Epidemiology of Fungal Infections in Hematological Malignancies in Italy: SEIFEM-2004 Study (Sorveglianza Epidemiologica Infezioni Fungine Nelle Emopatie Maligne).

Abstract Background: To evaluate the incidence and the outcome of fungal infections in patients (pts) affected by hematological malignancies (HM). Methods: A retrospective study, conducted over 1999–2003, in pts with HM, admitted in 18 Italian Hematology divisions in tertiary cares or university hospitals, who developed proven or probable fungal infections. Results: The population included 11,802 pts: 3,012 AML (25.5%), 1,173 ALL (9.9%), 596 CML (5%), 1,104 CLL (9.4%), 1,616 MM (13.7%), 3,457 NHL (29.3%), 844 HL (7.2%). Pts who underwent HSCT were included in a different analysis. A fungal infection occurred in 538 pts, with an incidence of 4.6%; in particular we registered 346 episodes sustained by moulds (incidence 2.9%) and 193 by yeasts (1.6%). The incidence rate depends upon underlying malignancy (12.3% in AML, 6.5% in ALL, 2.7% in CML, 0.6% in CLL, 0.5% in MM, 1.6% in NHL, 0.9% in HL). Among moulds, the etiological agents were Aspergillus (310 episodes, incidence 2.8%), Mucorales (13 pts, 0.1%), Fusarium (15 pts, 0.1%), and other rare fungi (7 pts, 0.1%). Among yeasts we registered septicemia due to Candida (175 pts, 1.6%). Other yeast infections were caused by Cryptococcus (8 pts, 0.1%), Tricosporon (7 pts, 0.1%) and other rare agents (2 pts). We did not observed an increase of A.terreus infections while the number of episodes sustained by A.flavus increased from 1999 to 2003 (RR 2.10; IC95% 0.8–5.49; p-value 0.117). The overall mortality rate was 1.8%. Among 538 pts with fungal infection 39% died for this complication, with differences between aspergillosis (42%), zygomycosis (63%), fusariosis (53%) and candidemia (33%). There was not variation in mortality rate during the study period; comparing these pts with those observed in our previous studies during the period 1987–1988 we observed a significant reduction of death due to aspergillosis (RR 1.90; IC 95% 1.17–3.09), but no differences in mortality rate due to Candida. Conclusions: Our study confirms the general trends already described: infections due to moulds are more frequent than those caused by yeast. Aspergillus remains the main etiologic agent, followed by Candida. The other agents (Mucorales, Fusarium, Trichosporon) remain rare. AML represents the most frequently involved category. The mortality rate due to aspergillosis is actually about 40%, with a remarkable decrease when compared to past years; as for candidemia, we observed a reduction in the incidence, but not in the mortality rate.

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Identification and in Vitro Susceptibility Pattern of Fungal Pathogens in Immunocompromised Patients with invasive Fungal Infections

10.51429/ejmm30317 ◽

2021 ◽

Vol 30 (3) ◽

pp. 127-134

Author(s):

Shaimaa A.S. Selem ◽

Neveen A. Hassan ◽

Mohamed Z. Abd El-Rahman ◽

Doaa M. Abd El-Kareem

Keyword(s):

