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Query: UMLS:C0027947 (neutropenia)
 17,527 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fungal infections are increasing in frequency, especially among patients with haematological malignancies. The fungi which cause most of the infections in cancer patients are Candida spp. and Aspergillus spp. These fungi seldom infect individuals with normal host defence mechanisms. Many factors predispose patients to fungal infection, including neutropenia, lymphopenia, gastro-intestinal ulceration, intravenous catheters and adrenal corticosteroid therapy. Candida spp. cause 5 major types of infection: dermatitis, thrush, gastro-intestinal, primary organ and disseminated infection. Aspergillus spp. and Phycomycetes cause pulmonary, disseminated or rhino-cerebral infection. Cryptococcus neoformans usually causes meningitis but may cause pneumonia or disseminated infection. The diagnosis of fungal infection is often made only at postmortem examination, because it is difficult to isolate the aetiological agent from sites of infection. Amphotericin B remains the mainstay of antifungal therapy, but is seldom effective in the patient with compromised host defences. Successful management of these infections in the future will depend upon improvement in diagnostic capabilities as well as the introduction of more effective and less toxic antifungal agents.
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PMID:Fungal infections in the cancer patient. 60 7

The use of high-dose chemotherapy and the subsequent prolonged neutropenia in patients with haematological diseases has resulted in an increased incidence of fungal infections. The only drug with proven efficacy in the treatment of deep seated fungal infections or invasive aspergillosis is amphotericin B. Unfortunately, this drug has adverse side effects, most importantly dose dependent nephrotoxicity. Furthermore, some patients fail to show a response to amphotericin B. We have treated 40 patients undergoing myeloablative chemotherapy and or bone marrow transplantation for haematological diseases with liposomal amphotericin for proven or suspected fungal infections. All patients had failed treatment with conventional Amphotericin B. Fourteen patients received liposomal amphotericin (AmBisome) due to progression of infection on conventional amphotericin B. Twenty six patients received liposomal amphotericin due to nephrotoxicity caused by conventional Amphotericin B. Nine patients had mycologically proven fungal infection and of these, 7 patients (78%) showed a complete response to liposomal amphotericin. Thirty one patients received liposomal amphotericin due to suspected fungal infection. Eleven of these 31 patients (35%) showed a complete clinical response to liposomal amphotericin. However in the patients with suspected fungal infections 14 patients had no response and 6 patients could not be evaluated for response to liposomal amphotericin. Overall, of the 18 patients showing a response to liposomal amphotericin, 15 patients had either recovered their neutrophil count (> 0.5 x 10(9)/l) or achieved remission from their underlying haematological disease. Recovery from fungal infection in this group of patients occurred when there was complete remission of underlying disease and recovery of neutrophil counts, when concurrently treated by liposomal amphotericin.
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PMID:Successful treatment of fungal infections in neutropenic patients with liposomal amphotericin (AmBisome)--a report on 40 cases from a single centre. 149 62

Major advances in anticancer treatment have contributed to an increased frequency of severe fungal infections in patients with neoplastic diseases. Neutropenia remains the most important among the predisposing factors related to the malignancy or its treatment. Most fungal infections are caused by the commonly recognized opportunistic fungi Candida spp and Aspergillus spp, and the pathogenic fungi Cryptococcus neoformans, Histoplasma capsulatum, Coccidiodes immitis, and less often by Blastomyces dermatidis. However, recently newer pathogens such as Pheohyphomycetes, Hyalohyphomycetes, Zygomycetes and other fungi of emerging importance such as Torulopsis glabrata, Trichosporon beigelii, Malassezia spp, Saccharomyces spp, Hansenula spp, Rhodotorula spp, and Geotrichum candidum have appeared as significant causes of infection in this patient population. The increasing frequency of fungal infections is of great concern because of the difficulties in diagnosis and treatment. Amphotericin B remains the mainstay of antifungal treatment despite its toxicity and limited efficacy. Liposomal Amphotericin B may be more effective and less toxic. The activity of the azoles in immunocompromised patients is low. New azoles such as fluconazole and itraconazole may show future promise. The availability of the new granulocyte colony stimulating factors which can shorten the duration of neutropenia could represent a significant improvement in the management of fungal infections in cancer patients. As a preventive measure, the invasive procedures that predispose to infections should be done only when absolutely necessary and frequent handwashing by hospital personnel remains an effective prophylactic procedure.
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PMID:Fungal infections in cancer patients: an escalating problem. 152 39

