Association of hospital construction with the development of healthcare associated environmental mold infections (HAEMI) in pediatric patients with leukemia

Background

Healthcare associated mold infections (HAEMI) increase morbidity and mortality in children with leukemia. Excavation adjacent to Children's Medical Center Dallas (CMCD) April 2006–February 2007 provided an opportunity to determine if excavation adjacent to a hospital building is associated with increased risk of developing HAEMI in children receiving intensive chemotherapy for acute leukemia.

Methods

Children who began receiving intensive chemotherapy for acute leukemia at CMCD from 2004 to 2008 were identified (n = 275). Exposures to the CMCD campus during intensive chemotherapy and duration of neutropenia per exposure were recorded. Proven, probable, or possible invasive fungal disease (IFD) was classified using EORTC/MSG guidelines. Institutional guidelines categorized mold infections as definite or possible HAEMI. A bivariate time‐to‐event model compared the association of excavation with HAEMI and yeast infections, controlling for neutropenia.

Results

There were 7,454 CMCD exposures, 1,007 (13.5%) during excavation. Of 50 cases of IFD, 31 were HAEMI. By time‐to‐event analysis exposure to the CMCD campus during the excavation period was significantly associated with HAEMI (HR = 2.8, P = 0.01) but not yeast infections (HR = 0.75, P = 0.75). Neutropenia was significantly associated with both HAEMI and yeast infections (P < 0.001). Voriconazole prophylaxis did not prevent HAEMI in 42% of the 14 patients with AML who had been receiving this agent.

Conclusion

This study is the first to demonstrate an association between exposure to hospital construction that includes excavation and HAEMI in pediatric oncology patients. Since neutropenic patients need protection from aerosolized fungal spores during visits to expanding medical centers, preventive strategies with adherence monitoring need additional study. Pediatr Blood Cancer 2014;61:276–280. © 2013 Wiley Periodicals, Inc.     

戈谢病Ⅱ型患儿1例报告

目的探讨戈谢病的临床特点及诊断。方法回顾性分析1例经酶学及基因学诊断的戈谢病Ⅱ型患儿的临床特点、葡萄糖脑苷酯酶活性及基因突变类型。结果女孩,14个月,主要表现为肝脾大、眼球运动障碍、智力落后;骨髓片可见戈谢细胞;葡萄糖脑苷酯酶活性为0.3 nmol/(g·min),明显下降;壳三糖酶活力为87 317 nmol/(L·min),明显升高;分析葡萄糖脑苷脂酶基因,明确突变类型为M85T(c.371TC)和R120W(c.475CT)。结论戈谢病Ⅱ型主要表现为肝脾大,可伴有神经系统受损,葡萄糖脑苷脂酶活性及基因分析对诊断有重要意义。     

脾阴、脾阴虚证现代研究进展

脾阴虚证是具有阴虚证共性,且区别于脾阳(气)虚证,一种客观存在的脾虚证。脾阴虚证的现代研究,虽在动物模型、动物实验研究、病理实质、滋脾方剂作用机制、现代临床疾病应用、复方研究等方面均取得了较大的进展,但仍需要进一步拓宽思路,更完整、全面认识脾阴虚证。