Epidemiology, Molecular Mycology, and Environmental Sources ofFusariumInfection in Patients with Cancer

2002 ◽  
Vol 23 (9) ◽  
pp. 532-537 ◽  
Author(s):  
Issam Raad ◽  
Jeffrey Tarrand ◽  
Hend Hanna ◽  
Maher Albitar ◽  
Erle Janssen ◽  
...  
Keyword(s):  
Dna Analysis ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Uninfected Control ◽  
Cancer Center ◽  
Retrospective Case ◽  
Patients With Cancer ◽  
Random Amplification ◽  
Immunocompromised Status ◽  
Control Study

Objective:To investigate the epidemiology and environmental sources of Fusarium infections in patients with cancer.Design:Retrospective case-control study conducted following surveillance environmental cultures and DNA analysis of isolated organisms.Setting:A tertiary-care, university cancer center.Methods:In 1996 and 1997, environmental cultures were performed on air samples and water systems. A retrospective chart review was performed for 70 patients with cancer identified with fusariosis between 1987 and 1997. Patients with fusariosis were compared with 49 uninfected control patients who occupied hospital rooms with positive environmental cultures for Fusarium. With the use of random amplification of polymorphic DNA organisms isolated from infected patients were compared with environmental organisms.Results:Most of the patients with Fusarium (40, 57%) were infected on or within 3 days of admission, indicating community rather than nosocomial acquisition. Patients were comparable in terms of underlying immunocompromised status to 49 uninfected control patients. However, the duration from admission to infection in the patients with fusariosis tended to be shorter than the duration from admission to discharge in the exposed control patients (P= .06). Water cultured from the hospital tanks and from sinks and water fountains was negative for Fusarium. With the use of polymerase chain reaction, environmental isolates did not match clinical ones. Quantitative air sampling showed that the quantitative outdoor Fusarium levels were eightfold higher than the indoor levels. During the rainy summer season, outdoor air concentrations of Fusarium were at their highest, coinciding with the peak incidence of fusariosis at our center.Conclusion:The most likely source of fusariosis was the external environment rather than nosocomial sources, such as water.

Breakthrough Candidemia in Patients with Cancer Differs from De Novo Candidemia in Host Factors andCandidaSpecies But Not Intensity

2002 ◽  
Vol 23 (9) ◽  
pp. 542-545 ◽  
Author(s):  
Dimitrios P. Kontoyiannis ◽  
Bhavanandra T. Reddy ◽  
Hend Hanna ◽  
Gerald P. Bodey ◽  
Jeffrey Tarrand ◽  
...  
Keyword(s):  
Risk Factors ◽  
De Novo ◽  
Tertiary Care ◽  
Case Series ◽  
Cancer Center ◽  
Retrospective Case ◽  
Factors Associated ◽  
Patients With Cancer ◽  
Neutropenic Patients ◽  
Population Design

Objectives:To evaluate the risk factors associated with breakthrough candidemia in patients with cancer and to compare them with those of de novo candidemia in this patient population. DESIGN: Retrospective case series of 120 episodes of candidemia, 90 de novo and 30 breakthrough candidemias.Setting:University-affiliated, tertiary-care cancer center in Houston, Texas.Patients:All patients with cancer who acquired candidemia between January 1993 and December 1998 were included if they had non-catheter-related candidemia and information about quantitative blood cultures.Results:Although less frequent, breakthrough candidemia was seen more often in neutropenic patients with leukemia. The intensity of breakthrough candidemia was comparable to that of de novo candidemia. Most (70%) of the breakthrough candidemias were due toCandida glabrataorC. krusei.Conclusions:In breakthrough candidemia, the same risk factors seen in de novo candidemia were encountered, although more frequently.C. glabrataandC. kruseiare the leading causes of breakthrough candidemia in patients with cancer.

scholarly journals Characteristics of infective endocarditis in a cancer population

