scholarly journals Disseminated Pulmonary Mucormycosis Involving the Jejunum in an Acute Lymphoblastic Leukemia Patient

2020 ◽  
Author(s):  
Lan-lan Wang ◽  
Liang Zou ◽  
Zhong-ju Chen ◽  
Yang Yi ◽  
Qin-bin Meng ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Clinical Symptoms ◽  
Lymphoblastic Leukemia ◽  
Good Condition ◽  
Lymphocytic Leukemia ◽  
Calcofluor White ◽  
Pulmonary Mucormycosis ◽  
Therapeutic Outcomes ◽  
Intravenous Amphotericin ◽  
Disseminated Mucormycosis

Abstract Background: Pulmonary mucormycosis and aspergillosis with disseminated mucormycosis involving gastrointestinalin is a very rare but lethal infection leading to extreme mortality. Case presentation: A 51-year-old female was admitted in the hematology clinic following persistent fever. Bone marrow pathology was done on the third day and the common type of acute B-lymphocytic leukemia (B-ALL) with the IKZF1 mutation was diagnosed. IVCP program was prescribed as initial treatment. After five days, broad spectrum antibiotics and voriconazole were started due to febrile neutropenia. Forty-nine days after admission, based on characteristics of the clinical pulmonary symptoms, the feature of the computed tomography (CT) and the morphological profile of the hyphae, we switched the antifungal therapy to intravenous amphotericin B (AmB) with an initial dose of 0.5 mg/kg/d. On day sixty-two, according to the abdominal CT and clinical symptoms, intestinal perforation was diagnosed and emergency surgical management was performed. Histopathology of specimens from the jejunum and ileum showed broad septate fungal hyphae. L-AmB was added to 1.0 mg/kg/d for one week, followed by fever resolution. Considering the relief of symptoms and regression of lesions on imagery, our strategy switched to oral posaconazole 0.8 g/d. The patient was discharged in good condition for continuous therapy with antifungal agents and for follow-up at the outpatient clinic.Conclusions: Direct microscopic testing with calcofluor white is the key to rapid diagnosis of mucormycosis, and early administration of active antifungal agents at optimal doses and complete resection of all infected tissues led to improved therapeutic outcomes.

scholarly journals Disseminated pulmonary mucormycosis involving jejunum in an acute lymphoblastic leukemia patient

2020 ◽  
Author(s):  
Lan-lan Wang ◽  
Liang Zou ◽  
Zhong-ju Chen ◽  
Yang Yi ◽  
Qin-bin Meng ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Lymphoblastic Leukemia ◽  
Unique Case ◽  
Early Administration ◽  
Pulmonary Mucormycosis ◽  
Leukemia Patient ◽  
Cunninghamella Bertholletiae ◽  
Therapeutic Outcomes ◽  
Lethal Infection ◽  
Disseminated Mucormycosis

Abstract Pulmonary mucormycosis and aspergillosis with disseminated mucormycosis involving gastrointestinalin is a very rare but lethal infection leading to an extremely mortality. Herein, we present a unique case of pulmonary co-infection with Cunninghamella bertholletiae and Aspergillus flavus, with dissmiated mycomycosis involving jejunum caused by Cunninghamella bertholletiae in a B-ALL patient with familial diabetes. Early administration of active antifungal agents at optimal doses, complete resection of all infected tissues led to improved therapeutic outcomes.

scholarly journals The Effect of Bovine Colostrum on the Absolute Neutrophil Counts of Pediatric Patients with Acute Lymphocytic Leukemia Undergoing Chemotherapy: A Double Blind Randomized Placebo Controlled Study

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Lymphoblastic Leukemia ◽  
Chemotherapeutic Agents ◽  
Bovine Colostrum ◽  
Lymphocytic Leukemia ◽  
Controlled Study ◽  
Double Blind ◽  
Treatment Groups ◽  
Therapeutic Outcomes ◽  
The Absolute ◽  
To Receive