Intensive Care ◽

Fungal Infection ◽

Fungal Pathogens ◽

Fungal Infections ◽

Antifungal Susceptibility ◽

Invasive Fungal Infections ◽

Immunocompromised Patients ◽

University Hospitals ◽

Vitek 2

Background: In intensive care units, invasive fungal infections have become more common, particularly among immunocompromised patients. Early identification and starting the treatment of those patients with antifungal therapy is critical for preventing unnecessary use of toxic antifungal agents. Objective: The aim of this research is to determine which common fungi cause invasive fungal infection in immunocompromised patients, as well as their antifungal susceptibility patterns in vitro, in Assiut University Hospitals. Methodology: This was a hospital based descriptive study conducted on 120 patients with clinical suspicion of having fungal infections admitted at different Intensive Care Units (ICUs) at Assiut University Hospitals. Direct microscopic examination and inoculation on Sabouraud Dextrose Agar (SDA) were performed on the collected specimens. Isolated yeasts were classified using phenotypic methods such as chromogenic media (Brilliance Candida agar), germ tube examination, and the Vitek 2 system for certain isolates, while the identification of mould isolates was primarily based on macroscopic and microscopic characteristics. Moulds were tested in vitro for antifungal susceptibility using the disc diffusion, and yeast were tested using Vitek 2 device cards. Results: In this study, 100 out of 120 (83.3%) of the samples were positive for fungal infection. Candida and Aspergillus species were the most commonly isolated fungal pathogens. The isolates had the highest sensitivity to Amphotericin B (95 %), followed by Micafungin (94 %) in an in vitro sensitivity survey. Conclusion: Invasive fungal infections are a leading cause of morbidity and mortality in immunocompromised patients, with Candida albicans being the most frequently isolated yeast from various clinical specimens; however, the rise in resistance, especially to azoles, is a major concern.

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Effectiveness of Homoeopathy in Tinea corporis and Tinea cruris – A Prospective, Longitudinal Observational Study

International Journal of Advanced Ayurveda Yoga Unani Siddha and Homeopathy ◽

10.23953/cloud.ijaayush.488 ◽

2021 ◽

Vol 10 (1) ◽

pp. 618-627

Author(s):

Yogeshwari Gupta ◽

◽

Sonia Tuteja ◽

Ankita Acharya ◽

Vikrant Tripathi ◽

...

Keyword(s):

Observational Study ◽

Fungal Infection ◽

Clinical Symptom ◽

Fungal Infections ◽

Tinea Corporis ◽

P Value ◽

Tinea Cruris ◽

Longitudinal Observational Study ◽

Before And After ◽

Prospective Longitudinal

Dermatophytoses refers to superficial fungal infection of keratinized tissues caused by keratinophilic dermatophytes. According to observations worldwide, dermatophytoses are the most common of the superficial fungal infections. It is common in tropics and may present in epidemic proportions in areas with high rates of humidity. This prospective, longitudinal, observational study was conducted at SKHMC, Jaipur for a period of 1 year (April 2018 to March 2019), aiming to ascertain the effectiveness of homoeopathic medicines in the treatment of Tinea corporis and Tinea cruris. In this study, 65 cases of Tinea Infection (33 cases of Tinea cruris & 32 cases of Tinea corporis) were treated with homoeopathic medicines prescribed on the basis of totality of the symptoms. Treatment outcomes were assessed using Clinical Symptom Score, designed for this study & approved by Institutional Ethical Committee. Out of 65 patients, 41 patients (63.1%) got improved; 19 patients (29.2%) were at status quo and 05 patients (07.7%) became worse. Maximum patients were found to be in the age group of 11-40 years (n=50; 76.9%). Males were observed to be affected more as compared to females. Paired t-test was conducted on the Clinical Symptom Scores obtained before and after treatment and the result showed that p value is < 0.05 & value of t (11.623) is greater than the tabulated value in t-table at df = 64 (1.997), which was statistically significant and which also concluded that homoeopathic medicines were effective in treating Tinea corporis and Tinea cruris. Keywords Homeopathy; Dermatophytoses; Fungal infection; Observational study

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Prevalence, Demographic Patterns, and Outcome of Childhood Malignancies in a Tertiary Hospital in Nigeria: A 15-Year Retrospective Study

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz117.011 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S89-S90

Author(s):

Oluwakemi Otokiti ◽

Edamisan Temiye

Keyword(s):

