Summary:The efficacy of preemptive therapy was evaluated in bone marrow transplantation (BMT) recipients associated with Chagas disease (CD). The criterion to include patients in the protocol was the serological reactivity for CD in recipients and/or donors before transplant. After BMT, the monitoring was performed using the direct Strout method (SM), which detects clinical levels of Trypanosome cruzi parasitemia, and CD conventional serological tests. Monitoring took place during 60 days in ABMT and throughout the immunosuppressive period in allogeneic BMT. Reactivation of CD was diagnosed by detecting T. cruzi parasites in blood or tissues. In primary T. cruzi infection, an additional diagnostic criterion was the serological conversion. A total of 25 CD-BMT patients were included. Two ABMT and four allogeneic BMT recipients showed CD recurrences diagnosed by SM. One patient also showed skin lesions with T. cruzi amastigotes. Benznidazole treatment (Roche Lab), an antiparasitic drug, was prescribed at a dose of 5 mg/kg/day during 4-8 weeks with recovery of patients. Primary T. cruzi infection was not observed. This report proves the relevance of monitoring CD in BMT patients and demonstrates that preemptive therapy was able to abrogate the development of clinical and systemic disease.

Summary:and systemic tissue spread are also features of this stage. After the acute phase, patients enter an asymptomatic or indeterminate period, a long-lasting period of up to 10-30 We report the clinical course of five adult patients with chronic Chagas' disease (Cd) who underwent BMT.years in which patients persist with serological reactivity and subclinical parasitemia.3 Trypanosoma cruzi, the etioTwo patients with non-Hodgkin's lymphoma and one with ALL received an ABMT. Allogeneic BMT was perlogic protozoan agent, is transmitted to human beings in the endemic areas by sucking insects. 1 In urban areas of formed in two patients with AML and CML respectively. One donor had chronic Cd. Samples of peripheral developed and underdeveloped non-endemic countries, transmission through blood transfusions has acquired relblood for parasite investigation by the Strout method, blood culture, and immunological studies by indirect evance because infected people migrate to populated cities and are potential blood, bone marrow or organ donors. 4,5immunofluorescent assay, ELISA and indirect hemagglutination tests were performed weekly from the start Detection of high level of parasitemia has not been described during the course of chronic Cd in immunocomof chemotherapy until day +60 for ABMT and during the period of immunosuppression for allogeneic BMT.petent individuals. However, in immunosuppressed patients reactivation of chronic Cd associated with leukemia, 6 lymNo prophylaxis was given to any of these patients. In only one ABMT patient were trypomastigotes detected phoma, 7 heart, 8 BM 9 and kidney transplantation 10 and HIV infection, 11 has been reported. early by blood culture without symptoms of reactivation. Benznidazole as preemptive treatment wasWe report the course of chronic Cd in five patients undergoing BMT and define control measures for early administered at 5-8 mg/kg/daily for 30 days. Parasitemia was rapidly cleared and at the end of therapy detection of parasitemia and/or reactivation using a preemptive approach to avoid the development of clinical disease. xenodiagnosis was negative. The other Cd patients showed no evidence of relapse of parasitemia or signs and symptoms of reactivation. In brief, evidence of Cd should be sought in all BMT patients coming from Materials and methods endemic areas because parasitemia and reactivation are potential complications during the period of neutroBetween January 1989 and December 1996 we performed 28 allogeneic and 206 ABMT. In allogeneic patients penia and immunosuppression. The strategy used for early detection and treatment of parasitemia and reactiimmunosuppressive therapy to prevent acute GVHD included CsA and MTX. Selection criteria for including vation was safe and effective.

Identifying the risk factors for carbapenem-resistant Enterobacterales (CRE) bacteremia in cancer and hematopoietic stem cell transplantation (HSCT) patients would allow earlier initiation of an appropriate empirical antibiotic treatment. This is a prospective multicenter observational study in patients from 12 centers in Argentina, who presented with cancer or hematopoietic stem-cell transplant and developed Enterobacterales bacteremia. A multiple logistic regression model identified risk factors for CRE bacteremia, and a score was developed according to the regression coefficient. This was validated by the bootstrap resampling technique. Four hundred and forty-three patients with Enterobacterales bacteremia were included: 59 with CRE and 384 with carbapenem-susceptible Enterobacterales (CSE). The risk factors that were identified and the points assigned to each of them were: ≥10 days of hospitalization until bacteremia: OR 4.03, 95% CI 1.88–8.66 (2 points); previous antibiotics > 7 days: OR 4.65, 95% CI 2.29–9.46 (2 points); current colonization with KPC-carbapenemase-producing Enterobacterales: 33.08, 95% CI 11.74–93.25 (5 points). With a cut-off of 7 points, a sensitivity of 35.59%, specificity of 98.43%, PPV of 77.7%, and NPV of 90.9% were obtained. The overall performance of the score was satisfactory (AUROC of 0.85, 95% CI 0.80–0.91). Finally, the post-test probability of CRE occurrence in patients with none of the risk factors was 1.9%, which would virtually rule out the presence of CRE bacteremia.

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