scholarly journals Rothia mucilaginosa Meningitis in a Child with Myelodysplastic Syndromes

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Fumihiro Ochi ◽  
Ryota Nakamura ◽  
Reiji Miyawaki ◽  
Kyoko Moritani ◽  
Shinobu Murakami ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Antimicrobial Susceptibility ◽  
Myelodysplastic Syndromes ◽  
Opportunistic Pathogen ◽  
Neurological Complications ◽  
Primary Treatment ◽  
Rothia Mucilaginosa ◽  
Unrelated Cord Blood ◽  
Evidence Based Guidelines ◽  
Immunocompromised Hosts

Rothia mucilaginosa is a Gram-positive coccus and an opportunistic pathogen in immunocompromised hosts. The microorganism has been implicated in serious infections, including bacteremia meningitis or endocarditis. However, there is a dearth of investigations on meningitis, especially in children. As this infection is rare and only a few cases have been recorded, evidence-based guidelines for adequate infection treatment are lacking. We herein report the case of a 12-year-old boy with myelodysplastic syndromes (MDS) presenting with a change in mental status who was diagnosed as having febrile neutropenia and bacterial meningitis caused by R. mucilaginosa at 23 days after unrelated cord blood transplant. In our case, the minimum inhibitory concentrations (MICs) of meropenem and vancomycin (VCM) were both ≤1 μg/mL, whereas the MIC of daptomycin (DAP) was 4 μg/mL. The patient was treated with intravenous antimicrobial therapy due to meropenem for 43 days because he had febrile neutropenia. During follow-up, the patient had no neurological complications. We retrospectively reviewed the antimicrobial susceptibility of all R. mucilaginosa isolates (n = 5) from blood or cerebrospinal fluid cultures at our hospital. The MIC of VCM was <0.5 μg/mL for all strains, whereas the MIC of DAP was ≥2 μg/mL for all strains. The MIC of MEPM was >1 μg/mL for one strain. We recommend choosing VCM as the primary treatment for invasive R. mucilaginosa infections until antimicrobial susceptibility results are known, especially in immunocompromised children.

scholarly journals A questionnaire survey on evaluation for penetration and compliance of the Japanese Guideline on Febrile Neutropenia among hematology-oncology physicians and surgeons

2021 ◽  
Author(s):  
Nobu Akiyama ◽  
Takuho Okamura ◽  
Minoru Yoshida ◽  
Shun-ichi Kimura ◽  
Shingo Yano ◽  
...  
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Supportive Care ◽  
Questionnaire Survey ◽  
Primary Treatment ◽  
Beta Lactam ◽  
Clinical Practices ◽  
High Risk Patients ◽  
Mascc Score ◽  
Risk Patients

Abstract Purpose The Japanese Society of Medical Oncology published a guideline (GL) on febrile neutropenia (FN) in 2017. The study’s purpose is to reveal how widely GL penetrated among physicians and surgeons providing chemotherapy. Methods A questionnaire survey was conducted with SurveyMonkey™ for members of the Japanese Association of Supportive Care in Cancer and relevant academic organizations. Each question had four options (always do, do in more than half of patients, do in less than half, do not at all) and a free description form. Responses were analyzed with statistical text-analytics. Result A total of 800 responses were retrieved. Major respondents were experts with more than 10-year experience, physicians 54%, and surgeons 46%. Eighty-seven percent of respondents knew and used GL. Forty-eight percent assessed FN with Multinational Association of Supportive Care in Cancer (MASCC) score “always” or “more than half.” Eighty-one percent chose beta-lactam monotherapy as primary treatment in high-risk patients. Seventy-seven percent did oral antibacterial therapy in low-risk patients ambulatorily. Seventy-eight percent administered primary prophylactic G-CSF (ppG-CSF) in FN frequency ≥ 20% regimen. Fifty-nine percent did ppG-CSF for high-risk patients in FN frequency 10–20% regimen. Ninety-seven percent did not use ppG-CSF in FN frequency < 10% regimen. The medians of complete and complete plus partial compliance rates were 46.4% (range 7.0–92.8) and 77.8% (range 35.4–98.7). The complete compliance rates were less than 30% in seven recommendations, including the MASCC score assessment. Conclusion GL is estimated to be widely utilized, but some recommendations were not followed, presumably due to a mismatch with actual clinical practices in Japan.

Uncommon Pathogen in an Unexpected Host: A Case of Rothia Mucilaginosa Endocarditis in an Immunocompetent Patient without Underlying Valvular Disease

2021 ◽  
Vol 4 (9) ◽  
pp. 01-01
Author(s):  
Ramy Abdelmaseih
Keyword(s):  
Opportunistic Pathogen ◽  
Immunocompetent Patient ◽  
Severe Neutropenia ◽  
Intravenous Drug Use ◽  
Upper Respiratory Tract ◽  
Infection Rates ◽  
Prosthetic Valves ◽  
Rothia Mucilaginosa ◽  
Upper Respiratory ◽  
Vascular Catheters

