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

We studied the efficacy of piperacillin and ciprofloxacin as initial parenteral therapy in 41 adult patients with leukemia who developed 47 febrile episodes during severe neutropenia following chemotherapy. 40 patients (98%) survived their febrile episode(s), whereas 1 patient died of infection. When assessed at 72 h after initiation of treatment (early evaluation), 24/47 episodes (51%) had been successfully treated. These 24 favourable responses were seen in 15/24 (63%) microbiologically documented infections and 9/19 (47%) fever of unknown origin (FUO). At the resolution of fever (late evaluation) 46 episodes were evaluable, and 28 (61%) had responded successfully to piperacillin and ciprofloxacin. Successful treatment was most frequently observed in microbiologically defined infections, 18/23 (78%). Three of 5 (60%) Gram-positive, 11/12 (92%) Gram-negative and 1 of 2 mixed bacteremias were successfully treated. In contrast, only 10/19 (53%) FUO and none of 4 clinically defined infections had responded. Thus, this pilot study indicates that piperacillin and ciprofloxacin may be a safe and effective combination for the treatment of febrile episodes in severely neutropenic leukemia patients, which merits further investigation in randomized trials.
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PMID:A pilot study of piperacillin and ciprofloxacin as initial therapy for fever in severely neutropenic leukemia patients. 141 13

We studied the efficacy of ceftazidime as initial monotherapy in 82 adult patients with acute leukemia who developed 123 febrile episodes during induction chemotherapy. 88% of the patients survived their febrile episode(s), whereas 10% died of infection. When assessed at 72 h after initiation of treatment (early evaluation), 43/123 episodes (35%) had been successfully treated with ceftazidime. These 43 favourable responses were seen in 15/47 (32%) microbiologically documented infections, 20/46 (43%) clinically defined infections, and 8/30 (27%) fever of unknown origin (FUO). At the resolution of fever (late evaluation) 115 episodes were evaluable, and 48% had responded successfully to ceftazidime. Successful treatment was most frequently observed in FUO, 18/29 (62%). In contrast, only 19/44 (43%) microbiologically documented infections and 18/42 (43%) clinically defined infections were cured during ceftazidime treatment. In bacteremia the response rate was only 8/26 (31%). Thus, this study shows that although ceftazidime can be safely used for initial empirical monotherapy in neutropenic leukemia patients, the need for therapy modification is high and few patients with serious infections are cured with ceftazidime alone.
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PMID:Ceftazidime as initial therapy in febrile patients with acute leukemia during induction chemotherapy. Leukemia Group of Middle Sweden. 158 31

Feline leukemia virus status and antibody titer to feline oncornavirus-associated cell membrane antigen (FOCMA) were determined on plasma from 183 outpatient cats and 61 cats from 2 closed, FeLV-positive, multiple-cat households. Cats with FOCMA antibody titer had a significantly (P less than 0.02) higher prevalence of history of disease than did cats without FOCMA antibody. Diseases included upper respiratory tract infections, abscesses, ear infections, lower urinary tract infections, gastrointestinal disease, pneumonia, uterine infection, lymphadenopathy, fever of unknown origin, and bacterial infections. The FOCMA antibody titer was determined by use of an indirect fluorescent antibody test; titer greater than or equal to 1:16 was considered to be positive results. Lower mean FOCMA antibody titer was observed in young cats with history of disease (P less than 0.05) than in young cats without history of disease or in older cats with or without history of disease. Prevalence of FOCMA antibody titer was identical (38%) in young and adult cats, indicating cats likely were exposed to FeLV as kittens because a higher prevalence of FOCMA antibody titer in older cats would otherwise be expected.
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PMID:Prevalence of disease in nonviremic cats previously exposed to feline leukemia virus. 215 93

Among infections in leukemia patients during their first induction treatment pneumonia was the third most frequent infection (11.4%) following fever of unknown origin and sepsis. Granulocytopenia was suggested to be very closely related to the onset of pneumonia. Laminar air flow rooms seemed very effective for preventing exogenous infections including pneumonia. They reduced pneumonia from 30 to 0 in 106 patients with acute leukemia during their first induction treatment. Bone marrow transplantation (BMT) is one of the most intensive immunosuppressive treatments. Major causes of failure were interstitial pneumonitis (IP) due to cytomegalovirus (CMV), relapse of leukemia and bacterial and fungal infections. The incidence of IP was reduced by fractionation of total body irradiation and selection of CMV antibody negative donor for platelet transfusion. Administration of anti CMV immunoglobulin has also reduced the incidence of IP significantly from 37.5% to 11.5%. Colony stimulating factor appeared to stimulate the recovery of leukocytes after BMT. By several modifications of BMT techniques, mainly for the prevention of infection and IP, the survival of patients after BMT has improved significantly from 20% to 85%. In conclusion, prevention and treatment of respiratory infections are important in the treatment of leukemia, both for chemotherapy and BMT.
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PMID:[Prevention and treatment of respiratory infections in leukemia patients]. 261 86