The increasing incidence of nosocomial candidal infections is a pivotal problem for patients who do not have neutropenia. In contrast with previous principles, candidemia--even in nonneutropenic patients--should be treated with systemic antifungal agents except in rare circumstances. Amphotericin B remains the agent of choice for treatment of hematogenously disseminated candidiasis and for candidemia, although the optimal dosage and duration of this therapy are poorly defined. Therapy with fluconazole is an alternative for patients who are intolerant to amphotericin B; the efficacy of fluconazole compared with that of amphotericin B in hematogenous candidal infections is unknown but is currently being evaluated. Removal of prosthetic devices that are infected with Candida is necessary in nearly all instances to cure the infection. Similarly, removal of an indwelling catheter whose use is associated with candidemia, as opposed to leaving the catheter in place during antifungal therapy, may increase survival rates of patients and lower their rates of complication. Antifungal prophylaxis may be useful for patients who are undergoing transplantation of an organ.
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PMID:Current strategies for treating invasive candidiasis: emphasis on infections in nonneutropenic patients. 156 80

Based on our previous experience treating children with cancer, fever and neutropenia we selected two different empirical regimens: Ceftriaxone once a day, for patients with solid tumors and lymphomas I-II (Low Risk group--LR) and Imipenem for patients with leukemias and lymphomas III-IV (High Risk group--HR). From Oct 1988 to Nov 1989, 121 episodes of fever (F+) and granulocytopenia (G+) in LR Group and 119 in HR Group were studied: the HR had 51.3% documented infections and the LR 58.7%. In the HR Group the following organisms were isolated from the blood cultures: Gram + 52%, Gram - 20% and fungal 28%. In the LR Group 78% of the organisms were Gram+. Positive blood cultures was 21% for the HR Group and 8.3% for the LR Group. There were 23.5% superinfections in the HR Group vs 5.7% in the LR. The mean time and the median time of granulocytopenia was 11.5 and 8 days (HR) and 6.9 and 6.0 days (LR), respectively. There were 14.5% (LR) and 45.4% (HR) modifications to the initial empirical antibiotic regimen (Amphotericin B, Vancomycin and Amikacin). The overall success rate was 97.6% (LR) and 94.2% (HR) and for documented infection the success rate was 95.7% (LR) and 91.8% (HR). We conclude that: a) The allocation of patients to two risk groups aiming to use distinguished therapy, allowed us to delineate two different populations, predominantly based on time of granulocytopenia, disappearance of fever, rate of superinfection, causative organisms and need of additional drugs to the initial scheme.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Fever and neutropenia in children with cancer: a new therapeutic proposal]. 166 24

Chemotherapy, while undeniably effective in controlling or eradicating a variety of neoplasms, is also accompanied by a number of toxicities. Foremost among these is neutropenia, which places the pediatric cancer patient at risk for serious fungal infections. The fungal organisms most commonly responsible for infection in neutropenic children are Candida, Aspergillus, Mucor, and the Phycomycetes. Common sites of infection include the oral cavity, sinuses, lung, and bloodstream. Recently, candidal infection of the liver was recognized as a growing problem. Diagnosis of deep-seated fungal infections, such as pneumonia and hepatic candidiasis, is extremely difficult, often requiring open-lung or liver biopsy, which a patient's hematologic status may not permit. Because early treatment significantly improves prognosis, empirical antifungal therapy may be indicated in selected patients. Amphotericin B is currently the antifungal agent of choice against most fungal organisms. Antifungal efficacy studies based on animal models of disseminated candidal infection suggest that amphotericin B combined with 5-fluorocytosine (5-FC) is more effective than amphotericin B alone against most deep-seated Candida infections. The investigational drug, fluconazole, appears as effective as amphotericin B plus 5-FC in the prevention and early treatment of disseminated candidiasis, and clinical trials to assess this potentially important role for the new antifungal agent are now being initiated.
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PMID:Fungal infections in the pediatric cancer patient. 219 45

A 46-year-old male was admitted to our hospital because of relapse of acute myeloblastic leukemia (M2). Remission was successfully reinduced after reinduction chemotherapy consisting of daunorubicin, cytosine arabinoside, etoposide and vincristine, but was complicated by neutropenia. After the therapy, the patient had persistent fever of about 38 degrees C despite broad-spectrum antibiotics therapy and the patient developed pain in the right quadrant of the abdomen. The white blood cell count rose to 23000/mm3. Liver function tests showed abnormal findings mainly consisting of an elevated serum alkaline phosphatase level. Ultrasonography showed multiple hypoechoic lesions in the liver and CT scans also revealed multiple low density areas. Therefore he was suspected of having a complication of liver abscesses. Amphotericin B was administered 75 mg/day intravenously every other day. A percutaneous liver biopsy was performed, but was not diagnostic. Blood cultures were negative for pathogens. Amphotericin B was administered up to a cumulative dosage of 2.3 g, but the patient remained febrile. Then he had an exploratory laparotomy and an open liver biopsy. The liver biopsy samples showed fungal elements proved by PAS staining. A catheter was inserted into the portal vein. Administration of Amphotericin B was started 20 mg daily through the catheter. The temperature fell to normal after institution of this therapy. The abnormal findings in CT scans almost disappeared and the inflammatory findings became negative after he had received intraportal administration of Amphotericin B over three months. Through the analysis of this case study, we confirmed that the intraportal administration of Amphotericin B was effective to the intractable liver abscesses due to fungi.
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PMID:[Liver abscesses successfully treated by intraportal administration of amphotericin B in a case of acute myeloblastic leukemia (M2)]. 221 57