Background: Changes in the blood counts mainly leukopenia and neutropenia in patients with Acute Lymphoblastic Leukemia (ALL) are common adverse events following chemotherapy. These commonly delays further administration of chemotherapeutic agents thereby potentially affecting therapeutic outcomes. Bovine colostrum has shown some promises in different fields of medicine and one claim is its use in prevention of neutropenia. However, there are no studies to support such claim Objective: The general objective of this study is to determine the efficacy of bovine colostrum in preventing neutropenia among patients with ALL receiving chemotherapy. Methodology: This is a randomized, double blind, placebo controlled study involving the use of bovine colostrum for 1 week against placebo in preventing neutropenia among patientsundergoing chemotherapy. Participants were randomly assigned to receive the test products which were given orally 2x a day for 7 days starting simultaneously with the chemotherapy before the outcome measures were evaluated. Results: A total of 21 subjects were enrolled, 10 of them received the placebo while 11 received the bovine colostrum. Results showed that there was significant increase in the Absolute Neutrophil Count (ANC) of patients given bovine colostrum as compared to the placebo group. There was also significant increase in the WBC and platelet counts among those who were given Bovine Colostrum. No incidence of infection or untoward effects on both treatment groups. Conclusion: Bovine Colostrum is effective and safe in increasing the absolute neutrophil counts of ALL patients undergoing chemotherapy

scholarly journals Adjuvant corticosteroid therapy in hepatosplenic candidiasis-related IRIS

2012 ◽  
Vol 4 (1) ◽  
pp. e2012018 ◽  
Author(s):  
Cengiz Bayram ◽  
Ali Fettah ◽  
Nese Yarali ◽  
Abdurrahman Kara ◽  
Fatih Mehmet Azik ◽  
...  
Keyword(s):  
Corticosteroid Therapy ◽  
Immune Reconstitution ◽  
Inflammatory Responses ◽  
Clinical Symptoms ◽  
Lymphoblastic Leukemia ◽  
Laboratory Findings ◽  
Hepatosplenic Candidiasis ◽  
Cell Acute Lymphoblastic Leukemia ◽  
Inflammatory Syndrome ◽  
Standard Risk

Hepatosplenic candidiasis (HSC) is a form of invasive fungal infection that occurs most commonly in patients with acute leukemia treated with chemotherapy and requires protracted antifungal therapy. Immune reconstitution inflammatory syndrome (IRIS) is best characterized as a dysregulated inflammatory responses triggered by rapid resolution of immunosuppression.We present a child diagnosed with standard-risk precursor B cell-acute lymphoblastic leukemia who developed HSC and Candida-related IRIS during recovery of neutropenia associated with induction chemotherapy. Addition of corticosteroid therapy to antifungal treatment is associated with the resolution of the clinical symptoms and laboratory findings

BONE MARROW PROFILE IN HEMATOLOGICAL DISORDERS IN YEMENI PATIENS

2021 ◽  
pp. 61-65
Author(s):  
Saeed Thabet Nasher ◽  
Fayed Alyousufy ◽  
Khaled Alkubati ◽  
Sadam Al Halimy ◽  
Ramia Al Athwary
Keyword(s):  
Bone Marrow ◽  
Visceral Leishmaniasis ◽  
Lymphoblastic Leukemia ◽  
Bone Marrow Examination ◽  
Myeloproliferative Disorder ◽  
Lymphocytic Leukemia ◽  
Published Data ◽  
Hematological Disorders ◽  
Hematological Diseases ◽  
Age Related

