Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0026764 (multiple myeloma)
 36,148 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty-four episodes of pneumococcal bacteremia were identified in 15 patients over 5 years in 10 hospitals in Franklin County, Ohio. Twelve patients each had 2 episodes of pneumococcal bacteremia, 2 had 3, and 1 had 4. All patients had predisposing conditions, with lymphoma, multiple myeloma, and chronic obstructive pulmonary disease being the most frequent. The mean interval between the first and second episode was 268 days. Serotyping and genotyping were performed on 29 isolates. The same serotypic and genotypic patterns were found for sequential isolates from four patients; three of these patients had a recurrence between 22 and 90 days after a previous episode. Seven (24%) of the 29 isolates were serotype 23F; four isolates (14%) were not susceptible to penicillin. All of our patients received appropriate antimicrobial therapy and appeared to be clinically cured of their initial infection. For patients with recurrent pneumococcal disease, alternate preventive measures such as immunization with conjugate pneumococcal vaccine and/or prophylactic antibiotic therapy should be considered.
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PMID:Recurrent pneumococcal bacteremia: 34 episodes in 15 patients. 956 86

Bacteremia caused by Plesiomonas shigelloides is a rare event, often associated with consumption of seafood and fresh or estuarine water in temperate or tropical climates. Most patients have showed underlying health disorders. Here we present a case of P. shigelloides septicaemia and cellulitis of the left hand associated with fish handling in Northern Sweden (65 degrees latitude north). The patient, who suffered from multiple myeloma, recovered uneventfully after initial treatment with intravenous cefuroxime followed by a course of oral ciprofloxacin. P. shigelloides seems to be ubiquitous in freshwater world-wide and may cause invasive infections also in cold climate areas.
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PMID:A case of Plesiomonas shigelloides cellulitis and bacteraemia from northern Europe. 957 48

In this retrospective study, 23 recipients of peripheral blood progenitor cells (PBPC) were compared to 23 recipients of bone marrow (BM). The donors were 12 HLA-A-B-DR identical siblings and 11 HLA-A-B-DR identical unrelated donors in the PBPC and BM groups, respectively. Diagnoses in the PBPC group were CML seven, AML, nine, ALL three, lymphoma one, myeloma two and aspartylglucosaminuria (AGU) one. The median age was 40 (5-55) years. The BM group was matched for diagnosis, age, conditioning therapy, GVHD prophylaxis and G-CSF treatment after BMT. A higher number of MNC (P<0.001), CD34+ (P = 0.05), CD3+ (P<0.001) and CD56+ (P<0.001) cells in the graft, a reduced number of platelet transfusions (P = 0.03) and a significant hastening of neutrophil and platelet recovery were seen in the PBPC group compared to the BM group. In logistic regression analysis, the following factors were important for engraftment of ANC >0.5 x 10(9)/l: peripheral blood progenitor cell transplantation (PBPCT) (P = 0.003) and mononuclear cells (MNC) > or =2.5 x 10(8)/kg recipient in the graft (above median) (P = 0.009) in univariate analysis. For recovery of platelets >30 x 10(9)/l: PBPCT (P = 0.03) and HLA-identical sibling donors (P = 0.05) were significant in multivariate analysis. A trend towards a lower incidence of bacteremia was seen in the PBPC group, ie 22 vs 48% (P = 0.06) in the BM group. GVHD, TRM and survival did not differ between the two groups.
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PMID:Faster neutrophil and platelet engraftment, but no differences in acute GVHD or survival, using peripheral blood stem cells from related and unrelated donors, compared to bone marrow. 970 19

We prospectively analyzed the episodes of febrile neutropenia at the American University of Beirut Medical Center. One hundred and four episodes were studied in 64 patients over a period of 15 months: 81 (78%) with leukemia, 11 (10.5%) with lymphoma, 3 (2.8%) with multiple myeloma, and 9 (8.6%) with solid tumors. Bacteremia was confirmed in 30 episodes (29%), of which 18 (60%) were caused by gram-negative bacilli and 12 (40%) by gram-positive cocci. The predominant organisms were: E. coli (9), coagulase negative staphylococci (CNS) (6), Pseudomonas aeruginosa (5), and S. aureus (4). In seven episodes (6.7%) urinary tract infections were diagnosed, 6 with E. coli. Sputum cultures were positive in eight episodes (7%), 2 with P. aeruginosa, and 2 with methicillin resistant S. aureus. All patients were started empirically on antibacterial agents. In twenty-one episodes, a single antibiotic was started, ceftazidime being the most commonly used agent. In most cases, however, 2 or 3 antibacterial agents were started empirically. Antifungal therapy with amphotericin B (11) or fluconazole (20) was added because of persistent fever despite broad antibacterial coverage. Thirteen patients died (20%), 6 of them had bacteremia; 2 with gram-negative bacilli, and 4 with gram-positive cocci. Except for one, all patients had been started, at the onset of the fever, on antimicrobial agents to which the isolated microorganisms turned out to be susceptible. Our results show that infections with gram-negative bacteria continue to predominate unlike what has been reported recently from European and North American trials. A trend toward a higher mortality of infections caused by gram-positive cocci was noted.
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PMID:Febrile neutropenia in cancer patients in a tertiary care medical center in Lebanon: microbial spectrum and outcome. 1126 66