This study included 44 children undergoing autologous marrow transplantation for leukemia between August 1979 and June 1987. Three of them received a second transplant. In the phase of neutropenia, 38 children presented with fever. Nineteen septicemia occurred (13 Gram positive cocci, 6 Gram negative bacteria), and 2 interstitial pneumonitis were observed. All children with documented infection or a fever of unknown origin recovered after treatment, except 3, who died from infection. The latest antimicrobial therapy used was a combination of an aminoglycoside and a third generation cephalosporin. When necessary, vancomycin or amphotericin B were added. After engraftment (granulocyte count greater than 0.5 X 10(9)/l) 14 septicemia (which recovered) and 10 herpes zoster infections were observed. Only one patient died of infection (herpes zoster with encephalitis).
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PMID:[Infections and bone marrow autograft carried out for leukemias in children. Apropos of 47 cases]. 306 29

The importance of viral infections in 150 children receiving therapy for leukemia was studied prospectively by application of comprehensive viral diagnostic procedures. One hundred five viral infections were identified, with herpes simplex virus and varicella-zoster virus being the most common agents. The spectrum of viruses associated with serious illness was wider than that in previous studies, and adenoviruses, parainfluenza viruses, rhinoviruses, and enteroviruses were important causes of morbidity. Viral isolation was the most sensitive diagnostic procedure used because complement fixation serology was falsely negative in two-thirds of cases. The occurrence of viral infection may be a previously overlooked important cause of respiratory tract infection and acute pyrexia of unknown origin. Viral infection rates were highest in patients with acute myeloblastic leukemia, in induction and relapse, and in patients treated with newer chemotherapeutic schedules. Thus, viruses are important pathogens in children with leukemia.
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PMID:Viral infections in childhood leukemia. 386 16

Toxoplasma serology was performed in 28 patients with hairy-cell leukaemia and was positive in eight patients (29%). In two patients (7%) reactivated toxoplasmosis was proven by either isolation of Toxoplasma gondii or by significant antibody titre rise with generation of specific IgM-antibodies. In four patients (14%), a clinical diagnosis of active toxoplasmosis was based on signs and symptoms, serologic tests, and response to specific treatment. The high proportion of patients in which active toxoplasmosis was proven or probable (six; 21%) may be related to the presence of severe monocytopenia. In patients with hairy-cell leukaemia developing fever of unknown origin and myositis, toxoplasma serology should be performed, particularly because treatment of active toxoplasmosis usually is successful.
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PMID:Toxoplasmosis in hairy-cell leukaemia. 394 97

In 15 patients with hairy cell leukaemia splenic epithelioid granulomas were demonstrated in 4 out of 13 investigated cases (31%) and liver granulomas in 2 out of 10 cases (20%). Granulomas were never found in bone marrow specimens. Histological stains for mycobacteria, fungi and bacteria failed to demonstrate an etiological agents and culture (sputum) for mycobacteria were only performed in 3 cases, 1 showing Mycobacterium Tuberculosis. Attention to the possible role of atypical mycobacterial infections as an explanation to the often reported unresponsive fever of unknown origin in hairy cell leukaemia and the use of lymph node and/or liver biopsies for culture as well as histology is recommended.
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PMID:Granulomas of spleen and liver in hairy cell leukaemia. 646 59

Presented is an autopsy case of a 79 year-old male who died of miliary tuberculosis. The patient was admitted to the University Hospital with an unknown fever and suspicion of leukemia. He expired on the 13th day of hospitalization. Postmortem examination revealed generalized miliary tuberculosis. The diagnosis of tuberculosis was established only after autopsy. Difficulty in diagnosis of miliary tuberculosis is discussed. Also discussed is a probable association of acute interstitial nephritis with chemotherapy or miliary tuberculosis. Leukemoid reaction is thought to be associated with miliary tuberculosis. The present case reminds us that miliary tuberculosis should never be forgotten when treating a patient having a fever of unknown origin. Cases with tuberculosis were compiled from the Annual of Pathological Autopsy Cases in Japan during 1974 through 1981. There were 3,242 cases of tuberculosis (1.4%) out of 235,095 autopsies recorded in the Annual of Pathological Autopsy Cases in Japan during the above 8 years. Of 3,242 cases 618 were miliary tuberculosis. The latter figure indicates 19.0% of all tuberculosis and 0.26% of all autopsies. Although all age groups were not spared, the 7th and 8th decades were more affected than the others. Tuberculosis has markedly declined since the advent of antituberculous antibiotics. But, autopsy cases with tuberculosis have not recently decreased in number. Clearly, increased awareness of the continuing presence of tuberculosis is needed.
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PMID:An autopsy case of miliary tuberculosis and review of autopsy cases in Japan. 647 78

The authors report 57 febrile episodes in 36 patients with leukemia and lymphoma. Patients with less than 1000 granulocytes and fever above 38.5 degrees C were included in this empirical antibacterial protocol (15 mg amikacin/kg/day/iv, 500 mg carbenicillin/kg/day/iv, 200 mg cefoxitin/kg/day/iv). The criteria for diagnosis of infection were those widely accepted [Schimpff et al. 1971]. Microbiologic documentation of infection was performed in 33.4% of febrile episodes. Antibacterial therapy induced an improvement in 75.1% of cases. Clinical response often occurred in the presence of profound granulocytopenia (in 72% of episodes). Therapy failure was higher in pneumonia (46%) and lower in fever of unknown origin (21%).
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PMID:Empiric antibiotic therapy with an amikacin-carbenicillin-cefoxitin combination in granulocytopenic febrile patients--a clinical report. 664 88


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