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001664
Author(s):  
Cullen Grable ◽  
Syed Yusuf ◽  
Juhee Song ◽  
George M Viola ◽  
Owais Ulhaq ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Mortality Data ◽  
Limited Information ◽  
Tertiary Care Centre ◽  
Indwelling Catheters ◽  
Patients With Cancer ◽  
Duke Criteria ◽  
Immunocompromised State

BackgroundInfective endocarditis (IE) is more common in patients with cancer as compared with the general population. Due to an immunocompromised state, the need for invasive procedures, hypercoagulability and the presence of indwelling catheters, patients with cancer are particularly predisposed to the development of IE.ObjectivesLimited information exists about IE in patients with cancer. We aimed to evaluate the characteristics of patients with cancer and IE at our tertiary care centre, including a comparison of the microorganisms implicated and their association with mortality.MethodsA retrospective chart review of patients with cancer who had echocardiography for suspicion of endocarditis was conducted. A total of 56 patients with a confirmed diagnosis of cancer and endocarditis, based on the modified Duke criteria, were included in the study. Baseline demographics, risk factors for developing IE, echocardiography findings, microbiology and mortality data were analysed.ResultsFollowing the findings of vegetations by echocardiography, the median survival time was 8.5 months. Staphylococcus aureus was the most common organism identified as causing endocarditis. The mitral and aortic valves were the most commonly involved sites of endocarditis. Patients with S. aureus endocarditis (SAE) had a significantly poorer survival when compared with patients without SAE (p=0.0217) over the 12-month period from diagnosis of endocarditis.ConclusionsOverall survival of patients with cancer and endocarditis is poor, with a worse outcome in patients with SAE.

Therapy of Ulcerated Hemangiomas

2013 ◽  
Vol 17 (4) ◽  
pp. 233-242 ◽  
Author(s):  
Catherine C. McCuaig ◽  
Lynn Cohen ◽  
Julie Powell ◽  
Afshin Hatami ◽  
Danielle Marcoux ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Chart Review ◽  
Wound Care ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Dye Laser ◽  
Pulsed Dye Laser ◽  
Pediatric Dermatology ◽  
Tertiary Referral Center ◽  
Control Study

Background: Cutaneous ulceration is the most common complication of infantile hemangiomas (IHs) seen in a pediatric dermatology practice. Objective: The most effective treatments in our experience are compared to those in the current literature. Methods: The study was a retrospective chart review of therapy of 169 ulcerated IHs at a tertiary care pediatric hospital and a literature review. Results: Combination therapy was the rule. Local wound care was required in all, pain management in 72%, pulsed dye laser in 42%, infection control in 38%, diminution of the hemangioma through systemic therapy in 36%, and suppression of bleeding in 2%. Limitations: A retrospective review compared to a case-control study has inherent bias. In addition, our cases were all at a tertiary referral center. Conclusion: All ulcerated IHs benefit from local barrier creams or dressings. Pulsed dye laser, antibiotics, topical morphine 0.1% in hydrogel, topical becaplermin, and, most importantly, systemic therapy (especially propranolol) to reduce the hemangioma may be useful.

Cancer pain management at a tertiary care cancer center in India—A retrospective analysis of 3,238 patients

2018 ◽  
Vol 4 (6) ◽  
pp. 361 ◽  
Author(s):  
Sushma Bhatnagar, MD ◽  
Seema Mishra, MD ◽  
Madhurima Srikanti, MD ◽  
Deepak Gupta, MD
Keyword(s):  
Cancer Pain ◽  
Tertiary Care ◽  
World Health ◽  
Cancer Center ◽  
Intractable Pain ◽  
Patients With Cancer ◽  
Analgesic Regimen ◽  
Good Pain Relief ◽  
Health Organization

Effective pain control is essential for the management of patients with cancer. About 70-80 percent of patients with cancer present in an advanced stage of disease. Patients with advanced cancer frequently experience intractable pain, with diverse symptoms that can make daily living impossible and affect the quality of life. This article reports the management of 3,238 patients with cancer pain over a period of five years. Nearly 89.6 percent patients had good pain relief, with Visual Analogue Scale score less than 3. These promising results were achieved by careful patient assessment, close liaison with clinicians from other specialties, and using a variety of analgesic regimen including oral analgesics, anesthetic procedures, psychological interventions, and supportive care. However, the main stay of treatment was oral analgesics, following the principles of World Health Organization ladder, with continuing follow-up.