Health Care ◽

Retrospective Study ◽

Mortality Rate ◽

Hematological Malignancies ◽

Financial Burden ◽

Age At Diagnosis ◽

Childhood Cancers ◽

Childhood Malignancies ◽

Wilm’S Tumor ◽

Overall Mortality

Abstract Objectives Childhood cancers are increasingly recognized as a cause of childhood morbidity and mortality following improvement in immunization programs and sanitation against communicable diseases. With improvement in health care, better survival outcomes have been reported in childhood cancers worldwide. However, mortality associated with childhood cancers remains high in developing countries. This study aims to determine the prevalence, demographic characteristics, and outcome of childhood cancers seen in Lagos University Teaching Hospital, Lagos, Nigeria. Methods A retrospective study analyzed 749 cases of childhood malignancies between 2003 and 2017. Data on gender, age at diagnosis, diagnosis, and outcome were extracted using a data extraction proforma. Data were analyzed using SPSS v23. P value of .05 was considered statistically significant. Results Median age at diagnosis was 4.75 years with a male to female ratio of 1.3:1. Highest prevalence was noticed with hematological malignancies (41%), Wilm’s tumor (18%), retinoblastoma (13%), and soft tissue tumors (6.5%) and lowest prevalence with testicular cancers (0.3%). Apart from liver malignancy, males had a higher incidence in all malignancies. Median age at diagnosis was 12 years for nasopharyngeal carcinoma, 11 years for bone cancers, 8 years for gynecological cancers, 6 years for hematological cancers, and 0.47 years for testicular cancers. Overall mortality rate was 30%, and a significant number (53%) were lost to follow-up (discharged against medical advice, defaulted, financial burden, medical tourism). Hematological malignancies had the highest mortality rates, with Wilm’s tumor having best survival chances (lowest mortality). Conclusion Prevalence patterns mirror what was obtained in other centers (Jos, Ife, and Ibadan). A mortality rate of 30% is significant. Financial burden, religious beliefs, delay in presentation, and ignorance are major hindrances to health care and might contribute significantly to overall mortality and outcome. More needs to be done concerning childhood cancers.

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Autopsy Analysis On Epidemiology and Site of Involvement Of Invasive Fungal Infections (IFI) In Hematological Malignancies : A Retrospective Study at Hematologic Tertiary Care Department

Blood ◽

10.1182/blood.v122.21.5589.5589 ◽

2013 ◽

Vol 122 (21) ◽

pp. 5589-5589

Author(s):

Anna Chierichini ◽

Francesca Monardo ◽

Barbara Anaclerico ◽

Paola Anticoli Borza ◽

Velia Bongarzoni ◽

...

Keyword(s):

Acute Leukemia ◽

Hematological Malignancies ◽

Conflicts Of Interest ◽

Fungal Infections ◽

Tertiary Care ◽

Diagnostic Methods ◽

Diagnostic Tools ◽

P Value ◽

Candida Spp ◽

Acute Leukemias

Abstract Background Clinical diagnosis of IFI is difficult ,due to lack of sensitive and specific diagnostic tools. An assessment of trends concerning the prevalence of IFI is a challenge and postmortem data may be useful to monitor the local epidemiology ,the frequency and the disease patterns. Aim The aim of this retrospective analysis is to determinate the local epidemiology and the prevalence at autopsy of IFI, occurring in hematological malignancies at a single center over a eleven years period. Methods We have retrospectively reviewed 161 patients – median age 62,5 yrs, range 22 -83 - with hematological malignancies, who underwent autopsy between 2002 -2012. Acute Myeloid Leukemia (AML) were 77, Acute Lymphoid Leukemia (ALL) 11, Lymphoproliferative disorders (LPD) 56 and other disorders 17. Acute leukemia pts received systemic antifungal prophilaxis, whereas the others not absorbable prophilaxis. None patients received transplant procedures. An experienced pathologist evaluated the organ involvement and the IFI pathologic pattern. Fisher’s Exact test was used to recognize the IFI prevalence, the main occurring pathogens and the involved site; a p-value of <0.05 was considered statistically significant. Results The analysis of 161 consecutive autopsies identified 40 pts.(25%)resulting to have IFI; of these, 22 were AML (55%) ,6 ALL (15%),11LPD (28%) and 1 other. Aspergillus spp. infection was detected in 20 cases (50%), Mucor spp in 8 (20%) and Candida spp. in 12 (30%). Moulds were prevalent in acute leukemia pts. and Aspergillus spp. is the leading pathogen with respect to Candida and Mucor spp. (p 0,0396),with a statistically significant prevalence in ALL (p 0,0186).The site more involved resulted lung (p 0.0002). Whereas the standardized EORTC/MSG criteria applied in vivo were conclusive for IFI in 6 pts ( 15%) only, the postmortem findings revealed fungal infections in further 34 pts (85%). Conclusion This analysis confirms that the IFI diagnosis is still an unresolved issue in hematological malignancies. Acute leukemias remain the subset with the higher prevalence of mould infections. As in other largest studies, in our experience Aspergillus spp and lung proved to be the most recurrent pathogen and site of involvement. At now, the diagnostic methods are not still completely able to identify the underlying IFI, thus the autopsy rate should be increased to achieve a better knowledge of epidemiology and to critically review previous misdiagnosis. Disclosures: No relevant conflicts of interest to declare.

