phenylephrine-hydrochloride and Neutropenia

Several studies have compared nasal swabs to the more invasive nasopharyngeal aspirate (NPA) for detection of respiratory viruses. Mostly, the comparisons have been performed on immunocompetent children with upper respiratory tract symptoms. The results range from a relatively poor sensitivity for the swabs to an even higher sensitivity than for the NPA. We aimed to investigate the sensitivity of a flocked nasal swab (fNS) on immunocompromised adults with febrile neutropenia.. During 16 months, adults with a hematological disorder presenting with febrile neutropenia were enrolled in the study. Paired samples of the fNS and NPA were collected in the outer part of the nasal cavity and the nasopharynx, respectively. The samples were analyzed regarding a panel of 15 respiratory viruses by means of quantitative polymerase chain reaction. Furthermore, as an indirect measure of cell yield by either method, the copy number of the human beta actin gene was also determined. Cohen's kappa was calculated as a measure of agreement of the results obtained from either method. Wilcoxon signed-rank test was used for comparison of cell yield.. A total of 98 paired samples from a total of 89 patients were collected. Twenty of the pairs had virus detected in at least one of the specimens; 11 in both, 7 in NPA only, and 2 in fNS only. For the fNS, the overall sensitivity for any virus and for rhinovirus only was 65% and 78%, respectively. NPA was significantly superior to the fNS in collecting epithelial cells.. We found the overall sensitivity of 65% to be too low to replace NPA with this sampling technique in this patient category.

Topics: Adult; Aged; Female; Fever; Humans; Immunocompromised Host; Male; Middle Aged; Nasopharynx; Neutropenia; Nose; Respiratory Tract Infections; Sensitivity and Specificity; Specimen Handling; Virus Diseases

Staphylococcus aureus is a common cause of serious infection in patients infected with HIV.. To evaluate risk factors for and quantitative effect of S. aureus infection in HIV-infected patients, with special attention to nasal carriage.. Prospective, multihospital cohort study.. Three tertiary care Veterans Affairs Medical Centers.. 231 ambulatory HIV-infected patients.. Thirty-four percent of patients were nasal carriers of S. aureus. Of these patients, 38% were persistent carriers and 62% were intermittent carriers. Twenty-one episodes of infection occurred in 13 patients: Ten were bacteremias (including 2 cases of endocarditis), 1 was pneumonia, and 10 were cutaneous or subcutaneous infections. Seventeen (85%) of these episodes occurred in patients with CD4 counts less than 100 cells/mm3. Recurrent infections occurred in 3 of 7 patients who survived an initial S. aureus infection. The mortality rate was higher among patients with S. aureus infection than among those without infection (P = 0.03). Factors significantly associated with S. aureus infection were nasal carriage, presence of a vascular catheter, low CD4 count, and neutropenia. Molecular strain typing indicated that for 6 of 7 infected patients, the strain of S. aureus isolated from the infected sites was the same as that previously cultured from the nares.. Nasal carriage is an important risk factor for S. aureus infection in HIV-infected patients. Controlled studies are indicated to determine whether eradication of nasal carriage in a selected subset of patients (for example, those with a low CD4 cell count) might prevent invasive S. aureus infection in patients with HIV infection.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Analysis of Variance; CD4 Lymphocyte Count; Humans; Neutropenia; Nose; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

We report the first case of invasive disease caused by Fusarium chlamydosporum. The patient had aplastic anemia with prolonged neutropenia and was treated with immunosuppressive therapy. While she was receiving empirical amphotericin B, a dark crusted lesion developed on her nasal turbinate. Histologic analysis revealed invasive hyaline hyphae and some darkly pigmented structures that resembled conidia of dematiaceous molds. Only after the mold was grown in culture were characteristic colonial morphology, phialides, conidia, and chlamydospores evident, thus permitting the identification of F. chlamydosporum. This case illustrates the ever-increasing spectrum of pathogenic Fusarium spp. in immunocompromised patients and emphasizes the potential pitfalls in histologic diagnosis, which may have important treatment implications.

Topics: Adult; Amphotericin B; Anemia, Aplastic; Female; Fusarium; Humans; Immunocompromised Host; Mycoses; Neutropenia; Nose

There is presented an atypical case Wegener's granulomatosis of maxillo-nasal region without bony destruction. The case is unusual because of sepsis and purulent coxitis. The patient responded well to treatment with vincristine and cyclophosphamide. ANCA assays have very good sensitivity and specificity for Wegener's granulomatosis.

Topics: Adolescent; Bone Diseases; Granulomatosis with Polyangiitis; Hip; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Immunosuppression Therapy; Lymphocytes; Male; Maxilla; Neutropenia; Nose; Radiography

Noma is an uncommon gangrenous process usually affecting malnourished children. A full-term neonate with orofacial noma, bilateral choanal atresia, and transient neutropenia with B cell deficiency is reported. This unusual appearance of noma in a well-nourished newborn might be related to the combination of choanal atresia and transient immune deficiency.

Topics: Agranulocytosis; B-Lymphocytes; Candidiasis; Female; Fistula; Humans; Infant, Newborn; Mouth Diseases; Neutropenia; Noma; Nose; Nose Diseases; Pseudomonas Infections