There is paucity of information about the prevalence of hematological disorders in Yemen and neighboring countries .This is the rst project to evaluate the relative spectrum of hematological diseases in Taiz and Ibb governorate Yemen ,by method of bone marrow examination which is considered an important valuable diagnostic tool, for evaluation and nal diagnosis of various hematological and non-hematological disorders especially when CBC and peripheral blood lm study and other investigation failed to give a diagnosis . OBJECTIVES: The aim of this study was to evaluate the spectrum of haematological diseases diagnosed by bone marrow examination in Taiz and IBB governorates Yemen between September 2016 and October 2020 .Patients and method : A total of 1108 patients aged between (1 -100 )years old were evaluated by bone marrow examination at referral hematological center in IBB city Yemen . Relevant investigations were performed when needed. After exclusion of 98 patients with normal bone marrow ndings ,a total of 1010 patients had hematological disorders , and their data were analyzed. There were 527 (52.2 %) males and 483(47.8 %) females . A total of 655(64.9%) patients had benign hematological diseases and 355 (35.1% ) patients had malignant hematological diseases . RESULTS :A total of 138 patients had Iron deciency anemia ,107 had immune thrombocytopenic purpura (ITP) , 92 had hypersplenism,84 had Acute lymphoblastic leukemia ,79 had Acute myeloid leukaemia, 71 had megaloblastic anemia 58 had myeloproliferative disorder , 53 had Chronic myeloid leukemia , 45 had hemolytic anemia ,45had visceral leishmaniasis. 44 had malaria, 38 had chronic lymphocytic leukemia 38 had anemia of chronic disease ,25 had aplastic anemia ,25 had myelodysplastic syndromes, ,21 had anemia of infection ,19 had congenital syndroms,7had multiple myeloma ,6 had mixed deciency anemia and 5 had metastatic deposits , 4 had myeloid leukomoid reaction ,4 had lymphoma inltration and 2 had hairy cell leukemia . Sex- and age-related distribution of the various disorders was also presented. CONCLUSION: The anemias of all types were the most frequently encountered diagnosis followed by acute and chronic leukemias , ITP , Hypersplenism , ,myeloproliferative disorder , visceral leishmaniasis , malaria, myelodysplastic syndrome and congenital syndromes respectively. The other haematological disorders were less common. These ndings are comparable with published data in previous studies done in Yemen and other developing countries

scholarly journals Cryptococcal Meningoencephalitis in an Immunosuppressed Patient with Chronic Lymphocytic Leukemia

2021 ◽  
Vol 16 (2) ◽  
pp. 87-89
Author(s):  
Md Monirul Hoque ◽  
Sonia Chakraborty ◽  
Arif Ahmed Khan
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Antifungal Agents ◽  
Immunosuppressive Drugs ◽  
Rapid Diagnosis ◽  
Lymphocytic Leukemia ◽  
Cell Mediated Immunity ◽  
Immunosuppressed Patient ◽  
Cryptococcal Meningoencephalitis ◽  
India Ink ◽  
Cryptococcal Disease

Cryptococcal meningoencephalitis, an invasive fungal infection caused by an encapsulated fungus Cryptococcus neoformans should be suspected in immune compromised individuals with defective cell-mediated immunity and patients on immunosuppressive drugs with recent development of fever, confusion and loss of consciousness. A rapid diagnosis is fundamental for decreasing morbidity and mortality from cryptococcal disease. Cerebrospinal fluid (CSF) study and simple stain like India Ink Stain can be performed for diagnosis of cryptococcal meningoencephalitis. Here, we report a case of cryptococcal meningoencephalitis in chronic lymphocytic leukemia (CLL) patient on immunosuppressive drugs diagnosed by CSF study and India ink stain which responded dramatically with antifungal agents after diagnosis. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 87-89

scholarly journals Anlotinib Shows Potent Antileukemia Effects in B-Cell Acute Lymphocytic Leukemia through the Blockage of Angiogenic Related Pathways

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 49-49
Author(s):  
Qiuling Chen ◽  
Yuelong Jiang ◽  
Qinwei Chen ◽  
Long Liu ◽  
Bing Xu
Keyword(s):  
B Cell ◽  
Solid Tumors ◽  
Molecular Mechanisms ◽  
Conflicts Of Interest ◽  
Lymphoblastic Leukemia ◽  
Unmet Need ◽  
Lymphocytic Leukemia ◽  
Advanced Lung Cancer ◽  
Antitumor Effects

