Efficacy and feasibility of aerosolized amphotericin B lipid complex therapy in caspofungin breakthrough pulmonary zygomycosis.

Safdar A, O’Brien S, Kouri IF.

Bone Marrow Transplant. 2004 Sep;34(5):467-8.

Mycobacterium tuberculosis at a comprehensive cancer centre: active disease in patients with underlying malignancy during 1990-2000.

De La Rosa GR, Jacobson KL, Rolston KV, Raad II, Kontoyiannis DP, Safdar A.

Clin Microbiol Infect. 2004 Aug;10(8):749-52.

Abstract

Thirty HIV-seronegative cancer patients with active tuberculosis were evaluated. Eighteen (60%) were immigrants, 19 (63%) had haematological malignancy, and fever was the most common presentation (97%). Of 19 (63%) patients with pulmonary tuberculosis, 11 (58%) were misdiagnosed initially as suffering from cancer following radiography. Death was attributed to tuberculosis for six (21%) of 29 patients who received anti-mycobacterial therapy. All four patients who had received high-dose systemic corticosteroids within 4 weeks of diagnosis of infection died, whereas two (8%) deaths occurred in 25 individuals without corticosteroid exposure (p < 0.001; OR 8.67). At this institution, active tuberculosis was rare, and was seen mostly in immigrants. Recent high-dose corticosteroid therapy is a significant predictor of mortality in cancer patients with tuberculosis.

Antimicrobial susceptibility of 128 Salmonella enterica serovar typhi and paratyphi A isolates from northern India.

Safdar A, Kaur H, Elting L, Rolston KV.

Chemotherapy. 2004 Jun;50(2):88-91.

Abstract

Most systemic Salmonella enterica serovar typhi and paratyphi A infections diagnosed in the United States (up to 70%) are acquired during travel to regions of high endemicity. Increasing resistance to agents commonly used for the treatment of such infections (including multidrug resistant isolates) is being reported from several areas of the world (Southeast Asia, Africa, Latin America). Since regional differences in susceptibility patterns may exist, we sought to determine the frequency of antimicrobial resistance among blood and stool isolates (n = 128) from patients in Northwestern India. Salmonella enterica serotype typhi (n = 101) isolates from 14 patients were susceptible to all agents tested. Among 55 isolates with single drug resistance, 44 (81%) were resistant to chloramphenicol. Multidrug resistant (>/=3 drugs) Salmonella enterica was more common in pediatric patients (10 of 30) compared to adults (10 of 71 patients; p = 0.05). All isolates (S. enterica serovar typhi and serovar paratyphi A) were susceptible to ciprofloxacin and ceftriaxone. Travelers to Northwestern India may still receive trimethoprim-sulfamethoxazole, or ciprofloxacin for effective chemoprophylaxis if indicated. Ceftriaxone and ciprofloxacin remain favorable choices for treatment of patients with enteric fever in this region.

Clinical significance of non-Candida fungal blood isolation in patients undergoing high-risk allogeneic hematopoietic stem cell transplantation (1993-2001).

Safdar A, Singhal S, Mehta J.

Cancer. 2004 Jun 1;100(11):2456-61.

Abstract

BACKGROUND:

The clinical relevance of mold isolated from blood cultures, even in severely immunosuppressed allogeneic hematopoietic stem cell transplantation (HSCT) recipients, remains uncertain. The authors hypothesized that isolation of non-Candida fungi from blood cultures in patients undergoing high-risk HSCT would have clinical significance.

METHODS:

The authors reviewed the records of 73 allogeneic HSCT recipients between January 1, 1993 and January 1, 2001 in whom fungal species were isolated from blood cultures.

RESULTS:

Fifty-two episodes of non-Candida fungemia occurred in 48 patients (66%) after a median of 10 days (range, 2-341) after transplantation. All 48 patients had indwelling intravascular catheters, and 23 patients (48%) had profound neutropenia. Thirty-five of 48 patients had received partially matched, related donor stem cell grafts (19 patients had 3-antigen-mismatched grafts); 35 patients had undergone T-cell depleted transplantation and 9 patients were receiving treatment for acute graft-versus-host disease. In 5 of 48 patients (10%), death was attributed to fungemia that occurred 8-11 days after the initial fungal blood culture was obtained; all 5 patients were age > 30 years. No deaths occurred in the younger age group (n = 22 patients; P = 0.05). In the 24 patients who did not receive systemic antifungal therapy, 4 deaths (17%) were attributed to infections with Penicillium (n = 2 patients), Epicoccum (n = 1 patient), or Penicillium plus Cladosporium species (n = 1 patient). Of the 24 patients who received amphotericin B, only 1 patient (4%) died as a result of a probable hematogenous Aspergillus species infection; this difference in outcome, however, was not significant (P = 0.2).

CONCLUSIONS:

Most of the non-Candida fungal blood culture isolates in recipients of high-risk, mismatched donor transplantation were clinically nonsignificant. However, because these low-virulence saprophytes occasionally may cause life-threatening disease, a reevaluation of the existing diagnostic paradigm is needed so that clinically significant fungemia may be differentiated from pseudofungemia.

The predictors of outcome in immunocompetent patients with hematogenous candidiasis.

Safdar A, Bannister TW, Safdar Z.

Int J Infect Dis. 2004 May;8(3):180-6.

Abstract

OBJECTIVE:

Clinical parameters that predict outcome in non-immunosuppressed candidemic patients are not fully understood.

METHODS:

Eighty-one consecutive episodes of candidemia were retrospectively evaluated in 75 patients during 1998-2000.