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Characteristics and Outcome of Adults with Severe Autoimmune Hemolytic Anemia Admitted in Intensive Care Unit: Results from a Large French Observational Study

Blood ◽

10.1182/blood-2021-146588 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 930-930

Author(s):

Clara Pouchelon ◽

Charlotte Lafont ◽

Antoine Lafarge ◽

Thibault Comont ◽

Etienne Riviere ◽

...

Keyword(s):

Mortality Rate ◽

Bilirubin Level ◽

Research Funding ◽

Median Number ◽

P Value ◽

Inclusion Criteria ◽

Baseline Characteristics ◽

High Bilirubin ◽

Overall Mortality

Abstract Introduction : Adult' autoimmune hemolytic anemia (AIHA) can be life-threatening with an overall mortality rate of 8-10% which can rise up to 30% for patients admitted in intensive care unit (ICU). The factors associated with the need of management in ICU are partially unknown as only few data are available in the literature. To better describe the baseline characteristics and outcome of severe adult'AIHA admitted in ICU and to identify some prognostic factors, an observational multicentre study was set up by the French reference center of adult' immune cytopenias. Patients and Methods : This was an observational retrospective multicentre study. Patients had to fulfill the following inclusion criteria : 1) Age ≥ 18 years at time of AIHA onset ; 2) Definite diagnosis of primary or secondary warm (wAIHA), cold (cAIHA) or mixed AIHA ; 3) At least one admission in ICU specifically for the management of AIHA. Patients with AIHA admitted in ICU for another reason than the severity of AIHA were excluded. Patients' baseline characteristics at time of admission in ICU were recorded by means of a standardized form including the Charlson comorbidity score, the Knaus score, the Sequential Organ Failure Assessment (SOFA) and the Simplified Acute Physiology Score (SAPS II). Categorical variables were expressed as number (percentage) and quantitative variable as median [interquartile range]. To identify factors associated with death in ICU or after 1 year of follow-up, patients' characteristics were compared using usual tests. In order to identify some parameters associated with the risk of admission in ICU, the main characteristics of the patients were compared to those of controls (1 to 2 ratio) diagnosed with AIHA and followed over the same period who were never admitted in ICU. Univariate logistic regressions analyses were performed followed by a multivariate logistic regression using a backward stepwise selection procedure. A p-value <0.05 was considered as statistically significant. Results : In total, 62 patients (42% of females) from 11 centers fulfilling the inclusion criteria were included for a total of 69 admissions in ICU (see table for baseline characteristics). Of note, 57/62 patients (92%) had a low (< 121) bone marrow reticulocytes index (BMRI) reflecting an impaired erythropoiesis. The mortality rate in ICU was 13%; 3 patients died from massive pulmonary embolism. Compared to the 54 survivors the 8 patients who died in ICU had: a higher CRP level (p value = 0.011); a higher need for transfusion (median number of packed red cells was 12 versus 4, p value = 0.008); higher SOFA and IGS scores (p value = 0.006); a higher number of organ failures on admission (p value < 0.001), thrombotic events (p value = 0.024) and sepsis during the stay in ICU (p value = 0.019). Among the survivors, 9/49 (5 lost of follow-up) eventually died within a year after the admission in ICU leading to an overall mortality rate of 30% at 1 year. For the management of AIHA in ICU, 56 patients (90%) were transfused (median number of packed red cells = 4 [2-7]); recombinant Epo was administered to 14 patients (22.5%) and 5 patients (8%) had plasma exchange. In ICU, 58 patients (95%) were treated with corticosteroids, 29 (46%) received at least one other treatment line including mostly : rituximab (n = 22), intravenous immunoglobulin (n = 10), iv cyclophosphamide (n = 5), cyclosporin (n = 3). Other treatment lines including chemotherapy-based regimen (n=8) were given afterwards. The characteristics of the 62 patients were compared to those of 138 controls with AIHA who were never admitted in ICU. In univariate analyses, younger age, Evans' syndrome, Hb level < 6 g/dl; reticulocytes count < 100 x 10 9/L, BMRI <121 and high bilirubin level were significantly associated with an admission in ICU. In multivariate analysis, a low Hb level and a high bilirubin level were the only parameters that were significantly associated with the risk of admission in ICU Conclusion : Based on this retrospective study, the mortality rate of adult patients admitted in ICU for AIHA was lower than expected (13%) but the 1 year mortality rate in this population of patients rose up to 30%. Patients with AIHA and a Hb level < 6g/dl, a high bilirubin level and/or an inadequate reticulocytes count must be treated promptly and monitored closely beyond the initial phase of the disease in order to reduce the mortality rate. The treatment of severe refractory cases is not consensual and should be harmonized. Figure 1 Figure 1. Disclosures Comont: Takeda: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Bristol Myers Squibb: Honoraria, Research Funding; AstraZeneca: Honoraria, Research Funding; Abbvie: Honoraria, Research Funding. Riviere: Octapharma: Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees. Haioun: Janssen: Honoraria, Research Funding; Gilead: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Amgen: Honoraria, Research Funding; F. Hoffmann-La Roche Ltd: Honoraria, Research Funding; Servier: Honoraria, Research Funding; Takeda: Honoraria, Research Funding; Miltenyi: Honoraria, Research Funding. Godeau: Amgen: Consultancy; Sobi: Consultancy; Novartis: Consultancy; Grifols: Consultancy. Michel: Amgen: Consultancy; Rigel: Honoraria; Alexion: Honoraria; UCB: Honoraria; Argenx: Honoraria; Novartis: Consultancy. OffLabel Disclosure: rituximab is commonly used off-label as a second line for adult' AIHA

