[Show abstract][Hide abstract] ABSTRACT: Invasive fungal infections (IFIs) are a primary cause of morbidity and mortality in patients with hematological malignancies. Establishing a definite diagnosis of IFI in immunocompromised patients is particularly challenging and time consuming, but delayed initiation of antifungal treatment increases mortality. The limited overall outcome has led to the strategy of initiating either 'empirical' or 'preemptive' antifungal therapy before the final diagnosis. However, diagnostic procedures have been vastly improved in recent years. Particularly noteworthy is the introduction of newer imaging techniques and non-culture methods, including antigen-based assays, metabolite detection and molecular detection of fungal DNA from body fluid samples. Though varying widely in cancer patients, the risk of IFI is highest in those with allogeneic stem cell transplantation and those with acute leukemia. The AGIHO presents recommendations for the diagnosis of IFIs with risk-adapted screening concepts for febrile episodes in patients with haemato-oncological disorders.
Full-text · Article · Sep 2011 · Annals of Oncology
[Show abstract][Hide abstract] ABSTRACT: Invasive fungal infections are a main cause of morbidity and mortality in cancer patients undergoing intensive chemotherapy regimens. Early antifungal treatment is mandatory to improve survival. Today, a number of effective and better-tolerated but more expensive antifungal agents compared to the former gold standard amphotericin B deoxycholate are available. Clinical decision-making must consider results from numerous studies and published guidelines, as well as licensing status and cost pressure. New developments in antifungal prophylaxis improving survival rates result in a continuous need for actualization. The treatment options for invasive Candida infections include fluconazole, voriconazole, and amphotericin B and its lipid formulations, as well as echinocandins. Voriconazole, amphotericin B, amphotericin B lipid formulations, caspofungin, itraconazole, and posaconazole are available for the treatment of invasive aspergillosis. Additional procedures, such as surgical interventions, immunoregulatory therapy, and granulocyte transfusions, have to be considered. The Infectious Diseases Working Party of the German Society of Hematology and Oncology here presents its 2008 recommendations discussing the dos and do-nots, as well as the problems and possible solutions, of evidence criteria selection.
Full-text · Article · Nov 2008 · Annals of Hematology
[Show abstract][Hide abstract] ABSTRACT: Ein 4-jähriges Kind wird am 11.08.2003 mit massiven Durchfällen, Erbrechen und Somnolenz vom Rhein-Main-Flughafen in die Frankfurter
Uniklinik eingewiesen. Der Junge war mit seiner Familie auf dem Rückflug von einem Besuch bei Verwandten in Pakistan in die
USA, dem derzeitigen Wohnort. Bei Aufnahme zeigt sich das Kind in deutlich reduziertem Allgemeinzustand, mit geblähtem Abdomen,
halonierten Augen, und trotz hohen Fiebers bis 40°C hat er trockene und kalte Extremitäten. Es besteht ein prärenales Nierenversagen
mit metabolischer Azidose und Elektrolytentgleisung bei ausgeprägter Exsikkose. Die maximale Stuhlfrequenz beträgt 20/Tag,
die Stuhlentleerungen sind nicht blutig und von grünlich-schleimiger Konsistenz. Übelkeit und Erbrechen sind nur gering ausgeprägt.
Anamnestisch war das Kind bis zum 10.08.03 völlig gesund, die mitreisenden Verwandten (Mutter, Tante und 10-jähriger Bruder)
sind klinisch unauffällig.
[Show abstract][Hide abstract] ABSTRACT: Herein, we describe a case of leprosy in a 29-year-old pregnant southeast-asian woman who presented with joint pain and multiple disseminated erythematous macules, papules and plaques. Histological examination and stains for acid-fast bacilli from skin biopsies substantiated the clinical suspicion of a cutaneous mycobacterial disease and both should be performed in all patients with unidentified skin lesions. The definitive laboratory diagnosis of leprosy was achieved by the application of a species-specific real-time polymerase chain reaction from infected tissue.
[Show abstract][Hide abstract] ABSTRACT: We report a mixed enteric infection in a 4-y-old child who returned from Pakistan with fever, vomiting and profuse diarrhoea leading to severe dehydration. Vibrio cholerae O1, Salmonella paratyphi A and Campylobacter coli were cultured from stool. Furthermore, Giardia lamblia antigen and hepatitis A RNA were detected. This is the first paediatric cholera case seen in Frankfurt/Main.
No preview · Article · Feb 2005 · Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: This report presents two cases of cervical lymphadenitis due to Mycobacterium interjectum in healthy young children, identified by sequencing of the 16S rRNA gene. Surgical resection combined with chemotherapy resulted in cure.
Conclusion: The attention of clinicians needs to be drawn to an emerging mycobacterial pathogen which might be overlooked or misidentified in routine laboratory testing.
