rifampin and Precursor-Cell-Lymphoblastic-Leukemia-Lymphoma

We report the first know case of disseminated fungal infection due to Fusarium proliferatum in a bone marrow transplant recipient to our knowledge. Fusarium was cultured from the blood, a paranasal sinus, and necrotic skin lesions. The isolate was sensitive to amphotericin B and on further sensitivity testing, synergy was demonstrated using rifampin in combination with amphotericin B. The patient had this infection while she was receiving alternate-day amphotericin, rifampin, and 5-flucytosine (5-FC) therapy. The infection was documented within 48 h of discontinuing daily granulocyte transfusions, which she had received for 3 weeks. The 5-FC was discontinued when sensitivities showed the organism resistant. After 6 weeks of treatment she showed complete remission of the infection, although neutrophil counts remained below 0.25 X 10(9)/L. From this case and from a review of the literature, it appears that synergic antifungal agents combined with leukocyte transfusions may be beneficial in the successful treatment of fusariosis in the compromised host.

Topics: Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Bone Marrow Transplantation; Child, Preschool; Combined Modality Therapy; Female; Fusarium; Humans; Mycoses; Neutropenia; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rifampin; Skin; Spider Bites; Staphylococcal Infections

Children who undergo treatment for malignancies are at high for infection with both typical and opportunistic pathogens. Fever in these children prompts extensive evaluation and empiric treatment with broad-spectrum antimicrobials. In the United States (US), tuberculosis is an infrequently reported cause of fever in the pediatric cancer patient and has not been well described. In this report we describe a case of primary pulmonary tuberculosis (TB) in a boy with precursor B-cell acute lymphoblastic leukemia (ALL) and review the pertinent literature.

Topics: Antineoplastic Combined Chemotherapy Protocols; Antitubercular Agents; Azithromycin; Child, Preschool; Combined Modality Therapy; Contact Tracing; Cyclophosphamide; Cytarabine; Dexamethasone; Doxorubicin; Drug Therapy, Combination; Ethambutol; Fever of Unknown Origin; Humans; Immunocompromised Host; Isoniazid; Lymphopenia; Male; Mycobacterium tuberculosis; Pneumonectomy; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrazinamide; Rifampin; Tuberculosis, Pulmonary; Vincristine

Topics: Adrenal Cortex Hormones; Antineoplastic Combined Chemotherapy Protocols; Antitubercular Agents; Asparaginase; Comorbidity; Daunorubicin; HIV Infections; Humans; Immunocompromised Host; Immunosuppressive Agents; Incidence; India; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Purpura, Thrombocytopenic, Idiopathic; Retrospective Studies; Rifampin; Thrombocytopenia; Tuberculosis; Vincristine

We report on 3 children undergoing treatment for acute lymphoblastic leukemia (ALL), who developed systemic nontuberculous mycobacterial (NTM) infections. All 3 patients were treated successfully with 5 months or less of antimicrobial therapy and completed their chemotherapy with no further recurrence of their NTM infection. NTM infections in some children with ALL may be successfully treated with antimicrobial agents without necessarily compromising the ALL treatment. The optimal duration of therapy for NTM remains unclear, but may be shorter than previously reported.

Topics: Child, Preschool; Clarithromycin; Female; Humans; Male; Mycobacterium avium-intracellulare Infection; Mycobacterium chelonae; Mycobacterium Infections, Nontuberculous; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rifampin

We describe a patient with acute lymphocytic leukemia and multidrug-resistant tuberculosis of the brain and spinal cord. Despite treatment with six antituberculous drugs and a steroid medication for 11 months, there was no appreciable clinical or radiological improvement in the patient's condition. Within 5 months of initiating adjunctive therapy with IFN-gamma and granulocyte colony stimulating factors, substantial neurological and radiological improvement was noted. Therapy with IFN-gamma was continued for 12 months, resulting in complete resolution of the lesions in the brain and spinal cord.

Topics: Adult; Antitubercular Agents; Brain; Drug Resistance, Microbial; Fatal Outcome; Female; Granulocyte Colony-Stimulating Factor; Humans; Immunocompromised Host; Interferon-gamma; Isoniazid; Magnetic Resonance Imaging; Mycobacterium tuberculosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Refractory Period, Electrophysiological; Rifampin; Tuberculosis, Multidrug-Resistant

Topics: Antineoplastic Combined Chemotherapy Protocols; Antitubercular Agents; Child, Preschool; Drug Contamination; Ethionamide; Female; Humans; Iatrogenic Disease; Immunocompromised Host; Isoniazid; Male; Meningitis, Bacterial; Mycobacterium bovis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrazinamide; Rifampin; Streptomycin; Tuberculosis, Meningeal

The records were reviewed for all patients hospitalized at a pediatric oncology center for complications of leukemia (n = 822) or lymphoma (n = 290) during an 8-year period. The results of surveillance cultures (throat, rectal, and urine) and blood cultures were analyzed to identify cases of Candida tropicalis and C. albicans colonization and/or fungemia. None of the patients with lymphoma who had positive surveillance cultures for C. albicans (n = 89) or C. tropicalis (n = 23) had fungemia. Among patients with leukemia, significant fungal infection was documented in 12 of 107 colonized with C. tropicalis (11.2%) versus 14 of 700 (2%) colonized with C. albicans (P less than 0.001). The two groups of children with fungemia were similar in primary diagnoses (predominantly acute lymphoblastic leukemia) and in the frequency of several known risk factors for infection, including the duration of neutropenia (absolute neutrophil counts, less than 500/microliters). Patients with C. tropicalis fungemia all had disseminated disease compared with nine of 14 patients with C. albicans fungemia. Also, subcutaneous abscesses were unique to patients with C. tropicalis in this series. Two patients in each group died of their infection; central nervous system involvement was present in both fatal cases of C. tropicalis fungemia. A high index of suspicion and the early institution of appropriate antifungal therapy are critical to the successful management of these infections in patients with leukemia.

Topics: Adolescent; Adult; Amphotericin B; Candida; Candida albicans; Candidiasis; Child; Child, Preschool; Flucytosine; Humans; Infant; Pediatrics; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rifampin; Risk Factors; Tomography, X-Ray Computed

Topics: Amphotericin B; Aspergillosis; Child; Femur; Flucytosine; Humans; Male; Osteomyelitis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rifampin

We evaluate the efficacy of rifampin combined with low dose harringtonine in acute leukemia (Group A, acute lymphocytic leukemia (ALL) 6 cases and acute non-lymphocytic leukemia (ANLL) 8 cases) in comparison with the patients treated with low dose harringtonine only (Group B, 8 ALL, and 5 ANLL). The complete remission (CR) rate in Groups A and B was 64.3% and 23.1%, while the median CR duration, 17 months and 8 months respectively, Group A was more effective than Group B. We also consider that rifampin and low dose harringtonine are more applicable for treatment of ANLL patients without peripheral leukocytosis and those complicated with infection.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Female; Harringtonines; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rifampin