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Incidence & outcome of invasive fungal infections in patients with febrile neutropenia

QJM ◽

10.1093/qjmed/hcaa052.029 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

F S K Hennawy ◽

M M T Elzimaity ◽

N N Moustafa ◽

G M Kamal ◽

E A Abdelhady ◽

...

Keyword(s):

Febrile Neutropenia ◽

Hematological Malignancies ◽

Fungal Infections ◽

Primary Diagnosis ◽

P Value ◽

Hematopoietic Stem ◽

Hypertensive Patients ◽

Lv Mass ◽

Egyptian Patients ◽

Lv Diastolic Dysfunction

Abstract Background Invasive fungal infection (IFI) is a major cause morbidity and mortality among patients with hematological malignancies who receive chemotherapy or hematopoietic stem cell transplantation (HSCT). Thus, early diagnosis and treatment of these infections are of crucial importance. Certain factors have been identified as risk factors for IFI. Objectives Assessment of incidence and outcome of IFI in Egyptian patients with febrile neutropenia. Patients and Methods 50 febrile neutropenia episodes were studied. Patients were all subjected to history taking, clinical examination and further investigations including imaging studies, Galactomannan and Mannan antigen assays, and patients were followed up for observing the outcome. Results Our study found that hypertensive patients had significantly reduced LA function as measured by speckle tracking when compared to normotensive controls (P-value < 0.001). Also, many factors were associated with worse LA function in hypertensive patients as old age, high BMI, DM, LV diastolic dysfunction, high LV mass index, larger LA size, lower LA expansion index and higher systolic BP. Conclusion IFI incidence is affected by age, gender, primary diagnosis and severity of neutropenia, and IFI has a worse outcome compared to other causes of febrile neutropenia.

