Infectious Morbidity in Critically Ill Patients With Cancer

Background: Within the past two decades, Candida species have emerged as major human pathogens and are currently the fourth most common cause of nosocomial infection. Propose of this study was to determine the occurrence of oral Candidiasis among cancer patients at Qods hospitals in Sanandaj. Materials and Methods: Sixty cancer patients were examined for oral candidiasis. For all patients, the clinical diagnosis had to be confirmed microbiologically by the presence of yeasts and / or hyphae or pseudohyphae on potassium hydroxidetreated smears of oral swabs. Oral samples were obtained and cultured on Sabouraud's dextrose agar and CHROMagar. Results: 25 out of the 60 patients (41.7%) were males and 35 (58.3%) were females ranging in age from 15 to 79 years. Gastrointestinal cancer and Breast cancer were the most frequent cancer in the studied group, accounting for 65 % and 18.4 % respectively. The mean weight of the patients was 52.67 Kg (range,. Similarly, the mean of hospital stay was 3.58 days (range; 1-9 days). From these patients, 19 Candida spp were isolated; C. albicans alone outnumbered other species and accounted for 73.68% episodes of trash. For C. albicans isolates, the MIC values ranges from 1 to 9 µ g / ml µg / ml for polyenes and from 0.03 to 16 µ g / ml for the azole antifungals. All the Candida albicans had closely related MFCs values. Conclusion: In conclusions, the finding of our study strongly suggest that oral candidiasis is a frequent complication among cancer patients, being C. albicans the main etiological agent.

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“…Candidal infections are a major problem in the world, especially among the cancer patients [10][11].…”

Section: Discussionmentioning

confidence: 99%

Oral <i>Candidiasis</i> amongst cancer patients at Qods Hospital

Afraseyabi¹,

Afkhamzadeh²,

Sabori³

et al. 2011

Af J Clin Exp Micro

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“…3 Recipients of allogeneic marrow and solid organ transplantation are at additional risk of disease due to opportunistic, facultative intracellular pathogens such as L. monocytogenes, Nocardia asteroids, Legionella pneumophila and Salmonella spp. 2,[16][17][18][19] Most of these opportunistic bacterial infections are observed during the early marrow engraftment period (30 to 180 days). 16,19 In patients undergoing antimicrobial prophylaxis and myelosuppressive treatment for acute (patient 4) or acute exacerbation of chronic GVHD (patient 1) these opportunistic infections may be delayed (Ͼ360 days post BMT).…”

Section: Discussionmentioning

confidence: 99%

“…1,2 In allogeneic transplant recipients with severe CD4 + T cell defects, systemic Listeria monocytogenes infection is seldom seen. [2][3][4] Reactivation of human cytomegalovirus (HCMV), on the other hand, is not uncommon in patients undergoing allogeneic blood, marrow or organ transplants and is associated with a marked increase in short-term morbidity and mortality. 5,6 Reactivation of HCMV is associated with impairment of T lymphocyte recovery due to virus-related marrow aplasia, and graft failure.…”

mentioning

confidence: 99%

Listeriosis in recipients of allogeneic blood and marrow transplantation: thirteen year review of disease characteristics, treatment outcomes and a new association with human cytomegalovirus infection

Safdar

Papadopoulous

Armstrong

2002

Bone Marrow Transplant

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Summary:Listeriosis is uncommon in recipients of allogeneic blood, marrow and organ transplantation. Six patients with systemic Listeria monocytogenes infection during 1985-1997 at Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center are described. In two male and four female patients, the median duration from transplantation to isolation of L. monocytogenes was 62.5 (range 29 to 821) days. Among five allogeneic marrow transplant recipients, four (80%) received HLA antigen matched, T cell-depleted grafts from three unrelated and a single related donor. One patient underwent mismatched-related marrow graft transplant. Cord stem cell transplantation was performed in a single patient. Two required therapy for graftversus-host disease (GVHD). The 13 year incidence of systemic Listeria infections was 0.47 percent. All six presented with fever (Ͼ39؇C), and L. monocytogenes bloodstream invasion. Mental status changes and meningioencephalitis were observed in two (33.3%). A concurrent primary opportunistic infection was present in five individuals (83.3%), and four (80%) were being treated for acute human cytomegalovirus (HCMV) viremia. Sixty-six percent responded to therapy and two died from unrelated, non-listeric causes. Systemic listeriosis was uncommon in our high-risk allogeneic blood and marrow transplantation population, and response to therapy with parenteral ampicillin and gentamicin was excellent. The association between primary HCMV reactivation and subsequent listeric infection emphasizes the significance of HCMV-related dysfunction in