The authors report two cases of splenic and hepatosplenic candidiasis occurring during a protracted neutropenia induced by chemotherapy for acute leukemia (lymphoblastic and myeloblastic respectively). Fungal infection was revealed by persistent or recurrent fever after correction of neutropenia. Diagnosis was suggested by findings at abdominal ultrasonography. It was confirmed by histological analysis which, in the first case, required open liver biopsy. In both cases, lack of improvement of splenic lesions despite treatment with Amphotericin B followed by fluconazole led to splenectomy. Both patients received postoperative anti fungal therapy with Ampho B and at one year's follow up, the patient who had the hepatosplenic candidiasis seems to have recovered.
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PMID:[Visceral candidiasis in 2 children treated for acute leukemia]. 236 69

Saperconazole (R 66905) is a broad-spectrum antifungal triazole with potent in vitro activity against Aspergillus spp. A total of 279 strains were tested in brain heart infusion broth. Development of the Aspergillus spp. was completely inhibited at 0.1 and 1 microgram of saperconazole per ml for 80.3 and 99.6% of the strains, respectively. Normal and immunocompromised guinea pigs were infected intravenously with Aspergillus fumigatus and treated orally, intravenously, or intraperitoneally with saperconazole or intraperitoneally with amphotericin B. Leukopenia, neutropenia, lymphocytosis, and monocytosis were obtained with mechlorethamine hydrochloride; leukopenia, neutrophilia, and lymphopenia were obtained with cyclophosphamide. Saperconazole was dissolved for oral treatment in polyethylene glycol and for parenteral treatment in cyclodextrins. Amphotericin B was given parenterally as Fungizone (E.R. Squibb & Sons). Treatment was given once daily for 14 days. An early starting treatment was efficacious, but the activity of saperconazole was maintained even when the onset of the treatment was delayed to the moribund state. The activity of saperconazole was not altered in immunocompromised animals. Saperconazole was clearly superior to amphotericin B and free of side effects. The oral and parenteral formulations of saperconazole were equipotent. The systemic activity of saperconazole in guinea pigs was confirmed in invasive aspergillosis in pigeons.
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PMID:Oral and parenteral therapy with saperconazole (R 66905) of invasive aspergillosis in normal and immunocompromised animals. 261 73

Children undergoing ABMT, a procedure which entails massive doses of chemotherapy along with total-body irradiation, are candidate to develop severe gastrointestinal toxicity and prolonged anorexia requiring administration of Parenteral Nutrition (PN) for variable periods. We report a series of 35 consecutive children affected by malignancies who underwent 37 courses of PN after ablative therapy followed by ABMT. Age ranged from 8 months to 17 years; 16 were females, 19 males. There were 23 cases of neuroblastoma, 5 of Wilms' tumor, 3 of acute myelogenous leukemia, 2 of Ewing's sarcoma, 1 case each of rhabdomyosarcoma and acute lymphoblastic leukemia. All patients developed severe neutropenia for 9-42 days (median 18 d). Fever occurred in all patients; sepsis was documented in 10. Duration of PN ranged from 10 to 64 days (23 +/- 9; mean +/- SD). PN solution, containing crystalline L-Aminoacids (8.5%) mixed with 33% glucose, minerals, trace elements and vitamins provided for children a caloric intake of 49.8 +/- 17.3 Kcal/Kg/day with a nitrogen intake of 0.26 +/- 0.27 g/Kg/day. Nutritional assessment, utilizing percent ideal body weight, serum protein electrophoresis, C3, pseudocholinesterase and fibrinogen, was performed at the beginning and at the completion of each course of PN. Mean percent ideal body weight was 95.8 before PN, 98.5 on last day of PN (p less than 0.0005). Other parameters did not change significantly. No metabolic complication nor severe electrolyte imbalance were observed except for 5 patients who developed hypokalemia in coincidence with administration of Amphotericin B.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Autologous bone marrow transplantation in children. Use of parenteral nutrition]. 311 38


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