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Surgical treatment for fungal infections in the central nervous system

Journal of Neurosurgery ◽

10.3171/jns.1985.63.3.0371 ◽

1985 ◽

Vol 63 (3) ◽

pp. 371-381 ◽

Cited By ~ 56

Author(s):

Ronald F. Young ◽

George Gade ◽

Verity Grinnell

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Mortality Rate ◽

Fungal Infection ◽

Surgical Therapy ◽

Fungal Infections ◽

Neurological Deficits ◽

Morbidity Rate ◽

Communicating Hydrocephalus ◽

The Central Nervous System

✓ The hospital records of 78 patients who underwent surgical therapy for fungal infections of the central nervous system (CNS) between 1964 and 1984 are summarized. Nine different fungal types were identified, but Coccidioides immitis and Cryptococcus neoformans accounted for most (67.1%) of the infections. A variety of clinical syndromes were seen, including chronic basal meningitis (45 patients), intracranial mass lesions (12 patients), and communicating hydrocephalus (six patients). Thirteen patients had rhinocerebral forms of fungal infection, and two presented with spinal involvement. Delays in diagnosis were frequent and ranged from 2 months to 11 years. In 31 patients the CNS lesion was the first indication of a fungal infection, and lesion biopsy or cerebrospinal fluid (CSF) examination confirmed the diagnosis. A total of 144 surgical procedures were carried out, including lesion biopsy or excision in 13 patients, primary CSF shunting in 22, and placement of an Ommaya reservoir for administration of intraventricular or intracisternal antifungal agents in 48. All patients received parenteral and, in some cases, intrathecal or oral antifungal chemotherapy in addition to surgical therapy. Overall mortality was 43.6% (34 deaths). With prompt diagnosis and treatment, the mortality rate was 39% whereas, when appropriate treatment was delayed, the mortality rate was 64%. An additional 14 surviving patients (17.9%) exhibited permanent morbidity due to neurological deficits, seizure disorders, or renal toxicity following treatment with amphotericin B. The combined mortality and morbidity rate was 62.8%. Clinical symptoms were resolved completely in 29 patients, although in 10 evidence of disease persisted and chemotherapy was continued. Fungal infections of the CNS are being recognized with increased frequency. It is suggested that a high index of suspicion, aggressive attempts to obtain a diagnosis, and early and vigorous therapy may reduce the unfortunate outcome seen in a relatively high proportion of patients with CNS fungal infections.

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Micafungin Is Extremely Effective Against Fungal Infections Complicating Hematological Malignancies: Report of a Multicenter Study by N-FISH (Niigata Fungal Infection Study Group in Hematology).

Blood ◽

10.1182/blood.v106.11.5350.5350 ◽

2005 ◽

Vol 106 (11) ◽

pp. 5350-5350

Author(s):

Sadao Aoki ◽

Jun Takizawa ◽

Yoshinobu Seki ◽

Kazue Takai ◽

Koji Nikkuni ◽

...

Keyword(s):