Acute lymphoblastic leukemia (ALL) derives from the malignant transformation of lymphoid progenitor cells with ~85% being originated from B-cell progenitors (B-ALL). Despite fairly good prognoses for most pediatric B-ALL patients, the outcome is fatal in over 50% of adult patients who have a recurrent or progressive disease and lack of effective therapeutic approaches. Therefore, novel treatment strategies with high efficacy and low toxicity are an unmet need for B-ALL patients, especially those with relapsed or refractory status. Angiogenesis is a process of new vessel formation that requires the participation of multiple proangiogenic factors (e.g., VEGF, PDGF, and FGF) and their corresponding receptors (e.g., VEGFR, PDGFR, and FGFR). Angiogenesis, a well-established feature of solid tumors, also contributes to leukemia progression and correlates with the involvement of specific sanctuary sites in ALL, highlighting that the perturbation of angiogenesis would be an attractive approach for ALL treatment. Anlotinib is an oral tyrosine kinase (TKI) inhibitor with a broad range of antitumor effects via the suppression of VEGFR, PDGFR and FGFR. Of importance, anlotinib has been approved for the treatment of advanced lung cancer in China. Here, we evaluated the antileukemia activity of anlotinib in preclinical B-ALL models and its underlying molecular mechanisms. In this study, we observed that anlotinib significantly blunted the capability of cell proliferation and arrested cell cycle at G2 phase in B-ALL cell lines. Subsequently, we found that anlotinib resulted in remarkably enhanced apoptosis in B-ALL in vitro. To assess the in vivo antileukemia potential, we established a B-ALL patient-derived xenograft (PDX) mouse model and then treated the B-ALL PDX model with anlotinib. As a result, oral administration of anlotinib pronouncedly delayed in vivo B-ALL cell growth and reduced leukemia burden with acceptable safety profiles in this model. As for the mechanism of action, the antileukemia effect of anlotinib was associated with the disruption of the role of VEGFR2, PDGFRb, and FGFR3. Moreover, we revealed that this drug blocked the PI3K/AKT/mTOR/ signaling, a pathway that is linked with angiogenesis and its proangiogenic regulators, including VEGFR2, PDGFRb, and FGFR3. In aggregate, these results indicate that anlotinib is a potent antitumor agent for the treatment of B-ALL via the inhibition of angiogenic relevant pathways, which provide a novel potential treatment intervention for patients with B-ALL who have little effective therapy options. Disclosures No relevant conflicts of interest to declare. OffLabel Disclosure: Anlotinib originally designed by China is a novel orally active multitarget inhibitor that is evaluating in clinical trials against multiple solid tumors.

scholarly journals 1098. Norovirus Infection in Cancer Patients Undergoing Chimeric Antigen Receptor T-cell Immunotherapy (CAR-T)

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S578-S579
Author(s):  
Divya S Kondapi ◽  
Sasirekha Ramani ◽  
Adilene Olvera ◽  
Robert L Atmar ◽  
Mary K Estes ◽  
...  
Keyword(s):  
T Cell ◽  
Lymphoblastic Leukemia ◽  
Lymphocytic Leukemia ◽  
Nucleic Acid Amplification ◽  
High Dose ◽  
Cell Transplant ◽  
Research Support ◽  
Hematopoietic Stem ◽  
Car T Cell ◽  
Car T

