. In contrast to patients with leukemia, those with solid tumors, as a group, were at no greater risk of bloodstream infection than those without malignancy. In preparation for prophylactic trials of antibiotics or immunotherapy this study has more clearly defined the risk of bloodstream infection in cancer patients.
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PMID:Rates of hospital-acquired bloodstream infections in patients with specific malignancy. 708 23

A three-year prospective study was conducted to evaluate right atrial silicone elastomer catheters for long-term venous access in adults with acute leukemia. Objectives included establishing the safety of catheter insertion in thrombocytopenic patients and the feasibility of maintaining the catheter during septicemia. Seventy-one catheters were placed in 57 consecutive patients entering intensive leukemia therapy. Excessive bleeding occurred at three catheter insertion sites. Eight catheter-related infections occurred. In 34 of 36 noncatheter-related and two catheter-related bacteremias, catheters were left in place with intensive monitoring. In 20, bacteremia cleared. Fourteen patients died; in eight autopsies, no evidence of catheter-related mortality was found. Catheters were in use 6,799 days, including 3,932 home use and 2,570 granulocytopenic days. The data indicate that thrombocytopenia does not preclude catheter insertion and that catheters can be safely maintained in septicemic granulocytopenic patients.
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PMID:A prospective study of prolonged central venous access in leukemia. 714 50

Patterns of fever, shock, and chills in 100 episodes of febrile, Gram-negative bacillemia were retrospectively analyzed to determine features predictive of the site of infection, organism, and prognosis. Pneumonias most often produced morning temperature rises, whereas infections in other sites were usually associated with an afternoon or evening peak. Peritonitis (usually due to Bacteroides fragilis) tended to cause an indolent temperature rise (over a day or more), whereas pyelonephritis and cholangitis typically produced an abrupt "spike." Relatively low fevers characterized Enterobacter pneumonias while very high fevers were noted in Pseudomonas aeruginosa infections in patients with leukemia. Chills occurred with unusually high frequency in cholangitis and in Klebsiella bacteremia. Patients going into shock had higher fevers than those who did not. More importantly, the development of shock was shown to be related to severity of underlying disease. Shock never developed if the disease was not serious, unless the bacteremia was caused by instrumentation, but occurred in 73% of patients with leukemia or lymphoma. The clinical setting, pattern of fever, and presence or absence of a chill can in many cases usefully guide diagnosis and therapy in patients with Gram-negative bacillemia.
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PMID:Fever, shock and chills in gram-negative bacillemia: clinical correlations in 100 cases. 731 Dec 56

A review of the hospital records of 71 patients from whose blood viridans streptococci were isolated showed that in 13 cases the patient's illness was definitely related to the bacteremia: 4 patients had endocarditis, 3 had pneumonia, 2 had peritonitis and 1 each had meningitis, a scalp wound infection, sinusitis and otitis media. The bacteremia may have contributed to the two deaths among these 13 patients. In 45 cases the viridans streptococci may have contributed to the patient's illness: 15 patients had an infection of the lower respiratory tract and 7 an infection of the upper respiratory tract, 8 were neonates with suspected septicemia, 3 had soft tissue infections, 3 had leukemia and sepsis, and 9 had miscellaneous infections; the bacteremia was unrelated to the two deaths in this group. In another 13 cases the viridans streptococci could not be related to the patient's illness. The species most frequently isolated were Streptococcus mitis, S. sanguis II and S. MG-intermedius. The outcome of the bacteremia was generally good, even among the 11 patients not treated with antibiotics. When viridans streptococci are cultured from a single blood sample, further samples of blood and, if feasible, specimens from the associated focus of infection should be obtained for culture; further blood cultures are especially important in cases of suspected endocarditis.
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PMID:Bacteremia caused by viridans streptococci in 71 children. 733 84