A case-control study examining the role of recent chemotherapy in causing Clostridium difficile infection among cancer patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19563-19563
Author(s):  
P. Thapaliya ◽  
A. Donato ◽  
K. Curl
Keyword(s):  
Cancer Patients ◽  
Case Control Study ◽  
Case Control ◽  
Hospitalized Patients ◽  
Retrospective Case ◽  
Chi Square ◽  
Patients With Cancer ◽  
Toxin Assay ◽  
Chemotherapy Agents ◽  
Control Study

19563 Background: Clostridium difficle infection is a major cause of morbidity and mortality in hospitalized patients. The recent use of cancer chemotherapy agents is a frequently cited risk factor but there is a paucity of evidence to this regard. Objective: To determine if an association exists between C. difficile infection requiring hospitalization and recent chemotherapy in patients with cancer. Design: A retrospective case control study. Setting: Community Teaching Hospital Participants: 357 cancer patients admitted with diarrhea or developed diarrhea during their hospital stay that were tested for C. difficile diarrhea via toxin assay over a 2 year period. Outcome Measurements: C. difficile infection using tests for toxin A and or B in stool. Results: Eighty-nine cases had stool positive for C. difficile toxin whereas 267 controls were negative. 30/89 (33%) cases and 90/268 (33%) controls were found to have chemotherapy in the six weeks before collection of stool for toxin assay (Odds Ratio (OR) 1.09, p=1.0 using Pearson Chi square). Factors associated with infection on logistic regression analysis included recent antibiotic usage (OR 1.99, 95% CI 1.01- 3.93),hospitalization in preceding 2 wks with OR 4.1 (95%CI 2.39–7.05) and institutionalization with OR 2.13 (95 % CI 1.03–4.39). Conclusions: C .difficile infection in cancer patients is more likely in recently institutionalized or hospitalized patients who have received recent antibiotics, but not patients with recent chemotherapy. No significant financial relationships to disclose.

Incidence of brain metastases and overall survival in patients with primary cardiac sarcoma: A retrospective case series.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10584-10584
Author(s):  
Maryann Shango ◽  
Lili Zhao ◽  
Monika Leja ◽  
Jonathan B. McHugh ◽  
Scott Schuetze ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Cancer Center ◽  
R0 Resection ◽  
Left Heart ◽  
Retrospective Case ◽  
Imaging Evaluation ◽  
Presenting Symptoms ◽  
Primary Cardiac Sarcoma

10584 Background: Primary cardiac sarcoma (PCS) is the most common primary cardiac malignancy, but is a rare primary site of sarcoma. We present 21 cases from a tertiary care center to better understand this uncommon malignancy. Methods: A cancer center-based registry and pathology database were searched to identify pts diagnosed with PCS from 1992-2013 at University of Michigan. Kaplan-meier method was used to estimate survival. Cox proportional hazard model was used to associate variables to occurrence of metastases (mets) or death. Results: Atotal of 21 pts (F12, 9M) with PCS were identified, median age 36 (range 11-74). The most common presenting symptoms included dyspnea (16) and chest pain (6; 5 with associated pericardial effusion). Histologies included: angiosarcoma (9), leiomyosarcoma (4), undifferentiated pleomorphic (3), spindle cell (2), fibrosarcoma (1), rhabdomyosarcoma (1) and synovial (1). Sites of origin were R atrium (7), R ventricle (2), L atrium (10) and pericardium (2). Ten pts presented with mets; most common sites were lung (8), liver (2), brain (2), pancreas (2) and bone (2). Surgery was attempted in 12 pts, achieving 1 R0 resection. Pts received a median of 1 (0-7) systemic therapies. Median overall (OS) was 12.6 mos (range 3-79) from diagnosis. Pts without prior surgery were more likely to have mets or death (p=0.038). Brain mets were common, occurring in 7 of 21 pts after a median of 7 mos (range 1-75) from diagnosis. Median OS after diagnosis of brain mets was 8 mos. Of the 7 pts who developed brain metastasis, 5 had PCS originating in the left heart. Of the 2 pts with PCS in the right heart, one was evaluated for and had a right to left shunt. The likelihood of developing brain mets did not correlate with age, chemotherapy, or surgery. Conclusions: PCS portends an extremely poor prognosis, marked by inability to achieve complete resection and a high incidence of disseminated disease at diagnosis. Metastatic disease to the brain was much more common in PCS (33%) as compared to STS of any origin (approximately 1-8%), particularly in pts with PCS originating in the left heart. Clinicians should have a low threshold for brain imaging evaluation of PCS pts.

