Fatal hemorrhagic pneumonia: Don’t forget Stenotrophomonas maltophilia

Gutiérrez, Cristina; Pravinkumar, Egbert; Balachandran, Diwakar D.; Schneider, Virginia V

doi:10.1016/j.rmcr.2016.06.003

Cited by 12 publications

(10 citation statements)

References 11 publications

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“…In addition, it was recently reported that SM can cause fatal hemorrhagic pneumonia in severely immunocompromised patients who have undergone anticancer chemotherapy or stem cell transplantation (2)(3)(4)(5)(6)(7)(8). Although some cases of SM hemorrhagic pneumonia have been reported, the exact mechanism by which SM causes hemorrhaging as well as the risk factors involved remain unknown (9). However, due to the very high mortality of SM hemorrhagic pneumonia (2), the urgent detection of the characteristics of the disease is required.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Rapidly Progressive Fatal Hemorrhagic Pneumonia Caused by <i>Stenotrophomonas maltophilia</i>

et al. 2020

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Objective Hemorrhagic pneumonia due to Stenotrophomonas maltophilia (SM) in severely immunocompromised patients has a very poor prognosis. However, the risk factors for hemorrhagic pneumonia are not clear. Methods This study assessed the predictive factors of hemorrhagic pneumonia caused by SM. The medical records of patients admitted to Osaka City University Hospital with SM bacteremia between January 2008 and December 2017 were retrospectively reviewed. Patients All patients who had positive blood cultures for SM were included in this study. They were categorized into two groups: the SM bacteremia with hemorrhagic pneumonia group and the SM bacteremia without hemorrhagic pneumonia group. The clinical background characteristics and treatments were compared between these groups. Results The 35 patients with SM bacteremia included 4 with hemorrhagic pneumonia and 31 without hemorrhagic pneumonia. Hematologic malignancy (p=0.03) and thrombocytopenia (p=0.04) as well as the prior use of quinolone within 30 days (p=0.04) were more frequent in the SM bacteremia patients with hemorrhagic pneumonia than in those without hemorrhagic pneumonia. The mortality of the SM bacteremia patients with hemorrhagic pneumonia was higher than that of those without hemorrhagic pneumonia group (p= 0.02). Conclusion Patients with SM bacteremia who have hematologic malignancy, thrombocytopenia, and a history of using quinolone within the past 30 days should be treated with deliberation.

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Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Rapidly Progressive Fatal Hemorrhagic Pneumonia Caused by <i>Stenotrophomonas maltophilia</i>

et al. 2020

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“…Walaupun demikian, infeksi pada tempat lain seperti aliran darah, selulitis, osteomielitis, saluran kencing, dan infeksi nosokomial telah dilaporkan pada studi sebelumnya. 15,16 Bakteri tersebut memiliki ciri khas yaitu resisten terhadap berbagai antibiotik, dari trimetropim-sulfametoksasol hingga karbapenem oleh karena rendahnya permeabilitas membran sel, disertai adanya produksi enzim beta-laktamase yang didapatkan secara alamiah. 17,18 Hal ini dijumpai pula pada kasus pertama yaitu didapatkan kuman tersebut resisten pada berbagai antibiotik dan memiliki aktivitas intermediate terhadap levofloksasin.…”

Section: Diskusiunclassified

Sindroma Cushing Eksogen: Kapan Penggunaan Dosis Stres Glukokortikoid Bermanfaat?

Soelistijo¹,

Gunawan²,

Primasatya³

et al. 2020

JPDI

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Sindrom cushing eksogen merupakan jenis sindrom cushing yang paling sering dijumpai dalam praktik klinis. Penyebab yang paling sering adalah efek samping terapi glukokortikoid yang diberikan dalam bentuk tablet maupun obat tradisional. Manifestasi klinis sindrom cushing eksogen mirip dengan sindrom cushing endogen, dikuatkan dengan adanya riwayat konsumsi glukokortikoid dalam berbagai bentuk. Artikel ini melaporkan serial kasus sindrom cushing eksogen akibat pemberian glukokortikoid eksogen dan obat tradisional dengan manifestasi utama infeksi oportunistik. Pada kasus pertama tidak diberikan suplementasi glukokortikoid sedangkan pada kasus kedua diperlukan terapi suplementasi glukokortikoid. Tata laksana komprehensif sindrom cushing eksogen seyogyanya dilakukan secara komprehensif dengan pertimbangan pemberian dosis stres glukokortikoid dan terapi ditujukan terhadap edukasi penghentian glukokortikoid disertai tata laksana penyakit dasar pada pasien.

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“…The extracellular protease secreted by SM is reported to cause tissue destruction, vascular damage, and subsequent hemorrhage [2][3][4]. Although pulmonary hemorrhage (PH) is an uncommon complication of SM respiratory infection, previous studies have reported mortality as high as 85% within 30 days of infection onset [5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Serial Platelet Level Index Improves Prediction of Pulmonary Hemorrhage in Stenotrophomonas maltophilia Respiratory Infections

Cheng

et al. 2022

Preprint

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Background: Thrombocytopenic patients who acquire Stenotrophomonas maltophilia (SM) respiratory infection often develop pulmonary hemorrhage (PH), resulting in a high respiratory failure rate and increased mortality. This study aimed to evaluate risk factors for PH and develop an index measuring serial platelet deficit to predict PH in patients with SM respiratory infection.Methods: Data of patients with both SM isolated from sputum/endotracheal suction culture and thrombocytopenia (platelet count < 150x103 /μL) who were treated at National Cheng Kung University Hospital during 2018-2020 were extracted from electronic medical records and analyzed retrospectively. SM respiratory infection was defined as positive bacterial isolates plus respiratory infection symptoms. Clinical parameters and laboratory findings were compared between PH and non-PH groups. The platelet dissimilarity index (d-index) was calculated by accumulating differences between the actual and the lowest normal level of platelet count in each patient at different time points.Results: Among 437 SM respiratory infection cases, 125 (28.6%) patients developed PH. Patients with PH had increased prothrombin time/international normalized ratio (PT/INR), lower platelet count, and higher platelet d-index. Multivariate analysis revealed that extreme thrombocytopenia (platelet count < 50x103 /μL) is a common independent risk factor for PH and mortality. The performance of platelet deficit and d-index varied between patients with different comorbidities. Performance of single time-point platelet deficit to predict PH is more reliable in patients with hematology/oncology and liver disease (area under curve 0.705-0.757), while performance of d-index is more reliable in patients with sepsis/treatment and various other groups (0.711-0.816).Conclusions: Prolonged and extreme thrombocytopenia is a determinant risk factor for PH in patients with SM respiratory infection. Given the complexity of causes of thrombocytopenia and associated comorbidities, different strategies should be applied to assess the degree of thrombocytopenia when evaluating the risk for PH.

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Fatal hemorrhagic pneumonia: Don’t forget Stenotrophomonas maltophilia

Cited by 12 publications

References 11 publications

Clinical Characteristics of Rapidly Progressive Fatal Hemorrhagic Pneumonia Caused by <i>Stenotrophomonas maltophilia</i>

Clinical Characteristics of Rapidly Progressive Fatal Hemorrhagic Pneumonia Caused by <i>Stenotrophomonas maltophilia</i>

Sindroma Cushing Eksogen: Kapan Penggunaan Dosis Stres Glukokortikoid Bermanfaat?

Serial Platelet Level Index Improves Prediction of Pulmonary Hemorrhage in Stenotrophomonas maltophilia Respiratory Infections

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