From November 1994 to May 1998, 117 patients (66 with solid tumor, 36 with lymphoma, 14 with multiple myeloma, one with acute leukemia) underwent 178 cycles of high-dose chemotherapy and autologous stem cell transplantation (ASCT) at our institution. We retrospectively analyzed the infectious complications that occurred after ASCT. Median duration of neutropenia (granulocyte count <0.5 x 10(9)/l ) was 8 days, the overall incidence of fever requiring antimicrobial treatment was 63%. 35.4% of patients had fever of unknown orign (FUO), whereas primary bacteremia occurred in 21.3%, pneumonia in 3.4% and severe skin infection in 1.1% of patients. Invasive fungal infections occurred in three, and enterocolitis in one patient. Infection was fatal in three patients (2.6%), in each case due to septic shock. The most frequently isolated pathogens were Gram-positive cocci. Median time to defervescence with antimicrobial therapy was 4 days (6 days in patients with bacteremia or other severe infection, and 3 days in patients with FUO). First-line antimicrobial therapy was successful in 65% of patients with FUO and 30.6% of patients with documented infections. With respect to the incidence, type and clinical course of infection, no significant differences between patients with lymphoma or multiple myeloma and those with solid tumors were detected.
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PMID:Infectious complications after high-dose chemotherapy and autologous stem cell transplantation: comparison between patients with lymphoma or multiple myeloma and patients with solid tumors. 1131 87

MRSA infection or colonization developed in eleven patients with neoplastic disease including malignant lymphoma (5 cases), soft tissue sarcoma (2 cases), acute myeloblastic leukemia (one), myelodysplastic syndrome (one), multiple myeloma (one), and mesothelioma (one) at our ward from October to December 1999. The infections were pneumonia (six cases), enteritis (three), bacteremia (one), and wound infection (one). Ten of 11 cases received antimicrobial agent (s) during one month before isolation of MRSA, suggesting selection of MRSA. Five cases improved and survived, but six cases died of infection. At the isolation of MRSA, the neutrophil count (NC) of the alive cases was 1, 500/microliter or more but the NC of five cases who died was less than 1,000/microliter, especially less than 100/microliter in three cases who had just received a cancer chemotherapy. Pulsed-field gel electrophoresis, performed in 9 cases, showed an identical DNA-pattern of MRSA in 7 cases, indicating a nosocomial infection. Our method to prevent spread of MRSA targeting solely the patients with MRSA infection was obviously unsatisfactory. We should target also the cases of MRSA colonization and make an effort to wash hands more vigorously. Furthermore, radical reformation such as increasing single sick-rooms drastically and increasing the number of nursing staff is also required.
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PMID:[Outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization among patients with neoplastic disease: a clinico-epidemiological study of 11 cases]. 1176 76

From January 1999 to May 2000 (17 months), 21 strains of streptococci and four strains of enterococci have been isolated from 74 blood cultures in 25 infectious episodes in hematologic patients. They concerned 21 patients, of 21 to 77 years old. These patients suffered from acute leukaemia (14 cases), chronic lymphoid leukaemia (two cases), non-Hodgkin's lymphoma (two cases) or myeloma (three cases). Seventeen patients displayed a single streptococcal or enterococcal episode, two had two episodes in the course of a single stay in the hospital, two others in the course of two different stays. During 16 episodes (64%), the bacteremia occurred within 15 days after the onset of neutropenia consecutive to antimitotic chemotherapy, and in nine episodes (36%) it has occurred after a period exceeding 15 days. In six cases the patients had already received antibiotics with a large antibacterial activity (beta-lactam, fluoroquinolone and/or glycopeptide +/- aminoside) and in four cases a single antibiotic (synergistine or cotrimoxazole). Most streptococci (20/21) were oral streptococci (ten Streptococcus mitis, five S. oralis, two S. sanguis, three S. pneumoniae). A single strain of beta-hemolytic streptococci has been identified as S. dysgalactiae subsp. equisimilis. The enterococci were one strain of Enterococcus faecalis and three E. faecium. Ten streptococci were susceptible to 0.25 mg/L of penicillin G, ten were less susceptible (0.5 < or = MIC < 32 mg/L), and a strain was resistant (MIC = 32 mg/L). Eighteen strains were susceptible to amoxicillin and cefotaxime. For three strains, the MICs of amoxicillin and cefotaxime (8-16 mg/L and 8-32 mg/L, respectively) were higher. Levels of resistance of the enterococci to the beta-lactam (penicillin, amoxicillin, and piperacillin) were variable. All species were susceptible to glycopeptides. Three patients were transferred in intensive care unit for respiratory distress or shock syndrome. Their evolution has remained severe under antibiotherapy comprising beta-lactam or vancomycin associated with an aminoside. This results demonstrate the interest of species identification to adapt the antibiotic treatment and confirms the frequency of oral streptococci in severe bacteremia in neutropenic patients.
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PMID:[Therapeutic impact of streptococcal and enterococcal bacteremia in hematology patients]. 1198 Mar 30