RESULTS:

Infection due to Candida albicans was common (n = 30; 37%) followed by Candida glabrata (n = 25; 31%), Candida parapsilosis (n = 14; 17%), Candida tropicalis (n = 6; 7%), Candida krusei (n = 5; 6%), and Candida lusitaniae (n = 1; 1%). Among 70 evaluable patients, 31 (44%) had fungemia-associated mortality; advanced age (P < 0.004), underlying malignancy (P < 0.025), coronary artery disease (P < 0.01), and concurrent non-Candida species fungal infection (P < 0.047) were significant prognosticators of compromised short-term survival by multivariate analysis. Mortality was higher in patients with Candida glabrata (60%) and C. tropicalis (75%) infection compared to 44% deaths in individuals with C. albicans infection (P > 0.1). 11/25 (44%) of non-immunocompromised individuals died and 20/45 (44%) immunosuppressed patients succumbed to fungemia: persistent vs. non-persistent (< 3 days) Candida bloodstream invasion, neutropenia, diabetes mellitus, renal insufficiency, prior antimicrobial therapy, cirrhosis of liver, abdomino-pelvis surgery, and critical-care-unit vs. non critical-care-unit admission did not significantly impact outcome in either group. All 11 infants, including nine with prematurity, survived Candida species bloodstream infection (P < 0.025).

CONCLUSIONS:

Short-term mortality in candidemic non-immunocompromised patients was comparable to fungemia-associated deaths in immunosuppressed patients. Ischemic heart disease has appeared as a new predictor of unfavorable outcome in patients with hematogenous candidiasis.

Strongyloidiasis in patients at a comprehensive cancer center in the United States.

Safdar A, Malathum K, Rodriguez SJ, Husni R, Rolston KV.

Cancer. 2004 Apr 1;100(7):1531-6.

Abstract

BACKGROUND:

The frequency of Strongyloides stercoralis infestation and complication in patients with cancer in the United States is unknown.

METHODS:

The authors performed a retrospective analysis of S. stercoralis infection in patients who were undergoing cancer treatment at The University of Texas M. D. Anderson Cancer Center (Houston, TX).

RESULTS:

The overall S. stercoralis infection frequency was approximately 1.0 per 10,000 new cancer cases between 1971 and 2003. Twenty-two of 25 patients (88%) were U.S. residents (19 from Texas; 1 each from Mississippi, Tennessee, and Puerto Rico), and the remaining 3 (13%) were from Latin America. Thirteen (52%) had solid-organ malignancies, whereas 12 (48%) had hematologic malignancies (lymphoma or multiple myeloma, n=8; leukemia, n=3; aplastic anemia, n=1). Twelve patients (48%) received systemic corticosteroids, 9 (36%) received antineoplastic therapy, and 2 underwent hematopoietic stem cell transplantation (HSCT). Diarrhea was reported in 13 patients (57%), and eosinophilia was observed in 11 patients (48%); 4 patients (16%) had probable hyperinfection syndrome (in 3 cases of polymicrobial gram-negative bacteremia, 1 patient had Klebsiella pneumoniae pneumonia, whereas 1 patient presented with K. pneumoniae lung infection alone). Evidence of definite pulmonary hyperinfection syndrome was observed in 2 HSCT recipients (8%). Fourteen (74%) of 19 patients responded to thiabendazole therapy. Two patients with definite pulmonary hyperinfection syndrome developed fatal S. stercoralis hemorrhagic alveolitis despite receiving high-dose thiabendazole plus ivermectin therapy.

CONCLUSIONS:

In the current study, strongyloidiasis was uncommon in patients with cancer and remained localized in individuals with solid-organ malignancies. Definite pulmonary accelerated autoinfections were observed only in HSCT recipients. Therefore, pre-HSCT S. stercoralis screening in individuals from endemic regions of the United States warrants further study.

Role of quantitative human cytomegalovirus PCR in predicting antiviral treatment response among high-risk hematopoietic stem-cell transplant recipients.

Safdar A, Bruorton M, Henslee-Downey JP, van Rhee F.

Bone Marrow Transplant. 2004 Feb;33(4):463-4.

Curvularia–favorable response to oral itraconazole therapy in two patients with locally invasive phaeohyphomycosis.

Safdar A.

Clin Microbiol Infect. 2003 Dec;9(12):1219-23.

Abstract

Curvularia species are ubiquitous and occasionally lead to infections in humans. In immunosuppressed patients, infections are often serious, and systemic dissemination is not uncommon. The optimal antifungal therapy is unclear. I here present two cases, a healthy man with locally invasive, mulicentric paranasal fungal sinusitis, and a case of progressive verrucal distal onychomycosis that developed while the patient was undergoing accelerated chemotherapy for non-Hodgkin’s lymphoma. Both patients showed excellent responses to treatment with itraconazole suspension. Oral itraconazole may provide a safe and effective alternative for patients with locally invasive non-disseminated mycoses due to Curvularia species.

Hospitalization of an oncology patient suspected of having severe acute respiratory syndrome: a setup for an infection control quagmire at a comprehensive cancer center.

Safdar A, Chemaly RF, Perego CA, Gonzalez VR, Rolston KV, Raad II, Tarrand JJ, Callender DL.

Cancer. 2003 Dec 15;98(12):2738-9.

Efficacy of vancomycin plus levofloxacin combination therapy for refractory pericarditis due to multiresistant Streptococcus pneumoniae.

Safdar A.

Int J Infect Dis. 2003 Dec;7(4):287.