Rothia mucilaginosa, formally known as Stomatococcus mucilaginosus, is a gram-positive coccus that is found as a commensal in the oral cavity and upper respiratory tract. It is an infrequent opportunistic pathogen with very rare infection rates, mostly affecting immunocompromised patients such as patients with severe neutropenia, HIV infection, malignancy, diabetes mellitus, and liver cirrhosis. Infections in immunocompetent individuals are extremely rare, and usually related to pre-existing valvular heart disease, prosthetic valves and indwelling vascular catheters. Other risk factors for Rothia bacteremia include: intravenous drug use (IVDU).

scholarly journals Robotic-Assisted Digital Exoscope for Resection of Cerebral Metastases: A Case Series

2021 ◽  
Author(s):  
Alexander J Schupper ◽  
Gabrielle Price ◽  
Constantinos G Hadjipanayis
Keyword(s):  
Case Series ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Neurological Complications ◽  
Primary Treatment ◽  
Complete Resection ◽  
Cerebral Metastases ◽  
Discharge Disposition ◽  
Tumor Tissues ◽  
Postoperative Symptoms

Abstract BACKGROUND Surgical resection is the primary treatment for cerebral metastases with safe complete resection as the goal. The robotically assisted digital surgical exoscope is a novel system with advanced visualization methods with recent applications in neurosurgery. OBJECTIVE To evaluate the outcomes for patients with cerebral metastases undergoing resection with the surgical exoscope. METHODS Data were retrospectively collected from patients with cerebral metastases where resection was achieved with using the surgical exoscope from 2016 to 2020. Demographics, clinical, imaging, and operative and outcome findings were collected. The relationship between perioperative data and discharge disposition as well as progression-free survival (PFS) and 12 mo overall survival (OS) was assessed. RESULTS A total of 31 patients (19 males) with a median patient age 63 yr (range 38-80) were included. Average pre- and postoperative volumes were 18.1 cc and 0.75 cc, respectively. Mean depth of the resected lesions was 0.6 cm (range 0-3.6 cm). Complete resection was achieved in 64.5% of patients. The mean extent of resection was 96.7%, with 71.0% achieving PFS at 6 mo. Overall PFS rate was 58.1% and the OS rate at 12 mo was 83.9%. Neurological complications included motor (35.5%) and sensory (12.9%) deficits, with 12 patients reporting no postoperative symptoms. CONCLUSION The surgical exoscope can delineate tumor tissues with high resolution, as shown by a gross total resection achieved for the majority of cases in our series. Postoperative complications and patient outcomes were similar to those reported with use of the operative microscope. Use of the exoscope can provide optimal visualization and delineation of cerebral metastases.

scholarly journals Chryseobacterium indologenes as a Rare Pathogen of Bacteremia in Febrile Neutropenia

2021 ◽  
Author(s):  
Begümhan Demir Gündoğan ◽  
Fatih Sağcan ◽  
Elvan Çağlar Çıtak
Keyword(s):  
Risk Factors ◽  
Febrile Neutropenia ◽  
Broad Spectrum ◽  
Antimicrobial Susceptibility ◽  
Neutropenic Fever ◽  
Susceptibility Test ◽  
Antimicrobial Susceptibility Test ◽  
Gram Negative ◽  
Chryseobacterium Indologenes ◽  
Test Result

Chryseobacterium indologenes (C. indologenes) is nonmotile, oxidase-, and indole-positive gram-negative aerobic bacillus. Immunosuppression, comorbidities, use of broad-spectrum antibiotics are known risk factors for C. indologenes-related infections. We report a neutropenic fever caused by C. indologenes in a 16-month-old boy who was treated due to the neuroblastoma. According to the antimicrobial susceptibility test result, he was treated with cephaperazone/sulbactam.

Iron overload in myelodysplastic syndromes: Evidence based guidelines from the Canadian consortium on MDS

2018 ◽  
Vol 74 ◽  
pp. 21-41 ◽  
Author(s):  
Heather A. Leitch ◽  
Rena Buckstein ◽  
Nancy Zhu ◽  
Thomas J. Nevill ◽  
Karen W.L. Yee ◽  
...  
Keyword(s):  
Iron Overload ◽  
Myelodysplastic Syndromes ◽  
Evidence Based ◽  
Evidence Based Guidelines

A multi-centre prospective study of febrile neutropenia in Norway: Microbiological findings and antimicrobial susceptibility

2005 ◽  
Vol 37 (6-7) ◽  
pp. 455-464 ◽  
Author(s):  
Katrin Sigurdardottir ◽  
Asbjørn Digranes ◽  
Stig Harthug ◽  
Ingerid Nesthus ◽  
Jon-Magnus Tangen ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Prospective Study ◽  
Antimicrobial Susceptibility

scholarly journals Genomic Insights into Drug Resistance Determinants in Cedecea neteri, A Rare Opportunistic Pathogen

2021 ◽  
Vol 9 (8) ◽  
pp. 1741
Author(s):  
Dorothea K. Thompson ◽  
Stephen M. Sharkady
Keyword(s):  
Drug Resistance ◽  
Sequence Data ◽  
Opportunistic Pathogen ◽  
Resistance Mechanisms ◽  
Whole Genome Sequence ◽  
Multidrug Efflux ◽  
Resistance Determinants ◽  
Multidrug Efflux Pumps ◽  
Novel Variant ◽  
Immunocompromised Hosts