scholarly journals Tobacco Use and Tobacco Treatment Referral Response of Patients With Cancer: Implementation Outcomes at a National Cancer Institute–Designated Cancer Center

2021 ◽  
pp. OP.20.01095
Author(s):  
Jessica L. Burris ◽  
Tia N. Borger ◽  
Brent J. Shelton ◽  
Audrey K. Darville ◽  
Jamie L. Studts ◽  
...  
Keyword(s):  
Tobacco Use ◽  
Cancer Diagnosis ◽  
Program Implementation ◽  
National Cancer Institute ◽  
Retrospective Chart Review ◽  
Population Based ◽  
Adverse Outcomes ◽  
Cancer Center ◽  
Patients With Cancer ◽  
Tobacco Treatment

PURPOSE: Smoking after a cancer diagnosis is linked to cancer-specific and all-cause mortality, among other adverse outcomes. Yet, 10%-20% of US cancer survivors are current smokers. Implementation of evidence-based tobacco treatment in cancer care facilities is widely recommended, yet rarely accomplished. This study focuses on the early outcomes of a population-based tobacco treatment program integrated within an National Cancer Institute–designated cancer center. METHODS AND MATERIALS: The sample consists of 26,365 patients seen at the cancer center during the first 18 months of program implementation. The study is a retrospective chart review of patients' tobacco use and, among current users, patients' treatment referral response. RESULTS: More than 99% of patients were screened for tobacco use. Current (past month) use was observed in 21.05% of patients; cigarettes were the most popular product. Only 17.22% of current users accepted a referral for tobacco treatment; among current users who declined, the majority were not ready to quit (65.84%) or wanted to quit on their own (27.01%). Multiple demographic variables were associated with tobacco use and treatment referral response outcomes. CONCLUSION: Despite cancer diagnosis presenting a teachable moment for tobacco cessation, patients with cancer may not be ready to quit or engage with treatment. Clinically proven strategies to increase motivation, prompt quit attempts, and encourage treatment use should be key components of tobacco treatment delivery to patients with cancer.

scholarly journals Diagnostic Utility of Procalcitonin and Neutrophil-Lymphocyte Ratio in Bacterial Septicaemia - A Retrospective Case Control Study from a Tertiary Care Institute

2020 ◽  
Vol 7 (48) ◽  
pp. 2856-2861
Author(s):  
Mamatha T. Shenoy ◽  
Hariharan Alexander ◽  
Jeyakumar Manavalan ◽  
Suganthy K ◽  
Pradipta Kumar Mohanty
Keyword(s):  
Blood Culture ◽  
Case Control Study ◽  
Tertiary Care ◽  
Cost Effective ◽  
Case Control ◽  
Retrospective Case ◽  
Gram Negative ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Control Study