Adverse Events ◽

Fungal Infection ◽

Multicenter Study ◽

Liver Dysfunction ◽

Hematological Malignancies ◽

Fungal Infections ◽

The United States ◽

Study Group ◽

The Mean ◽

Infection Study

Abstract [Background]Micafungin (MCFG) is a candin antifungal agent, and was marketed in Dec. 2002 in Japan and in Apr. 2005 in the United States. The Niigata Fungal Infection Study Group in Hematology (N-FISH) performed a multicenter prospective study to clarify the therapeutic effects of MCFG on deep fungal infections complicating hematological malignancies. [Methods]A total of 36 pts. who had been treated in centers belonging to N-FISH between Oct. 2003 and Apr. 2005 were included in this study. They consisted of 14 men and 22 women with a mean age of 53.5 years: 14 pts. with AML, 10 pts. with malignant lymphoma, 6 pts. with ALL, and 6 pts with other diseases. They had a proven fungal infection, or were suspected of having a fungal infection because of fever unresponsive to antimicrobial agents or from laboratory data. Three of them had a proven infection, and 33 were suspected of having a fungal infection. Three of these 33 pts. failed to respond to fluconazole. As a rule, MCFG was administered for more than 14 days until infectious symptoms improved or disappeared. When MCFG was judged ineffective because of the worsening of clinical symptoms despite the administration of MCFG, or when the administration of MCFG was judged difficult because of adverse effects, the drug was discontinued or replaced by other drugs. Two pts. orally received amphotericin B syrup singly. [Results]The mean dose of MCFG was 2.6 mg/kg (1.5–4.2 mg/kg), and the mean duration of administration was 15.9 days (5–85 days). Complete or partial response was achieved in 31 (86.1%) of the 36 pts., who showed improvements in infectious symptoms. In 4 pts, MCFG was discontinued because of insufficient effects. There were no breakthrough fungal infections within 7 days after the completion of MCFG therapy. Of the 36 pts., 31 (86.1%) and 24 (66.7%) survived 1 and 3 months after MCFG therapy, respectively. The cause of death was exacerbation of the primary disease, and not exacerbation or the onset of a fungal infection. Eight adverse events occurred in 7 pts.: hypoglycemia in 1, liver dysfunction in 3, eosinophilia in 1, kidney dysfunction in 2, and hypokalemia in 1. In 1 of the 3 pts. with liver dysfunction (grade 3), MCFG therapy was discontinued, with rapid improvement of the liver dysfunction. All other adverse events were mild, allowing continued MCFG therapy. [Conclusion]This multicenter study demonstrated the effectiveness and safety of MCFG therapy for deep fungal infections complicating hematological malignancies. The results suggest that MCFG should be promptly used for fever associated with a fungal infection complicating hematological malignancies.

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Micafungin Compared with Caspofungin for the Treatment of Febrile Episodes in Neutropenic Patients with Hematological Malignancies: A Retrospective Study

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2014/983724 ◽

2014 ◽

Vol 25 (6) ◽

pp. 299-304 ◽

Cited By ~ 2

Author(s):

Sarah Shalhoub ◽

Luchen Wang ◽

Arthur Ching ◽

Shahid Husain ◽

Coleman Rotstein

Keyword(s):

Fungal Infection ◽

Hematological Malignancies ◽

Fungal Infections ◽

Prospective Trial ◽

Invasive Fungal Disease ◽

Invasive Fungal Infections ◽

Successful Outcome ◽

European Organization ◽

Neutropenic Patients ◽

Revised Definitions

BACKGROUND: Invasive fungal infections are associated with morbidity and mortality in neutropenia secondary to hematological malignancies. Empirical antifungal agents are used to reduce their consequences. Caspofungin is the only echinocandin approved for this indication. Micafungin was compared with caspofungin for the treatment of patients with hematological malignancies and prolonged neutropenia.METHODS: A retrospective cohort study was conducted involving patients who had hematological malignancies with profound neutropenia for a minimum of 10 days, and received empirical micafungin or caspofungin for a minimum of five days, between April 2005 and November 2009. Successful outcome was based on a composite end point: survival for a minimum of seven days following antifungal cessation, successful treatment of baseline fungal infection, absence of adverse events and absence of breakthrough fungal infection. Fungal infections were defined according to revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC-MSG) criteria, with modification of the diagnostic imaging criteria.RESULTS: Micafungin had similar overall success to caspofungin (60.4% [29 of 48] versus 57.3% [47 of 82], respectively; P=0.729). Survival was higher in the micafungin group compared with the caspofungin group (100% [48 of 48] versus 89% [73 of 82]; P=0.02). No baseline invasive fungal infections were identified in the micafungin group, compared with three proven infections treated successfully with caspofungin (3.7%; P=0.18). Three proven breakthrough infections were observed in the micafungin group (three of 48 [27.3%]) compared with none in the caspofungin group (zero of 82; P=0.02).CONCLUSION: Micafungin has similar efficacy to caspofungin as empirical antifungal therapy in febrile neutropenic patients with hematological malignancies. Verification of these results in a prospective trial is warranted.

