Febrile neutropenic events in cancer patients Treatment for fever and neutropenia in young adult patients during intensive chemotherapy for solid tumours

Summary Febrile neutropenic events (FNE) were studied in 90 patients on chemotherapy protocols for solid tumours, from 1986 to 1990. All patients received intensive chemotherapy with a high dose intensity. There were 51 FNE admissions in 31 patients, with an average event rate of 1.6/patient. The average periods of granulocytopenia, fever and admission were 3.5, 2.7 and 5.4 days respectively. The management of FNE consisted of accurate clinical observation and antibiotic treatment if indicated by symptoms of infection or by bacteriological cultures. Only 25 of 51 patients admitted received empiric broad-spectrum antibiotics, while 7 were treated after the results of bacteriological cultures were known. One patient died during granulocytopenia, of interstitial pneumonitis for which no bacteriological source was established. Recurrences of infection after discharge from the hospital were not seen. We conclude that in this group of young adult patients, FNE runs a favourable course. Only a short period of admission and a limited form of antibiotic treatment are needed, minimizing the load on the patient and the costs of their care.Abbreviation FNE febrile neutropenic events     

Autoimmune neutropenia: clinical and laboratory studies in 143 patients

Summary Clinical and laboratory data of 143 patients with primary or secondary autoimmune neutropenia (AIN) were evaluated. Primary AIN was found predominantly in children below 3 years, whereas secondary AIN was more frequent in patients 40–60 years of age. Female patients with primary AIN were slightly more prevalent (54%) than male patients (46%). The peripheral blood count showed normal or diminished leukocyte counts with median absolute neutrophil counts of 250 cells/l. In 38% of the patients neutropenia was accompanied by monocytosis. Bone marrow examination revealed in 95% a normo- or hypercellular marrow with a marked reduction of mature neutrophils in 56% of the specimens. Twenty-three percent of the sera showed specificity for the NA1 antigen. Patients were usually affected by benign bacterial infections of the skin and of the upper respiratory tract, as well as by recurrent otitis media. Infections were treated symptomatically, and only six patients required continuous administration of antibiotics. Remission of neutropenia during treatment occurred in three of six patients treated with intravenous immunoglobulin G and in three of four patients who received steroid therapy. Except for one patient neutropenia relapsed after discontinuation of therapy. During a follow-up of 6–36 months, spontaneous remission has been observed in four patients.This work was supported by theDeutsche Forschungsgemeinschaft (Mu 277/9-7)     

颈部坏死性筋膜炎并粒细胞减少一例报告

正1病历资料患者女,33岁,无明显诱因出现右侧颈前区肿痛5 d,既往有甲亢病史5年余,规律口服甲巯咪唑片(10 mg,tid),半年前开始停药,近1个月复查甲功病情复发,遂继续口服甲巯咪唑片(10 mg,tid),无高血压、糖尿病等病史。症状有右侧颈前区肿胀、疼痛,少许瘙痒,无吞咽、呼吸困难,无张口受限,无咽痛、咽异物感,无发热。查体示:T:36.5℃,P 98     

药源性白细胞减少症和粒细胞缺乏(减少)症回顾性分析

目的探讨药源性白细胞减少症和粒细胞缺乏(减少)症的一般规律及特点,促进临床合理用药。方法对1994年1月~2005年11月国内医药学期刊报道的药源性白细胞减少症、粒细胞减少症和粒细胞缺乏症病例311例进行统计、分析。结果给药途径以口服的发生率最高(78.78%),致死率约为9.65%;给药种类以中枢神经系统用药、抗微生物药、激素及调节内分泌功能药的发生率居前3位。结论严格控制用药指征是减少药源性白细胞减少症和粒细胞缺乏(减少)症发生的必要措施。     

血液病并发急性盲肠升结肠炎的外科处理

目的急性盲肠升结肠炎是儿童血液病的严重并发症，本文讨论其诊断和处理。方法总结我院的临床病例资料，并行文献复习。结果过去5年间诊断血液病并发急性盲肠炎的病例共7例，主要症状是在血液粒细胞严重减低的基础上，出现右下腹痛伴高热和腹泻，CT、B超可提示盲升结肠壁增厚，保守治疗可获明显疗效。结论血液病治疗中出现急性腹痛的患儿，除了考虑阑尾炎外应注意盲升结肠炎的可能。高热、腹泻和CT检查中出现结肠和盲肠壁增厚或壁内积气常是盲肠炎的依据。治疗上以保守治疗为主。     

