trimethoprim--sulfamethoxazole-drug-combination and Anemia--Aplastic

Toxoplasmosis is a rare but life-threatening complication of allogeneic stem-cell transplantation. Polymerase chain reaction (PCR) offers the possibility to make the diagnosis earlier than conventional techniques, and is then expected to improve the prognosis. We undertook a prospective screening using a competitive PCR in blood in 32 stem-cell transplant recipients. The sampling covered the first 150 days post-transplant, at days 21, 30, 45, 60, 90, 120, and 150. Twenty-four patients had anti-toxoplasma antibodies before transplant. Three of them (12.5%) had transient PCR-positive samples at 21, 45, and 90 days post-transplant, respectively. The three PCR-positive patients were febrile but had no funduscopic examination or cerebral computerised tomography (CT) scan abnormalities. The PCR signal disappeared when the patients were given trimethoprim-sulfamethoxazole, and no full-blown toxoplasmosis was observed. Toxoplasma reactivation evidenced using PCR is frequent in seropositive patients not receiving trimethoprim-sulfamethoxazole during the 1-3 months post-transplant. Toxoplasma PCR should be included in the diagnostic strategy of fever of unexplained origin in allogeneic stem-cell transplant recipients. Then, prompt specific therapy can be initiated to avoid development of full-blown toxoplasmosis.

Topics: Adult; Anemia, Aplastic; Animals; Anti-Infective Agents; Antibodies, Protozoan; Child; Female; Hematopoietic Stem Cell Transplantation; Humans; Leukemia; Male; Middle Aged; Polymerase Chain Reaction; Prospective Studies; Toxoplasma; Toxoplasmosis; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination

To characterize clinical, diagnostic and course features of pneumonia caused by Pneumocystis carinii (PC) in hematologic inpatients.. 27 patients with blood diseases were studied. 22 of them had acute respiratory insufficiency and 5 had unclear lung affection. The data from bronchoalveolar lavage (BAL), lung biopsy, serum tests for IgG, IgM anti-PC-antibodies were used for diagnosis of PC-pneumonia.. PC-pneumonia was diagnosed in 8 of 27 patients. Clinical manifestations characteristic for PC-pneumonia were not found. In 5 patients the diagnosis was made on the evidence provided by BAL. Lymphocyte count in BAL was elevated to 27.7 +/- 8.7%. Open biopsy of the lung and transbronchial biopsy diagnosed PC-pneumonia in 2 and 1 patients, respectively. Previous BAL examinations failed to detect PC-pneumonia in 2 of them. In all the patients PC-pneumonia was associated with another infection (bacterial, cytomegaloviral). Histologically, the picture of the disease was determined by the severity of the lung affection or its complications. 5 of 8 patients failed treatment with trimethoprim-sulphamethoxazole and died. Marked respiratory insufficiency was registered at PC-pneumonia diagnosis in all the lethal cases.. Clinical and x-ray pictures of PC-pneumonia in hemoblastosis patients are not specific. All such patients with symptoms of lung infection resistant to antibacterial and antifungal therapy should be examined for PC-pneumonia.

Topics: Acute Disease; Adolescent; Adult; Aged; Anemia, Aplastic; Anemia, Refractory, with Excess of Blasts; Anti-Infective Agents; Biopsy; Bronchoalveolar Lavage Fluid; Female; Hematologic Diseases; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Myeloid; Lung; Lymphoproliferative Disorders; Male; Middle Aged; Multiple Myeloma; Pneumonia, Pneumocystis; Radiography, Thoracic; Respiratory Insufficiency; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Evaluation of digitized chest x-ray for the detection of pulmonary infiltrations in bone marrow transplant patients during aplasia.. Digitized chest x-rays of 40 patients (21 female, 19 male) with "Fever of unknown origin" (FUO) were evaluated concerning radiological signs of pulmonary infiltrations and correlated to clinical findings, blood chemistry, microbiology and bronchoscopy. Additionally, an individual risk profile was established.. In 11/40 patients pulmonary infiltrations were detected in digitized chest x-rays (group 1). 10/11 developed an infectious pulmonary infiltration. 29/40 patients developed no pulmonary infiltration (group 2). When fever increased for the first time (initial chest x-ray) a sensitivity, specificity, positive and negative predictive value of 46%, 86%, 56%, 81% and for the chest x-rays in progress of 61%, 79% 68% and 73% was found. C-reactive protein and temperature increase occurred statistically significantly earlier (p < 0.05) in group 1 compared to group 2. The average latency of digital chest x-rays in comparison to c-reactive protein and temperature increase was 6 days. The incidence of risk factors was significantly higher in group 1 in comparison to group 2 (p < 0.05).. Digitized chest x-rays are not a reliable method for primary detection of pulmonary infiltrations after bone marrow transplantation. Individual risk factors have to be taken into consideration to indicate further diagnostic methods such as computed tomography at an earlier time.

Topics: Adult; Anemia, Aplastic; Anti-Infective Agents; Antibiotic Prophylaxis; Antifungal Agents; Bone Marrow Transplantation; Diagnosis, Differential; Female; Fluconazole; Humans; Lung Diseases; Lung Diseases, Fungal; Male; Middle Aged; Ofloxacin; Pneumonia; Prospective Studies; Radiographic Image Enhancement; Radiography, Thoracic; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

The risks of agranulocytosis and aplastic anemia in relation to the use of anti-infective drugs were estimated in a population-based case-control study conducted in Europe and Israel. Anti-infective drug use in the 2-week period before the onset of illness was compared between 251 patients admitted to hospital with agranulocytosis and 1271 controls hospitalized for reasons judged to be unrelated to previous use of anti-infective drugs. Anti-infectives significantly associated with agranulocytosis when used for at least 3 consecutive days were trimethoprim/sulfamethoxazole (relative risk, 12; 95% confidence interval, 3.9 to 40) and macrolides (infinity). The relative risk estimate for any use of sulfonamides without trimethoprim was elevated, but not statistically significant (3.6; 0.7 to 18). These estimates took confounding by various factors, in particular the use of other drugs, into account. The estimated excess risks of agranulocytosis attributable to the use of trimethoprim/sulfamethoxazole and macrolides in a 2-week period were 1.6 and 7.1 per million, respectively. Anti-infective use during the 29- through 180-day period before hospital admission was compared between 135 patients with aplastic anemia and 1410 controls. Although relative risk point estimates were elevated for trimethoprim/sulfonamides (2.1), other sulfonamides (2.9), and beta-lactams (1.5), none was statistically significant.

Topics: Agranulocytosis; Anemia, Aplastic; Anti-Bacterial Agents; Anti-Infective Agents; Drug Combinations; Humans; Lactams; Risk Factors; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anemia, Aplastic; Drug Combinations; Female; Humans; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anemia, Aplastic; Anti-Bacterial Agents; Antifungal Agents; Antilymphocyte Serum; Bone Marrow; Bone Marrow Transplantation; Child; Child, Preschool; Drug Combinations; Fanconi Syndrome; Humans; Immunosuppression Therapy; Middle Aged; Neutropenia; Pancytopenia; Plateletpheresis; Prognosis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination