Infectious morbidity in critically ill patients with cancer.

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Safdar A, Armstrong D.

Crit Care Clin. 2001 Jul;17(3):531-70, vii-viii. Review.

Abstract

Infection frequently complicates the course of cancer treatment and often adversely affects the outcome. Patients have a greater tendency for acquiring infections caused by opportunistic microorganisms. Agents with low virulence potential may lead to invasive and often life-threatening infections because of altered host immune function. The immune dysfunction may be caused by the underlying malignancy, by antineoplastic chemotherapy, or by invasive procedures during supportive care.

Acute febrile myelodysplasia and pneumonitis due to human herpesvirus 6 after accelerated chemotherapy.

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Safdar A, Brown AE, Malkin M.

Am J Med. 2001 Sep;111(4):329-30.

 

 

Clinical microbiological case: refractory chest wall infection following reconstructive surgery in a patient with relapsed lung cancer.

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Safdar A, Bains M, Polsky B.

Clin Microbiol Infect. 2001 Oct;7(10):563-4, 577-9.

Candida glabrata and Candida krusei fungemia after high-risk allogeneic marrow transplantation: no adverse effect of low-dose fluconazole prophylaxis on incidence and outcome.

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Safdar A, van Rhee F, Henslee-Downey JP, Singhal S, Mehta J.

Bone Marrow Transplant. 2001 Nov;28(9):873-8.

Abstract

Candidemia is a serious complication in patients following allogeneic blood, marrow, and organ transplantation. Fourteen patients developed nosocomial fungemia among 204 allogeneic marrow transplants performed during 1997-1999. Incidence of hematogenous candidiasis was 6.8 per 100 allogeneic BMT. All 14 had an indwelling central venous catheter (CVC) and fluconazole (100-200 mg daily) was given prophylactically. In 11 (78.5%) neutropenic patients, duration between agranulocytosis and diagnosis of fungemia was (median, +/- s.d.) 10 +/- 8 days. Candida glabrata (53.3%) was the most common yeast species, followed by C. krusei (33.3%), and C. parapsilosis (13.3%). Candida albicans was conspicuously absent. Ten patients (71.4%) had primary transplant-related complication (>2 days) including hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP) (n = 5), severe hemorrhagic cystitis (n = 3), and bacteremia (n = 2). Seven (50.0%) patients expired and in three (21.4%) deaths were attributed to fungemia. The impact of a primary transplant-related complication on short-term survival in this setting was not significant (P = 0.07) (HUS/TTP (P > 0.5); neutropenia (P > 0.5); GVHD (P = 0.35)). Removal of CVC did not alter outcome in our group (P > or = 0.5) although in patients with persistent fungemia (>72 h), and those with preceding bacteremia, mortality was significantly higher (P = 0.002). Conventional prognosticators of poor outcome did not adversely effect short-term survival in our transplant recipients with hematogenous candidiasis. The predominance of C. glabrata and C. krusei breakthrough infections was similar to what is seen with high-dose fluconazole (400 mg) prophylaxis, and no adverse effects of low-dose fluconazole in terms of increased incidence of non-susceptible Candida species was seen.

Progressive cutaneous hyalohyphomycosis due to Paecilomyces lilacinus: rapid response to treatment with caspofungin and itraconazole.

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Safdar A.

Clin Infect Dis. 2002 May 15;34(10):1415-7. Epub 2002 Apr 23.

Abstract

A case of rapidly progressive cutaneous infection due to Paecilomyces lilacinus developed in a woman with advanced pancreatic cancer who did not have granulocytopenia. The infection responded favorably to caspofungin and itraconazole combination therapy.

Prosthetic valve endocarditis due to vancomycin-resistant Enterococcus faecium: treatment with chloramphenicol plus minocycline.

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Safdar A, Bryan CS, Stinson S, Saunders DE.

Clin Infect Dis. 2002 Jun 1;34(11):E61-3. Epub 2002 May 9.

Abstract

We report a case of prosthetic valve endocarditis and persistent bacteremia due to vancomycin-resistant Enterococcus faecium. The combination of parenteral chloramphenicol plus minocycline therapy was administered for 8 weeks and resulted in cure after treatment with quinupristin-dalfopristin had failed.

Clinical microbiological case: cardiac tamponade due to hemorrhagic pericarditis in a non-immunocompromised woman from south-eastern United States.

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Safdar A, Humphery SH, Harding SA, Close TP.

Clin Microbiol Infect. 2002 Apr;8(4):243-4, 248-51.

Adult T-cell leukemia-lymphoma during pregnancy.

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Safdar A, Johnson N, Gonzalez F, Busowski JD.

N Engl J Med. 2002 Jun 20;346(25):2014-5.

Listeriosis in recipients of allogeneic blood and marrow transplantation: thirteen year review of disease characteristics, treatment outcomes and a new association with human cytomegalovirus infection.

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Safdar A, Papadopoulous EB, Armstrong D.

Bone Marrow Transplant. 2002 Jun;29(11):913-6.

Abstract

Listeriosis is uncommon in recipients of allogeneic blood, marrow and organ transplantation. Six patients with systemic Listeria monocytogenes infection during 1985-1997 at Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center are described. In two male and four female patients, the median duration from transplantation to isolation of L. monocytogenes was 62.5 (range 29 to 821) days. Among five allogeneic marrow transplant recipients, four (80%) received HLA antigen matched, T cell-depleted grafts from three unrelated and a single related donor. One patient underwent mismatched-related marrow graft transplant. Cord stem cell transplantation was performed in a single patient. Two required therapy for graft-versus-host disease (GVHD). The 13 year incidence of systemic Listeria infections was 0.47 percent. All six presented with fever (>39 degrees C), and L. monocytogenes bloodstream invasion. Mental status changes and meningioencephalitis were observed in two (33.3%). A concurrent primary opportunistic infection was present in five individuals (83.3%), and four (80%) were being treated for acute human cytomegalovirus (HCMV) viremia. Sixty-six percent responded to therapy and two died from unrelated, non-listeric causes. Systemic listeriosis was uncommon in our high-risk allogeneic blood and marrow transplantation population, and response to therapy with parenteral ampicillin and gentamicin was excellent. The association between primary HCMV reactivation and subsequent listeric infection emphasizes the significance of HCMV-related dysfunction in hosts’ cellular immune responses, especially in the setting of allogeneic transplantation.

Intracranial perineural extension of invasive mycosis: a novel mechanism of disease propagation by Aspergillus fumigatus.

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Safdar A, Dommers MP Jr, Talwani R, Thompson CR.

Clin Infect Dis. 2002 Sep 1;35(5):e50-3. Epub 2002 Aug 1.

Abstract

We describe an immunocompetent woman who had refractory, invasive sphenoid sinus Aspergillus fumigatus infection for which there was radiologic evidence of intracranial perineural spread. The patient responded to a combination of antifungal and adjuvant recombinant cytokine therapy.