No preview · Article · Apr 2004 · Acta Paediatrica
[Show abstract][Hide abstract] ABSTRACT: Chronic rhinosinusitis (CRS) is a disease very frequently encountered by otorhinolaryngologists. According to Ponikau et al. fungi are accused to trigger eosinophilic CRS. Other authors quote fungi to cause CRS in only up to 10%. In Germany, data concerning fungal rhinosinusitis in CRS patients are rare. Therefore, a study on 51 patients with CRS and 10 controls was conducted. Nasal mucus was collected by cotton sponges (group A, n = 39) or by flushing the nose (group B, n = 12), the controls were treated respectively. Nasal secretions were processed for microbiology, fungal cultivation and cytology. Fungi and eosinophiles were visualised by microscopic study of smears in Pappenheim and Grocott. Skin prick tests and specific IgE measurements were done to evaluate an atopy. Five (12%) patients in group A and 1 patient (8%) in group B had positive fungal cultures. Altogether, from 6 (12%) patients with CRS and 2 controls fungi were cultivated. The species identified were Aspergillus, Alternaria, Aureobasidium, Candida, Cladosporium, Penicillium. Fourteen (36%) patients in group A and 2 (16%) in group B showed fungi on microscopic examination. So, in 16 (31%) patients with CRS fungi were found in the cytological preparations, 1 control was positive. In 3 patients, skin prick tests and specific antigen against fungi correlated with the microscopic and mycological findings. Our data indicate that allergic fungal rhinosinusitis can occur in 6% of CRS. In 31% of CRS fungi were found in nasal mucus. If in such patients conventional treatment fails, new therapeutic strategies could be of relevance.
[Show abstract][Hide abstract] ABSTRACT: Invasive fungal infections are a primary cause of morbidity and mortality in patients with hematological malignancies. Establishing a definite diagnosis of invasive fungal infection in febrile neutropenic patients is particularly challenging and time-consuming, but a delay of antifungal treatment leads to higher mortality. This situation has lead to the strategy of initiation "empirical" antifungal therapy prior to the detection of fungi. Meanwhile, improvements in diagnostic procedures are achieved, especially with imaging techniques and non-culture based methods which include antigen-based assays, metabolite detection and molecular detection of fungal DNA from body fluid samples using conserved or specific genome sequences. The AGIHO presents recommendations for the diagnosis of invasive fungal infections with risk-adapted screening concepts for the neutropenic and febrile episodes of patients with hemato-oncological disorders.
Full-text · Article · Nov 2003 · Annals of Hematology
[Show abstract][Hide abstract] ABSTRACT: A 60-year-old woman with non-Hodgkin's lymphoma was admitted to the hospital because of extensive subcutaneous abscesses developing on all limbs. The patient had an aquarium and kept tropical fish as pets. After repeated investigations, the diagnosis of Mycobacterium marinum was established from skin biopsy by PCR and culture. Long-term therapy with several drugs regimens had only a limited efficacy and was accompanied by severe adverse reactions. This report highlights the therapeutic problems posed by disseminated cutaneous M. marinum infection in the immunosuppressed host.
[Show abstract][Hide abstract] ABSTRACT: A 53-year-old man with known HIV infection and AIDS was admitted because of painful swelling at the right knee for 6 weeks. The cause was thought to be osteomyelitis and surgical treatment was planned.
No causative pathogen was found at curettage and lavage of an abscess at the right medical head of the tibia, but at a subsequent operative revision acid-fast rods were seen and identified as Mycobacterium haemophilum.
A systemic antibiotic, 1 g levofloxacin daily, had been started at the initial abscess operation. 2 weeks later, because swelling of the right knee had recurred with marked local and systemic signs of infection, a second surgical intervention was performed. Afterwards, in view of the histological finding of acid-fast bacteria suggesting tubercular osteomyelitis, the patient was put on combined treatment with 300 mg/d of isoniazid, 1600 mg/d of ethambutol, 2 g/d of pyrazinamide, and 1 g of streptomycin i.m. every other day. After molecular microbiological identification of M. haemophilum the antibiotic treatment was changed to 1600 mg/d of ethambutol, 300 mg/d of rifabutin and 1 g/d of clarithromycin. The operation wound healed well.
M. haemophilum infection can be lethal in immunodeficient patients if untreated. Although there is no standard treatment, this rare infectious disease responds relatively well to a modified combined tuberculostatic regimen. Special laboratory techniques to identify the specific causative pathogen are therefore of great importance.