头孢哌酮/舒巴坦与亚胺培南/西司他丁治疗严重感染的比较

目的　比较头孢哌酮 /舒巴坦 (舒普深 )与亚胺培南 /西司他丁 (泰能 )对中性粒细胞缺乏患者严重感染的疗效。方法　回顾性分析 5 6例中性粒细胞缺乏合并严重感染 (男 37例 ,女 19例 ,年龄 2 8a± s2 1a) ,其中 2 8例用头孢哌酮 /舒巴坦 2 .0 g加入 5 %葡萄糖 10 0 m l静滴 ,bid;2 8例用亚胺培南 /西司他丁 0 .5 g加入 5 %葡萄糖 10 0 m l静滴 ,q8h均 7～ 10 d为一疗程。结果　头孢哌酮 /舒巴坦临床有效率 89.2 8% ,痊愈率 71.42 % ;亚胺培南 /西司他丁组临床有效率 96 .42 % ,痊愈率 75 % ,两组间相差无统计学意义 (P>0 .0 5 )。结论　头孢哌酮 /舒巴坦与亚胺培南 /西司他丁治疗中性粒细胞缺乏时严重感染疗效相同     

Prevention and therapy of fungal infections in cancer patients

This review of recent publications in the field of fungal infections in cancer patients clearly confirms that protracted severe granulocytopenia is a major risk factor for their development. Because severe and prolonged granulocytopenia plays such a major predisposing role for fungal infections, it is likely that the use of the colony-stimulating factors, which are able to reduce the duration and the severity of granulocytopenia, might prove effective in decreasing the frequency and the severity of these infections. Another conclusion is that certain categories of patients with granulocytopenia might benefit from antifungal prophylaxis and empiric therapy. Conversely, there are other populations who will benefit only marginally from such strategies. Imidazoles, namely fluconazole, for the prevention of local and systemic Candida infections have been shown to be effective in granulocytopenic patients. So far, the development of resistance has not been a major problem. In patients at the greatest risk of developing severe fungal infections, such as those receiving high-dose corticosteroid therapy for GVHD after allogeneic bone marrow transplantation, early administration of low doses of amphotericin B seems to be effective in reducing the development of systemic fungal infection. In terms of therapy, amphotericin B is still the standard approach, especially for empiric treatment, prior to the recognition of a specific pathogen.     

药物所致急性粒细胞减少症33例

近１０年我院收治药物所致急性粒细胞减少症３３例。发病前均有明确用药史，外周血白细胞低于４．０×１０＾９／Ｌ，中性粒细胞绝对娄秒于１．５×１０＾９／Ｌ。治愈２９例，败血症死亡２例，自动出院２例。本对此症的临床表现、诊断标准、治疗措施及对药源性粒细胞减少症发病机制进行了讨论。     

Improvement of pneumonia and arthritis in Felty's syndrome by treatment with granulocyte-macrophage colony-stimulating factor (GM-CSF)

Summary A 63-year old man with Felty's syndrome and pneumonia of unknown origin was treated with GM-CSF. Granulocyte counts increased and arthritis-related symptoms improved under GM-CSF. Pneumonia was treated effectively with antibiotics only during or after GM-CSF application. This suggests, that antibiotic-resistent infections can be treated effectively in patients with Felty's syndrome when granulocyte counts are raised by GM-CSF.     

Aerosol treatment with cefoperazone or gentamicin protects granulocytopenic mice from acute Pseudomonas aeruginosa pneumonia

The usefulness of the aerosol route for delivery of either cefoperazone (CEF) or gentamicin (GEN) for the treatment of acute Pseudomonas aeruginosa pneumonia was assessed in mice rendered granulocytopenic by treatment with 200 mg/kg cyclophosphamide. Aerosol delivery of CEF (60 μg/ml final concentration in lung homogenate) was significantly more effective (90% survival) than the single intraperitoneal (i.p.) inoculation of 640 mg/kg CEF (0% survival) (P < 0.001). Similarly, aerosol delivery of gentamicin (11 μg/ml final concentration in lung homogenate) was significantly more effective (100% survival) than single or multiple inoculation of a total i.p. dose of 16 mg/kg (0% survival) (P < 0.001). Pulmonary half-life of both antibiotics after aerosol administration was higher than that obtained after i.p. inoculation.