Abstract Background CAR-T is used to treat certain refractory hematological malignancies. B-cell aplasia and immunosuppression used to treat CAR-T side effects increase infection risk. Little data are available describing Norovirus (NoV) infections in CAR-T recipients. Methods We reviewed the medical records of 134 patients with NoV diarrhea (identified by nucleic acid amplification test) between 2016-2019. Of these patients, nine received CAR-T prior to developing NoV. Here we describe their demographics, clinical characteristics, treatments, and complications. Results The median age was 49 years (Table 1). Patients’ underlying malignancies included Non-Hodgkin’s Lymphoma (4), Acute Lymphoblastic Leukemia (3), Chronic Lymphocytic Leukemia (1) and metastatic Sarcoma (1). Prior to development of NoV, six patients had undergone hematopoietic stem cell transplant, and 1 had received checkpoint inhibitor therapy. Five patients experienced cytokine release syndrome after CAR-T, and 1 experienced CAR-T-related encephalopathy syndrome (Table 2). Two patients received interleukin-6 antagonist therapy, and one received high dose steroids. Time to diarrhea onset post-CAR-T cell infusion was variable(median 256days, IQR 26-523 days).Six had an absolute lymphocyte count< 1000/mm3 at diarrhea onset. Three had diarrhea for >14 days; median diarrhea duration in the other 6 patients was 4 days. Other GI complaints included abdominal pain (3), nausea (4), and vomiting (3). For NoV treatment, three received oral immunoglobulin, and 8 received Nitazoxanide. Complications included development of concomitant GI-GVHD(5), ileus (2), need for TPN (3), renal failure requiring dialysis (2), ICU stay (3), and death (2). Two patients were co-infected with other enteropathogens such as rotavirus, enteropathogenic and enteroaggregative E.Coli and Clostridioides difficile. Three patients with diarrhea lasting >14 days had serial samples collected over time; NoV shedding lasted 81-546 days. NoV was genotyped in 6 patients(Table 3) and included GII.2(2), GII.4(2), GII.6(1) and GII.12(1). Table 1: Patient characteristics (N=9) Table 2: CAR-T related factors Table 3: NoV Genotypes Conclusion NoV belonging to various genotypes is an important cause of acute and chronic diarrhea in patients receiving CAR-T cell therapy. Disclosures Adilene Olvera, MPH MLS (ASCP), MERK (Grant/Research Support, Scientific Research Study Investigator) Robert L. Atmar, MD, Takeda Vaccines, Inc. (Grant/Research Support) Mary K. Estes, PhD, Takeda Vaccines (Consultant, Grant/Research Support)

scholarly journals Ketone bodies – causes and effects of their increased presence in cows' body fluids: A review

2021 ◽  
pp. 1492-1503
Author(s):  
Piotr Guliński
Keyword(s):  
Dairy Cows ◽  
High Performance ◽  
Clinical Symptoms ◽  
Ketone Bodies ◽  
Good Condition ◽  
Body Fluids ◽  
Protein Ratio ◽  
Loss Of Appetite ◽  
Point Body ◽  
Main Component

Ketosis is the most common metabolic disease in high-performance dairy cows during the first 6-8 weeks of lactation. Its main symptoms include an excessive amount of so-called ketone bodies in a cow's body fluids. Ketone bodies consist of β-hydroxybutyric acid (βHBA), acetoacetic acid, and acetone. βHBA is the main component with its share of the total volume of ketone bodies in the blood of about 70%. Clinical symptoms of ketosis in cows include loss of appetite, preference for forage to concentrated feed, and acetone odor in their mouth and urine. Those symptoms are accompanied by a production drop, an increase of concurrent illness (mastitis, metritis, and displaced abomasum), and poor reproductive performance. One of the ketosis characteristic effects is an increase in the level of fat in milk (>5%), while protein levels decrease (<2.9%). In the case of subclinical ketosis (SCK), the fat–protein ratio in milk is increased to above 1.4:1. The current consensus for SCK is to consider a cutoff point of βHBA to be at least 1.2 mmol/L in blood plasma. Ketosis prevention is based on keeping perinatal cows in good condition, that is, with around 3.5 points in the five-point body condition scoring, carefully balancing food doses during the first 2 months of lactation with the correct energy–protein ratio. Glucose precursor products should be administered orally, in particular to at-risk herds. Ketosis occurs in 7-14% on average of the total number of cows in a herd. In general, data on the prevalence of SCK vary considerably, depending on their source. Moreover, the problem is mostly observed in poorly-fed animals with high milk production potential. The objectives of this review are to reveal the current situation of ketosis prevalence, the possibility of diagnosis, consequences in dairy cows and to provide some recommendations for ketosis treatment and prevention.

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