Cedecea, a genus in the Enterobacteriaceae family, includes several opportunistic pathogens reported to cause an array of sporadic acute infections, most notably of the lung and bloodstream. One species, Cedecea neteri, is associated with cases of bacteremia in immunocompromised hosts and has documented resistance to different antibiotics, including β-lactams and colistin. Despite the potential to inflict serious infections, knowledge about drug resistance determinants in Cedecea is limited. In this study, we utilized whole-genome sequence data available for three environmental strains (SSMD04, M006, ND14a) of C. neteri and various bioinformatics tools to analyze drug resistance genes in this bacterium. All three genomes harbor multiple chromosome-encoded β-lactamase genes. A deeper analysis of β-lactamase genes in SSMD04 revealed four metallo-β-lactamases, a novel variant, and a CMY/ACT-type AmpC putatively regulated by a divergently transcribed AmpR. Homologs of known resistance-nodulation-cell division (RND)-type multidrug efflux pumps such as OqxB, AcrB, AcrD, and MdtBC were also identified. Genomic island prediction for SSMD04 indicated that tolC, involved in drug and toxin export across the outer membrane of Gram-negative bacteria, was acquired by a transposase-mediated genetic transfer mechanism. Our study provides new insights into drug resistance mechanisms of an environmental microorganism capable of behaving as a clinically relevant opportunistic pathogen.

scholarly journals Do high MICs predict the outcome in invasive fusariosis?

2020 ◽  
Author(s):  
Marcio Nucci ◽  
Jeffrey Jenks ◽  
George R Thompson ◽  
Martin Hoenigl ◽  
Marielle Camargo dos Santos ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Death Rate ◽  
Liposomal Amphotericin ◽  
Antifungal Agents ◽  
Fusarium Species ◽  
Primary Treatment ◽  
Clear Cut ◽  
The Poor ◽  
Immunocompromised Hosts ◽  
High Mics

Abstract Background Invasive fusariosis (IF) affects mostly severely immunocompromised hosts and is associated with poor outcome. Since Fusarium species exhibit high MICs for most antifungal agents, this could explain the poor prognosis. However, a clear-cut correlation between MIC and outcome has not been established. Objective To evaluate the correlation between MIC and outcome (6 week death rate) in patients with IF. Methods We performed a multicentre retrospective study of patients with IF who received treatment and had MIC levels determined by EUCAST or CLSI for the drug(s) used during treatment. We compared the MIC50 and MIC distribution among survivors and patients who died within 6 weeks from the diagnosis of IF. Results Among 88 patients with IF, 74 had haematological diseases. Primary treatment was monotherapy in 52 patients (voriconazole in 27) and combination therapy in 36 patients (liposomal amphotericin B + voriconazole in 23). The MIC50 and range for the five most frequent agents tested were: voriconazole 8 mg/L (range 0.5–64), amphotericin B 2 mg/L (range 0.25–64), posaconazole 16 mg/L (range 0.5–64), itraconazole 32 mg/L (range 4–64), and isavuconazole 32 mg/L (range 8–64). There was no difference in MIC50 and MIC distribution among survivors and patients who died. By contrast, persistent neutropenia and receipt of corticosteroids were strong predictors of 6 week mortality. Conclusions Our study did not show any correlation between MIC and mortality at 6 weeks in patients with IF.

scholarly journals Complete Genome Sequence of Rothia mucilaginosa DY-18: A Clinical Isolate with Dense Meshwork-Like Structures from a Persistent Apical Periodontitis Lesion

Sequencing ◽  
2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
Kazuyoshi Yamane ◽  
Takayuki Nambu ◽  
Takeshi Yamanaka ◽  
Chiho Mashimo ◽  
Chieko Sugimori ◽  
...  
Keyword(s):  
Clinical Isolate ◽  
Genome Sequence ◽  
Complete Genome Sequence ◽  
Sigma Factor ◽  
Complete Genome ◽  
Opportunistic Pathogen ◽  
Binding Activity ◽  
Apical Periodontitis ◽  
Responsive Systems ◽  
Rothia Mucilaginosa

Rothia mucilaginosa is an opportunistic pathogen in the human oral cavity and pharynx. We found that R. mucilaginosa DY-18, a clinical isolate from a persistent apical periodontitis lesion, had biofilm-like structures. Similar structures were also observed on R. mucilaginosa ATCC25296. To further study these structures, we determined the complete genome sequence of DY-18 and found it a 2.26-Mb chromosome. Regarding stress responsive systems known to affect biofilm formation in many bacteria, DY-18 genome possessed only two sigma factor genes. One of these encoded an additional sigma factor whose promoter-binding activity may be regulated in response to environmental stimuli. Additionally, several genes assigned to two-component signal transduction systems were presented in this genome. To the best of our knowledge, this is the first complete genome of R. mucilaginosa species and our data raise the possibility that this organism regulates the biofilm phenotype through these stress responsive systems.

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