No preview · Article · Oct 2002 · DMW - Deutsche Medizinische Wochenschrift
[Show abstract][Hide abstract] ABSTRACT: While Mycobacterium malmoense infections were originally restricted to northern Europe, there has been an increasing number of reports of cases of infection in other countries. Two cases of infections due to Mycobacterium malmoense in immunocompetent patients in Germany are presented. In both cases a presumptive diagnosis of tuberculosis was established initially. Mycobacterium malmoense was cultured after a long incubation period (6-8 weeks). The patients were successfully treated with a triple regimen consisting of rifampicin, ethambutol and clarithromycin. The epidemiology and difficulties in diagnosis of Mycobacterium malmoense infection are discussed.
No preview · Article · Sep 1999 · European Journal of Clinical Microbiology
[Show abstract][Hide abstract] ABSTRACT: In the absence of coexisting active pulmonary disease, tuberculosis is frequently not considered in the differential diagnosis of chronic inflammation of the joints. The cases of two immigrant patients with tuberculous arthritis involving the forearm are reported. In both cases non-specific arthritis or trauma was suspected, resulting in a delay between the onset of symptoms and institution of specific therapy of 21 and 24 months, respectively. Diagnosis was achieved by histological and microbiological examination of synovial biopsy material. Polymerase chain reaction for Mycobacterium tuberculosis complex was positive in only one patient. Treatment consisted of antituberculosis chemotherapy, surgical synovectomy, and debridement of the affected joints. These cases serve as a reminder that, although rare, tuberculosis can cause chronic arthritis.
No preview · Article · Jun 1998 · European Journal of Clinical Microbiology
[Show abstract][Hide abstract] ABSTRACT: Objective. The present study was designed to investigate the frequency and the distribution of yeasts in patients from the Intensive Care Unit (ICU) and to determine their clinical importance. Additionally, several yeast identification technique were compared in order to find out the most appropriate system for the routine laboratory. Patients and methods. Between August 1, 1994 and April 1, 1995 mycological follow-up were performed in 100 patients from the post surgical and in 26 patients from the neurological Intensive Care Unit. Tracheal and bronchial aspirate as well as urine samples obtained twice a week were cultured after dilution on Sabouraud agar at 30°C. Following methods for differentiation of the isolated yeast species were performed: germ tube test, microscopy on rice tween agar; Albicans ID agar, CHROMagar Candida, Fongiscreen 4H, API 20C Aux and Auxacolor identification panels. Results. Yeasts were found in 61.1% of all patients, more frequently in men (68.3 %) than in women (47.7 %). The colonisation rate with Candida species was higher in patients undergoing an abdominal operation (72.4 %) than in those after an operation of the thorax (58.7 %). The quantitative analysis of yeasts revealed fluctuating and only moderate numbers of colonies (< 106/ml). During the study period no case of deep mycosis could be ascertained. The 101 strains recovered were distributed among 11 species, mainly C. albicans (48.5 %), C. (Torulopsis) glabrata (26.7 %), C. tropicalis (10.9 %) and C. kefyr (2.9 %). C. albicans could be easily identified by germ tube test or by Albicans ID agar. With Fongiscreen 4H rapid diagnosis may be achieved, however only for the four main species. C. glabrata was difficult to distinguish from other species on CHROMagar Candida. Compared with API 20C Aux, Auxacolor appeared as effective but more rapid, permitting the identification of a wide spectrum of yeasts mostly within 24 h. Conclusions. Our results suggest that patients from Intensive Care Units without neutropenia are often colonized with Candida species but present rarely severe fungal infections. For the identification of these yeasts, the use of Albicans ID agar followed by Auxacolor seem to be a satisfying procedure for the routine laboratory.
[Show abstract][Hide abstract] ABSTRACT: To determine the frequency of disseminated Mycobacterium avium-complex infections (MAC) and the impact of MAC disease on overall survival in patients with HIV disease and AIDS.
Prospective study of HIV infected patients with a CD4 lymphocyte count < 150/microliter or patients with AIDS over a 7-year period. Blood cultures of all patients presenting symptoms and signs suggestive of disseminated MAC infection were grown. Only patients who deceased at our clinic (n = 427) were included in the final analysis in order to calculate MAC disease-free survival and overall survival after first CD4 lymphocyte count < 100/microliter.
101 out of 427 patients (24%) developed disseminated MAC disease: The median time between first CD4 lymphocyte count < 100/microliter and MAC disease was 441 days (range 16 to 1560). The actuarial risk of MAC disease for the entire patient population was 12%, 28%, and 42% after 1, 2, and 3 years, respectively. When comparing overall survival after first CD4 lymphocyte count < 100/microliter, there was no statistically significant difference between patients who subsequently developed disseminated MAC infection and those who did not.
MAC disease is a very frequent opportunistic infection in advanced AIDS, mostly in patients with less than 50 CD4 cells/microliter. In contrast to reports from the US, only 24% of our patients developed MAC disease. Survival time between patients with and without MAC infection did not differ.
No preview · Article · Mar 1997 · European journal of medical research