Neutropenic colitis is a severe condition usually affecting immunocompromised patients. Its exact pathogenesis is not completely understood. The main elements in disease onset appear to be intestinal mucosal injury to...Neutropenic colitis is a severe condition usually affecting immunocompromised patients. Its exact pathogenesis is not completely understood. The main elements in disease onset appear to be intestinal mucosal injury together with neutropenia and the weakened immune system of the afflicted patients. These initial conditions lead to intestinal edema, engorged vessels, and a disrupted mucosal surface, which becomes more vulnerable to bacterial intramural invasion. Chemotherapeutic agents can cause direct mucosal injury (mucositis) or can predispose to distension and necrosis, thereby altering intestinal motility. This article aims to review current concepts regarding neutropenic colitis’ pathogenesis, diagnosis, and management.展开更多
Neutropenic enterocolitis(NE)is a predominantly cecum-based disease with high mortality seen in patients post chemotherapy.The pathogenesis of NE is poorly understood and probably multifactorial involving mucosal inju...Neutropenic enterocolitis(NE)is a predominantly cecum-based disease with high mortality seen in patients post chemotherapy.The pathogenesis of NE is poorly understood and probably multifactorial involving mucosal injury,neutropenia,and impaired host defense to intestinal organisms.The clinical presentation is characterized as ileocolonic inflammation and bowel wall thickening in patients with neutropenia,fever,and abdominal pain.The pathological features of NE include patchy necrosis,hemorrhage,ulcer,edema,perforation,infiltrating organisms,and characteristically,depletion of inflammatory cells(neutrophils).NE should always be considered as a possible diagnosis in immunosuppressed patients,especially those receiving chemotherapy.High clinical and histological diagnostic discordance rate exists.High index of clinical suspicion and prompt appropriate personalized management are essential to achieve a lower mortality rate.展开更多
Neutropenia with fever is a special group of patients. Due to low immune function, inflammation-related clinical symptoms and signs are often not obvious, and pathogenic bacteria and infection focus are not clear. Fev...Neutropenia with fever is a special group of patients. Due to low immune function, inflammation-related clinical symptoms and signs are often not obvious, and pathogenic bacteria and infection focus are not clear. Fever may be the only sign of infection. If appropriate antimicrobial treatment is not given in time, infection-related mortality is high. In our study, we aimed to optimize the dosage regimen of Micafungin in children with febrile neutropenic against Candida spp. by Mote Carlo Simulation (MCS). Pharmacokinetic parameters and microbiological data of Micafungin were collected. Then we used MCS to calculate Probability of Target Attainment (PTA) and Cumulative Fraction of Response (CFR). With dosages of 0.5 mg/kg, 1 mg/kg, 1.5 mg/kg, 2 mg/kg, 3 mg/kg, and 4 mg/kg in oral group and dosages of 100 mg, and 200 mg in intravenous administration, all have different degree of antifungal effect. But when the dosage regimen was 50 mg IV, the therapeutic effect of Micafungin against Candida spp. was not good.展开更多
Neutropenic enterocolitis (NE) or typhlitis is a serious complication of anticancer therapy, especially in he- matological malignancies. We describe a case of acute lymphoid leukemia presenting the early onset of a sy...Neutropenic enterocolitis (NE) or typhlitis is a serious complication of anticancer therapy, especially in he- matological malignancies. We describe a case of acute lymphoid leukemia presenting the early onset of a syndrome with the clinical features and specific radiological findings of NE during the neutropenic phase.展开更多
Importance: In low resource countries, there has been scarcity of research on the risk factors associated with neutropenic enterocolitis, a serious complication that commonly develops during treatment of cancer patien...Importance: In low resource countries, there has been scarcity of research on the risk factors associated with neutropenic enterocolitis, a serious complication that commonly develops during treatment of cancer patients.Objective: To identify the pattern of intestinal complications in pediatric leukemia patients treated with intensive chemotherapy, including those with neutropenic enterocolitis;to assess the outcome;and to evaluate the risk factors associated with the mortality in these patients.Methods: During the period from June 2015 to December 2016, a prospective study was carried out on pediatric patients diagnosed with acute leukemia who received induction/or re-induction phases of chemotherapy at South Egypt Cancer Institute. Patients with documented episodes of intestinal complications were included in the study. Recovery or death from an episode of intestinal complication was utilized as the primary outcome measure for the study. Using univariable and multivariable methods, potential risk factors associated with mortality were delineated by logistic regression analysis, both for the entire intestinal complications episodes as a whole and for those episodes of neutropenic enterocolitis only.Results: Out of 88 documented episodes of intestinal complications from 77 patients;58 episodes were identified as neutropenic enterocolitis from 47 patients. In those patients who were having episodes of neutropenic enterocolitis, the presence of abdominal tenderness (OR 4.529, 95%CI 1.062-19.317,P = 0.041);a longer duration of neutropenia (OR 1.215, 95%CI 1.030-1.434,P = 0.021);and hemodynamic instability (OR 17.023, 95%CI 4.095-70.772,P < 0.001), were found to be independently associated with worse outcome.Interpretation: In Upper Egypt, the use of intensive systemic chemotherapy during the induction phase of acute leukemia was found to be associated with potentially lethal intestinal complications. A high index of clinical suspicion is warranted.展开更多
IN the presence of septic shock, every hour in delaying the administration of effective antibiotics is associated with a measurable increase in mortality. This is especially true for neutropenic patients with septic s...IN the presence of septic shock, every hour in delaying the administration of effective antibiotics is associated with a measurable increase in mortality. This is especially true for neutropenic patients with septic shock. As there is a higher incidence of involving multi-drug resistant pathogens for neutropenic patients, the decision on antibiotics regime remains a challenge for physicians.2 Immunosuppression and previous antibacterial use are factors that promote the spread of multi-drug resistant pathogens, and the possibility of co-existing multi-drug resistant pathogens should be suspected when treating patients with these risk factors who developed refractory shock. Here we present a case with neutropenic fever and refractory shock whose blood culture yielded multi-drug resistant Acinetobacter baumannii and carbapenem- resistant Klebsiella pneumoniae.展开更多
文摘Neutropenic colitis is a severe condition usually affecting immunocompromised patients. Its exact pathogenesis is not completely understood. The main elements in disease onset appear to be intestinal mucosal injury together with neutropenia and the weakened immune system of the afflicted patients. These initial conditions lead to intestinal edema, engorged vessels, and a disrupted mucosal surface, which becomes more vulnerable to bacterial intramural invasion. Chemotherapeutic agents can cause direct mucosal injury (mucositis) or can predispose to distension and necrosis, thereby altering intestinal motility. This article aims to review current concepts regarding neutropenic colitis’ pathogenesis, diagnosis, and management.