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“…5,6 Of the various fungal organisms, the non-Aspergillus filamentous molds, such as Alternaria, Cladosporium, Curvularia, Fusarium, Paecilomyces lilacinus, Pseudallescheria boydii, Scedosporium apiospermum, and Scedosporium prolificans, often are not susceptible to commonly prescribed antifungals, including amphotericin B. [5][6][7][8][9][10] Therefore, in patients with fungal infections that most likely will not respond well to amphotericin B, preemptive or empiric therapy with the new, broad-spectrum, triazole-based antifungals; the pneumocandin-echinocandin analogues; or both would be appropriate if clinical identifiers were available to distinguish "clinically significant" fungemia from pseudofungemia. Unfortunately, the current diagnostic guidelines are difficult to implement, because the required histologic analysis of the infected tissue seldom is available in these high-risk transplantation recipients because of the underlying severe thrombocytopenia.…”

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confidence: 99%

Clinical significance of non‐Candida fungal blood isolation in patients undergoing high‐risk allogeneic hematopoietic stem cell transplantation (1993–2001)

Safdar

Singhal

Mehta

2004

Cancer

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BACKGROUNDThe clinical relevance of mold isolated from blood cultures, even in severely immunosuppressed allogeneic hematopoietic stem cell transplantation (HSCT) recipients, remains uncertain. The authors hypothesized that isolation of non‐Candida fungi from blood cultures in patients undergoing high‐risk HSCT would have clinical significance.METHODSThe authors reviewed the records of 73 allogeneic HSCT recipients between January 1, 1993 and January 1, 2001 in whom fungal species were isolated from blood cultures.RESULTSFifty‐two episodes of non‐Candida fungemia occurred in 48 patients (66%) after a median of 10 days (range, 2–341) after transplantation. All 48 patients had indwelling intravascular catheters, and 23 patients (48%) had profound neutropenia. Thirty‐five of 48 patients had received partially matched, related donor stem cell grafts (19 patients had 3‐antigen‐mismatched grafts); 35 patients had undergone T‐cell depleted transplantation and 9 patients were receiving treatment for acute graft‐versus‐host disease. In 5 of 48 patients (10%), death was attributed to fungemia that occurred 8–11 days after the initial fungal blood culture was obtained; all 5 patients were age > 30 years. No deaths occurred in the younger age group (n = 22 patients; P = 0.05). In the 24 patients who did not receive systemic antifungal therapy, 4 deaths (17%) were attributed to infections with Penicillium (n = 2 patients), Epicoccum (n = 1 patient), or Penicillium plus Cladosporium species (n = 1 patient). Of the 24 patients who received amphotericin B, only 1 patient (4%) died as a result of a probable hematogenous Aspergillus species infection; this difference in outcome, however, was not significant (P = 0.2).CONCLUSIONSMost of the non‐Candida fungal blood culture isolates in recipients of high‐risk, mismatched donor transplantation were clinically nonsignificant. However, because these low‐virulence saprophytes occasionally may cause life‐threatening disease, a reevaluation of the existing diagnostic paradigm is needed so that clinically significant fungemia may be differentiated from pseudofungemia. Cancer 2004. © 2004 American Cancer Society.

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Infectious Morbidity in Critically Ill Patients With Cancer

Cited by 142 publications

References 274 publications

Oral <i>Candidiasis</i> amongst cancer patients at Qods Hospital

Oral <i>Candidiasis</i> amongst cancer patients at Qods Hospital

Listeriosis in recipients of allogeneic blood and marrow transplantation: thirteen year review of disease characteristics, treatment outcomes and a new association with human cytomegalovirus infection

Clinical significance of non‐Candida fungal blood isolation in patients undergoing high‐risk allogeneic hematopoietic stem cell transplantation (1993–2001)

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