Malignancy may be associated with impairment of the immune system. In children with acute leukemia, an impaired immunoglobulin M (IgM) antibody response to poliovirus was documented previously. It was of interest, therefore, to determine the immunoclass of antibodies produced against the O antigens of bacteria causing bacteremia in patients with leukemia and other malignancies. For control purposes, parallel studies were carried out in patients without maligancies but with infections caused by gram-negative bacteria. The patients with malignancies were adults, and those without malignancies were children. The serum specimens were selected from patients mounting an antibody response. IgG and IgM antibodies were identified by mercaptoethanol reduction and chromatography. Antibody titers against the O antigens of enteric bacteria were determined by the hemagglutination procedure. Antibodies of both IgM and IgG immunoclasses were produced by all but 1 of 16 patients with leukemia and by all but 1 of 12 subjects with other malignancies. Thus, a specific IgM immune deficiency in adult patients with leukemia or other malignancies complicated by bacteremia was not present; however, the magnitude of the antibody response of the patient with leukemia was less than that of the subjets with other maligancies, with the median antibody titers of the former being 320 and those of the latter being 2,560.
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PMID:Immunoglobulin G and immunoglobulin M antibody responses of patients with malignancies to the O antigens of bacteria causing bacteremia. 741 2

Based on the activity of fludarabine and doxorubicin in chronic lymphocytic leukemia (CLL), 30 patients received this combination. The median age of these patients was 61 years; median Zubrod performance status was one; median number of prior therapies was three; and median time to treatment was 53 months. Rai stage was 0 for two patients, I/II for 19 patients, and III/IV for nine patients. Prior treatment included fludarabine in 25 patients. In this regimen, fludarabine was administered as 30 mg/m2/d IV x 3 to 10 patients, 25 mg/m2/d IV x 4 to three patients, and to 17 patients as 30 mg/m2/d IV x 4. A 50 mg/m2 IV dose of doxorubicin was given to all patients. The first 17 patients received prednisone 30 mg/m2 x 5 days; however, this was discontinued due to other data demonstrating no therapeutic advantage and increased opportunistic infections when corticosteroids were added to fludarabine. Toxicity consisted primarily of infectious episodes: pneumonia nine, bacteremia one, FUO seven, and minor infection five. Two deaths from pneumonia occurred. Standard guidelines for response were used with the addition of a nodular CR group. Despite prior treatment with fludarabine in the majority of patients, the response rate in the 29 evaluable patients was CR 3%, nodular CR 17%, PR 35%, fail 38% and early death 7%. This combination of fludarabine and doxorubicin is active against CLL and warrants further study.
Leukemia 1995 Jun
PMID:Fludarabine plus doxorubicin in previously treated chronic lymphocytic leukemia. 759 81

We describe an outbreak of vancomycin-resistant Enterococcus faecium (vanA phenotype) bacteremia on the oncology ward of a tertiary care community hospital. In 10 of the 11 cases the patients had leukemia and were neutropenic (median duration of neutropenia, 21 days) at the time of bacteremia. On average, patients received six antibiotic agents for a total of 61 agent-days prior to development of vancomycin-resistant E. faecium bacteremia. The mortality rate was 73%. Molecular typing of 22 isolates revealed that the majority (83%) represented a common strain, indicating nosocomial spread. When the 11 cases were compared to 22 matched control patients, gastrointestinal colonization with vancomycin-resistant E. faecium (odds ratio [denominator, 0] infinity, P = .005) and the use of antimicrobial agents with significant activity against anaerobes (metronidazole, clindamycin, and imipenem; odds ratio infinity, P = .02) were found to be risk factors for the development of vancomycin-resistant E. faecium bacteremia. Since no proven therapy for such infection exists, there is an urgent need to identify effective measures to prevent and control the development of vancomycin-resistant E. faecium bacteremia.
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PMID:Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. 761 88

Candida krusei is a cause of invasive candidiasis (IC), with numerous cases reported among leukemia patients after bone marrow transplantation and treatment with fluconazole. The relation between fluconazole therapy and IC remains controversial. In a retrospective review covering 5 years, we identified 203 cases of IC, 71 (35%) of which were due to non-albicans species. Eight cases were caused by C. krusei: four of the patients involved had leukemia, two had breast cancer, one had end-stage liver disease, and one had undergone abdominal trauma. None of these patients received fluconazole. Surveillance cultures detected colonization with C. krusei before the onset of symptoms in seven cases. The median time from colonization to IC diagnosis was 10 days. Of six patients with neutropenia, five were neutropenic at IC diagnosis. Concomitant infections were common; four patients had both bacteremia and invasive aspergillosis. C. krusei was considered the immediate cause of five of the seven deaths among this group of patients. These eight cases extend the range of immunocompromised conditions in which IC caused by C. krusei develops in the absence of fluconazole therapy.
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PMID:Invasive infection due to Candida krusei in immunocompromised patients not treated with fluconazole. 774 40


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