BACKGROUND Sepsis is a frequently encountered critical care problem wherein great emphasis is laid on early and accurate diagnosis of the infective organism. Blood culture though precise, is time consuming. Empiric antibiotic therapy leads to development of antibiotic resistance amongst organisms. Thus, there is a need for a biomarker that is cost effective, simple and rapid to perform. Procalcitonin elevates in response to chemical mediators produced due to bacteraemia within 2 - 4 hours and serves as an early marker. Neutrophil-Lymphocyte Ratio is available universally and is highly cost-effective. We wanted to assess the utility of Procalcitonin (PCT) and Neutrophil-Lymphocyte Ratio (NLR) in detecting the bloodstream infections and determine their usefulness in establishing the nature of infective organisms. METHODS A retrospective case control study was undertaken from January 2018 to December 2018 in a tertiary care teaching hospital in Madurai, Tamil Nadu. Patients tested for serum PCT, complete blood count and blood culture simultaneously prior to antibiotic therapy were included in the study (n = 288). The study cohort was classified into two groups. Group I, controls (n = 155) and group II, cases (n = 133). Out of 133 patients, 73 % (98) were infected by Gramnegative bacteria and 27 % (35) by Gram-positive bacteria. Data was analysed using SPSS V.16 software (SPSS Inc., Chicago, IL, USA). Students unpaired t test and Mann-Whitney U test were used for intergroup comparisons of continuous variables. p < 0.05 was considered to be statistically significant. Cut off for detecting bacteriemia and gram negative bacteriemia was created using Receiver Operating Characteristic (ROC) curve. RESULTS The area under ROC of PCT to detect gram negative bacteraemia was 0.752 (95 % CI = 0.692 – 0.812). CONCLUSIONS Escherichia coli was the most frequent cause of sepsis. Higher levels of PCT and NLR were associated with gram negative organisms. PCT levels can help in determining the cause of infection. NLR and PCT are able to establish the presence of bacteraemia in a short span of time, thus alleviating the over dependence on blood culture reporting. Such earlier decision-making tools help in reducing empirical antibiotic usage and thereby lessen the burden of bacterial resistance to antibiotics. KEYWORDS Procalcitonin, PCT, Neutrophil Lymphocyte Ratio, NLR, Gram Negative Bacteria, Sepsis, Biomarker

scholarly journals High Prevalence of Hypocalcemia in Non-severe COVID-19 Patients: A Retrospective Case-Control Study

2021 ◽  
Vol 7 ◽  
Author(s):  
Rimesh Pal ◽  
Sant Ram ◽  
Deepy Zohmangaihi ◽  
Indranil Biswas ◽  
Vikas Suri ◽  
...  
Keyword(s):  
Serum Calcium ◽  
Case Control Study ◽  
Healthy Adult ◽  
Tertiary Care ◽  
Case Control ◽  
Retrospective Case ◽  
Hydroxyvitamin D ◽  
Number Of Patients ◽  
25 Hydroxyvitamin D ◽  
Control Study

Purpose: To compare serum total calcium and phosphate levels in patients with non-severe COVID-19 with age, sex, and serum 25-hydroxyvitamin D level matched healthy adult cohort.Methods: In this retrospective case-control study, medical records of patients (≥18 years) diagnosed as non-severe COVID-19 admitted at and discharged from our tertiary care institution during the period from April 10, 2020 and June 20, 2020 were retrieved. Baseline investigations, notably, serum calcium, phosphate, albumin, magnesium, 25-hydroxyvitamin D, and C-reactive protein (CRP), were performed at admission before any form of calcium or vitamin D supplementation were considered. The biochemical parameters were compared with age, sex, and 25-hydroxyvitamin D matched healthy adult controls (1:1 ratio) derived from the Chandigarh Urban Bone Epidemiological Study (CUBES).Results: After exclusion, 72 patients with non-severe COVID-19 (63 mild and 9 moderate disease) and an equal number of healthy controls were included in the final analysis. Age, sex, serum 25-hydroxyvitamin D, and albumin levels were matched between the 2 groups. Hypovitaminosis D and hypocalcemia were seen in 97 and 67% of the patients, respectively. The patients had lower serum calcium (P value &lt;0.001) and phosphate (P = 0.007) compared with the controls. There was no statistically significant correlation between serum calcium and CRP.Conclusions: Hypocalcemia is highly prevalent even in COVID-19 patients with non-severe disease probably implying that hypocalcemia is intrinsic to the disease. Prospective studies with larger number of patients are required to prove this hypothesis and unravel the underlying pathophysiological mechanisms.

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