Transplantation-associated thrombotic microangiopathy (TA-TMA) has been associated with significantly reduced survival following allogeneic bone marrow transplantation. In this study we describe the course and response to plasma exchange therapy of TA-TMA as well as risk factors for its' development. Twenty-five patients who underwent plasma exchange therapy were matched to fifty control patients selected for transplant indication and stage of disease at the time of transplant. Transplant indications were acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, aplastic anemia, myelodysplastic syndrome and multiple myeloma. Groups were well balanced with respect to disease status, age at time of transplant and use of radiation-based conditioning. TA-TMA was diagnosed a median of 27 days after transplantation and neurological abnormalities were present in ten cases. Patients received a median of 10 (range 2-43) plasma exchange treatments. Hematological responses were recorded in eight cases. Risk factors for the development of TA-TMA included transplantation from unrelated donors (p = 0.002), hepatic venoocclusive disease (VOD) (p = 0.034), grade 2-4 acute graft-versus-host disease (GVHD) (p = 0.042) and bacteremia with diphtheroid organisms (p = 0.009). Only hepatic VOD (p = 0.0026) and grade 2-4 acute GVHD (p = 0.0436) remained significant risk factors for later development of TA-TMA in a multivariate logistic regression model. The median survival of patients with TA-TMA was 66 (range 32-733) days while that of unaffected patients was 742 (range 15-2392) days after transplantation. Only one patient with TA-TMA remains alive 733 days after transplantation.
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PMID:Transplantation-associated thrombotic microangiopathy is associated with transplantation from unrelated donors, acute graft-versus-host disease and venoocclusive disease of the liver. 1220 69

Shewanella alga is a gram-negative bacillus found in all types of water as well as in a variety of tainted food. It has rarely been associated with human disease, either in healthy or in immunocompromised patients. We report a 66-year-old man with a multiple myeloma who developed a cellulitis in both forearms in the course of a Shewanella bacteremia. He had a renal insufficiency and was moderately neutropenic after chemotherapy (vincristine, adriamycin, dexamethasone). Outcome was good after treatment with ceftazidime-amikacin despite all the risk factors. Shewanella isolation may be clinically significant. Haematological patients constitute a group of risk as increasingly aggressive chemotherapy regimens are used. Clinical outcome is not necessarily bad.
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PMID:Shewanella alga bacteremia and associated cellulitis in a patient with multiple myeloma. 1224 59

Bacteraemia is a major cause of morbidity and mortality in patients with haematological disorders during chemotherapy-induced neutropenia. The generally reported trend during the last two decades has been a gradual replacement of Gram-negative bacilli by Gram-positive cocci as the major causes of bacteraemia in neutropenic hosts. However, data that are unaffected by the use of antibacterial prophylaxis are scarce. Our objective therefore was to study the incidence of bacteraemia with different microorganisms in a haematology centre where antibacterial prophylaxis has not been used during the years 1988-2001. A total of 1402 episodes of clinically significant bacteraemia in 927 patients were identified. All patients were treated in the haematology wards and had an underlying haematological disorder, with lymphoma, leukaemia, and myeloma dominating. There were 536 (58%) male, and 391 (42%) female patients, with a median age of 58 years. The dominating pathogens were coagulase-negative staphylococci (CNS) 17%, Escherichia coli 16%, alpha-haemolytic streptococci 12%, Staphylococcus aureus 9%, Klebsiella spp 9%, Enterococcus spp 7%, and Pseudomonas spp 5%. The only significant incidence change was an increase of E. faecium bacteraemia. The balance between Gram-negative and Gram-positive microorganisms was essentially stable over the 14-year period. The rates of antibiotic resistance were generally low and stable. Gram-negative bacteria exhibited resistance to fluoroquinolones after 1998. The 7- and 30-day mortality rates were 6.3 and 15.6%, respectively, being significantly higher in patients with bacteraemia caused by Pseudomonas aeruginosa, Stenotrophomonas maltophilia, or E. faecium.
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PMID:Bacteraemia in hospitalised patients with malignant blood disorders: a retrospective study of causative agents and their resistance profiles during a 14-year period without antibacterial prophylaxis. 1467 14


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