文摘Neutropenic enterocolitis(NE)is a predominantly cecum-based disease with high mortality seen in patients post chemotherapy.The pathogenesis of NE is poorly understood and probably multifactorial involving mucosal injury,neutropenia,and impaired host defense to intestinal organisms.The clinical presentation is characterized as ileocolonic inflammation and bowel wall thickening in patients with neutropenia,fever,and abdominal pain.The pathological features of NE include patchy necrosis,hemorrhage,ulcer,edema,perforation,infiltrating organisms,and characteristically,depletion of inflammatory cells(neutrophils).NE should always be considered as a possible diagnosis in immunosuppressed patients,especially those receiving chemotherapy.High clinical and histological diagnostic discordance rate exists.High index of clinical suspicion and prompt appropriate personalized management are essential to achieve a lower mortality rate.
文摘Neutropenia with fever is a special group of patients. Due to low immune function, inflammation-related clinical symptoms and signs are often not obvious, and pathogenic bacteria and infection focus are not clear. Fever may be the only sign of infection. If appropriate antimicrobial treatment is not given in time, infection-related mortality is high. In our study, we aimed to optimize the dosage regimen of Micafungin in children with febrile neutropenic against Candida spp. by Mote Carlo Simulation (MCS). Pharmacokinetic parameters and microbiological data of Micafungin were collected. Then we used MCS to calculate Probability of Target Attainment (PTA) and Cumulative Fraction of Response (CFR). With dosages of 0.5 mg/kg, 1 mg/kg, 1.5 mg/kg, 2 mg/kg, 3 mg/kg, and 4 mg/kg in oral group and dosages of 100 mg, and 200 mg in intravenous administration, all have different degree of antifungal effect. But when the dosage regimen was 50 mg IV, the therapeutic effect of Micafungin against Candida spp. was not good.
文摘Neutropenic enterocolitis (NE) or typhlitis is a serious complication of anticancer therapy, especially in he- matological malignancies. We describe a case of acute lymphoid leukemia presenting the early onset of a syndrome with the clinical features and specific radiological findings of NE during the neutropenic phase.
文摘Importance: In low resource countries, there has been scarcity of research on the risk factors associated with neutropenic enterocolitis, a serious complication that commonly develops during treatment of cancer patients.Objective: To identify the pattern of intestinal complications in pediatric leukemia patients treated with intensive chemotherapy, including those with neutropenic enterocolitis;to assess the outcome;and to evaluate the risk factors associated with the mortality in these patients.Methods: During the period from June 2015 to December 2016, a prospective study was carried out on pediatric patients diagnosed with acute leukemia who received induction/or re-induction phases of chemotherapy at South Egypt Cancer Institute. Patients with documented episodes of intestinal complications were included in the study. Recovery or death from an episode of intestinal complication was utilized as the primary outcome measure for the study. Using univariable and multivariable methods, potential risk factors associated with mortality were delineated by logistic regression analysis, both for the entire intestinal complications episodes as a whole and for those episodes of neutropenic enterocolitis only.Results: Out of 88 documented episodes of intestinal complications from 77 patients;58 episodes were identified as neutropenic enterocolitis from 47 patients. In those patients who were having episodes of neutropenic enterocolitis, the presence of abdominal tenderness (OR 4.529, 95%CI 1.062-19.317,P = 0.041);a longer duration of neutropenia (OR 1.215, 95%CI 1.030-1.434,P = 0.021);and hemodynamic instability (OR 17.023, 95%CI 4.095-70.772,P < 0.001), were found to be independently associated with worse outcome.Interpretation: In Upper Egypt, the use of intensive systemic chemotherapy during the induction phase of acute leukemia was found to be associated with potentially lethal intestinal complications. A high index of clinical suspicion is warranted.
文摘IN the presence of septic shock, every hour in delaying the administration of effective antibiotics is associated with a measurable increase in mortality. This is especially true for neutropenic patients with septic shock. As there is a higher incidence of involving multi-drug resistant pathogens for neutropenic patients, the decision on antibiotics regime remains a challenge for physicians.2 Immunosuppression and previous antibacterial use are factors that promote the spread of multi-drug resistant pathogens, and the possibility of co-existing multi-drug resistant pathogens should be suspected when treating patients with these risk factors who developed refractory shock. Here we present a case with neutropenic fever and refractory shock whose blood culture yielded multi-drug resistant Acinetobacter baumannii and carbapenem- resistant Klebsiella pneumoniae.