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EFEKTIFITAS KONSELING LAKTASI PADA IBU HAMIL TRIMESTER III TERHADAP PELAKSANAAN MENYUSUI

Jurnal Keperawatan ◽

10.32583/keperawatan.v11i1.429 ◽

2019 ◽

Vol 11 (1) ◽

pp. 41-50

Author(s):

Heni Purwaningsih ◽

Umi Aniroh ◽

Eko Mardiyaningsih

Keyword(s):

Mortality Rate ◽

Pregnant Women ◽

Body Position ◽

Development Program ◽

Optimal Growth ◽

Infant Mortality Rate ◽

P Value ◽

Time Data ◽

Emotional Bonding ◽

Post Test

Program pembangunan kesehatan di Indonesia masih berfokus pada upaya peningkatan derajat kesehatan ibu dan anak terutama pada masa prenatal. Hal ini disebabkan masih tingginya Angka Kematian Ibu (AKI) dan Angka Kematian Bayi (AKB). ASI yang diberikan sejak usia dini dan dilanjutkan dengan ASI eksklusif selama 6 bulan dapat menurunkan angka kesakitan dan angka kematian bayi serta meningkatkan tumbuh kembang bayi secara optimal. Penelitian ini bertujuan untuk mengetahui efektifitas pemberian konseling laktasi terhadap pelaksanaan menyusui pada ibu hamil trimester III. Desain penelitian menggunakan quasi eksperimen dengan rancangan One Group Pre-test dan Post-test Desain. Populasi dalam penelitian ini adalah ibu hamil trimester III dan sampel yang diambil adalah 18 ibu hamil. Alat penggumpulan data menggunakan lembar observasi BREAST (body position, respons, emotional bonding, anatomy dan sucking time). Analisis data menggunakan wilcoxon.Hasil penelitian didapatkan pelaksanaan menyusui sebelum dilakukan konseling laktasi dalam kategori kurang (72,2%) sedangkan pelaksanaan menyusui setelah dilakukan konseling laktasi (77,8%) dalam kategori baik. Konseling laktasi efektif dilakukan untuk meningkatkan pelaksanaan menyusui denganp-value 0,003 (p<0,005).Konseling laktasi seharusnya diberikan pada masa prenatal sehingga pada saat postpartum, ibu sudah mampu memberikan asi secara maksimal. Pendampingan terhadap ibu hamil juga berperan dalam pelaksanaan pemberian ASI. Kata kunci : Konseling laktasi, ASI, pelaksanaan menyusui THE EFFECTIVENESS OF LACTATION COUNSELING IN THE 3rd TRIMESTER PREGNANT WOMEN ON BREASTFEEDING IMPLEMENTATION ABSTRACT Indonesia's health development program still focuses on improving mother and child health, especially at the prenatal stage. It is due to the high maternal mortality rate (MMR) and Infant Mortality Rate (IMR). Breastmilk given from an early age and continued with exclusive breastfeeding for six months can reduce infants morbidity and mortality rate and increase their optimal growth. The purpose is to investigate the effectiveness of lactation counseling to the implementation of breastfeeding in third-trimester. The study design used quasi experiments with one group pre-test and post-test. Population was the 3rd-trimester pregnant mothers, and the samples were 18 mothers. The data collection tool used BREAST observation sheets (body position, response, emotional bonding, anatomy and sucking time). Data analysis used Wilcoxon. The result of the research shows that breastfeeding before lactation counseling is in less category (72,2%) while breastfeeding after lactation counseling (77,8%) is in a goodcategory. Effective lactation counseling is performed to improve the implementation of breastfeeding with p-value 0.003 (p <0.005). Lactation counseling should be given during the prenatal period so that at the time of postpartum, the mother has been able to give breastmilk maximally. Mentoring for pregnant women also plays a role in the implementation of breastfeeding Keywords: lactation counseling, breast milk, breastfeeding implementation

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