trimethoprim--sulfamethoxazole-drug-combination and Hodgkin-Disease

We evaluated the effect of oral ciprofloxacin on neutrophil recovery in 20 consecutive patients undergoing autologous bone marrow transplantation (BMT) for malignant lymphoma and compared the results with a control group of 20 patients receiving co-trimoxazole and folinic acid. Both groups started the prophylactic antibiotic as well as granulocyte-macrophage colony-stimulating factor (GM-CSF) the day after marrow infusion and continued the former until the onset of febrile neutropenia (median duration of treatment 6 days for co-trimoxazole and 7 days for ciprofloxacin). The time of attain an absolute neutrophil count > or = 0.5 x 10(9)/L was significantly shorter in patients receiving ciprofloxacin (16 days vs 22 days; P = 0.006). There was no difference in time to attain a platelet count > or = 20 x 10(9)/L independent of transfusion or in time to the first febrile episode or incidence of bacteremia. We conclude that antibiotic prophylaxis with ciprofloxacin results in more rapid neutrophil recovery than prophylaxis with co-trimoxazole. This may result from a myelosuppressive effect of co-trimoxazole or an enhancement of neutrophil recovery by ciprofloxacin, or both.

Topics: Administration, Oral; Adult; Bacteremia; Blood Platelets; Bone Marrow Transplantation; Cell Count; Ciprofloxacin; Female; Granulocyte-Macrophage Colony-Stimulating Factor; Hodgkin Disease; Humans; Lymphoma, Non-Hodgkin; Male; Neutrophils; Prospective Studies; Transplantation, Autologous; Trimethoprim, Sulfamethoxazole Drug Combination

A Polymerase Chain Reaction-based diagnosis of

Topics: Adult; Hodgkin Disease; Humans; Incidence; Pneumocystis carinii; Pneumonia, Pneumocystis; Polymerase Chain Reaction; Prospective Studies; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Drug Combinations; Hodgkin Disease; Humans; Hypoglycemia; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

To assess the results of diagnosing and treating Pneumocystis pneumonia (PP) in patients with Hodgkin lymphoma (HL) over 15 years.. In 1999 to 2013, PP occurred in 22 (3%) of 741 HL patients receiving programmed polychemotherapy (PCT). The male/female ratio was 1:1.1; median age was 32 (18-65) years. Advanced stages (IIB-IV) of the disease were seen in 82% of the patients. The diagnosis of PP was established when Pneumocystis (more than 5 cysts in the specimen) was detected in the lavage fluid by indirect immunofluorescence assay.. PP developed after 4 or more cycles of PCT. Along with Pneumocystis, all the cases were found to have additional pathogens: herpes virus in 72% and bacteria and fungi in 33%. All the patients received combined antimicrobial therapy using high doses of intravenous trimethoprim-sulfamethoxazole. Ten (45%) patients required mechanical ventilation (MV). The total mortality in PP was 32% (7 patients died); moreover, none of the patients without MV died whereas the mortality among those who had MV was 70% (7 of the 10 patients died). High death rates (80%) were noted among the patients with recurrent and resistant HL.. PP should be prevented with trimethoprim-sulfamethoxazole in patients with LH during PCT. If respiratory failure and X-ray signs of interstitial pneumonia appear, there is a need for fibrobronchoscopy with bronchoalveolar lavage and comprehensive microbiological testing of lavage fluid.

Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Bronchoalveolar Lavage Fluid; Female; Fluorescent Antibody Technique, Indirect; Hodgkin Disease; Humans; Male; Middle Aged; Pneumonia, Pneumocystis; Respiration, Artificial; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Inflammatory Agents; Antiretroviral Therapy, Highly Active; Hodgkin Disease; Humans; Immune Reconstitution Inflammatory Syndrome; Lymphohistiocytosis, Hemophagocytic; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Prednisone; Trimethoprim, Sulfamethoxazole Drug Combination

Chlamydia pneumoniae is known to cause acute respiratory tract infections in the non-immunocompromised population. So far, no data about the incidence of chlamydial infections in neutropenic patients are available. Macrolide antibiotics are not considered to be first-line treatment options in neutropenic patients. We report the case of a patient with Hodgkin's disease who developed C. pneumoniae pneumonia during mild neutropenia. C. pneumoniae should be considered as a causative agent of pneumonia in neutropenic patients.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Aza Compounds; Bleomycin; Chlamydophila Infections; Chlamydophila pneumoniae; Dacarbazine; Doxorubicin; Drug Therapy, Combination; Female; Fluoroquinolones; Hodgkin Disease; Humans; Imipenem; Immunocompromised Host; Moxifloxacin; Neutropenia; Pneumonia, Bacterial; Quinolines; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin; Vincristine

A review was undertaken of the clinical features and results of diagnostic tests in non-HIV infected patients who developed granulomatous Pneumocystis carinii pneumonia (PCP).. A retrospective review was performed of the charts and radiographs of patients with a granulomatous reaction to P carinii identified from computerised pathology records at Memorial Sloan Kettering Cancer Center, a university affiliated tertiary care hospital.. Three cases were identified; the incidence of granulomatous PCP was 3%. All patients had risk factors for PCP and had received high dose corticosteroids which had been stopped. Two patients had received chemotherapy. Presentation was insidious with only mild symptoms; only one patient had fever. Chest radiographs showed a reticulonodular pattern. Bronchoscopy was negative for PCP in all cases and open lung biopsy was necessary.. A granulomatous pathological reaction to PCP occurs rarely in patients with malignancy. In these cases the clinical presentation may be atypical and bronchoscopy can be non-diagnostic.

Topics: Adolescent; Adult; Anti-Infective Agents; Bronchoalveolar Lavage Fluid; Female; Glioblastoma; Granuloma; Hodgkin Disease; Humans; Male; Middle Aged; Pneumocystis Infections; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Hypouricemia has been reported in a substantial fraction of patients with AIDS and attributed to an HIV-related renal urate transport defect. We tested the alternative hypothesis that hypouricemia was associated with the administration of high-dose trimethoprim-sulfamethoxazole (TMP-SMX).. Sociodemographic, clinical, and repeated laboratory data on 45 hospitalized patients with Pneumocystis carinii pneumonia (PCP) with and without HIV infection, were abstracted by a blinded reviewer. The primary outcome of interest was the percent change in serum uric acid concentration from baseline to hospital day 5 +/- 1.. Subjects who received TMP-SMX were older (mean age 44.8 vs. 37.0, p = 0.02), less likely to be HIV-seropositive (61% vs. 94%, p = 0.01), and more likely to have received glucocorticoid therapy (75% vs. 35%, p = 0.01) than those who received pentamidine, dapsone-trimethoprim, clindamycin-primaquine, sulfadiazine-pyramethamine, or a combination of these agents. The administration of TMP-SMX was associated with a 37% +/- 12% reduction in serum uric acid concentration, adjusting for the effects of age, sex, race, HIV antibody status, renal function, serum sodium, and the use of diuretics and glucocorticoids (p = 0.005).. Among a diverse cohort of hospitalized patients with PCP, treatment with high-dose TMP-SMX was strongly associated with a reduction in serum uric acid concentration over time.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Case-Control Studies; Cohort Studies; Female; Hodgkin Disease; Humans; Male; Pneumonia, Pneumocystis; Risk Factors; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Uric Acid