The Experts below are selected from a list of 156 Experts worldwide ranked by ideXlab platform
Patricia Charache - One of the best experts on this subject based on the ideXlab platform.
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Response to Empiric Amphotericin B During Antileukemic
2016Co-Authors: Therapy-induced Granulocytopenia, Judith E. Karp, William G. Merz, Patricia CharacheAbstract:We analyzed the initial and overall responses to empiric therapy with amphotericin B as they related to the rate of occurrence and the type of fungal infection and colonization during 264 consecutive episodes of prolonged, profound, chemotherapy-induced bone marrow aplasia (>30 days, <100 polymorphonuclear leukocytes/mm') in 160 adults with acute leukemia. Amphoteri-cin B was administered during 248 (94%) of these granulocytopenic episodes; in 68 cases the drug was given because of documented infection with yeasts or filamentous fungi (OFf), and in 180 cases it was given because of refractory fever without OFf. The frequency of an initial response in patients with OFf (60%) was similar to that in non-OFf-infected patients (61%). Both the initial response rate and the overall survival rate were significantly decreased when therapy with amphotericin B was not initiated empirically before documentation of filamentous OF!. Given the comparatively high rates of initial and overall response (the latter being 74% and 71 % for OFI and non-OFI, respectively) and the lack of alternative fungicidal agents, our data support prompt empiric treatment with amphotericin B for refractory fever in adults with acute leukemia who are compromised by severe, therapy-induced Granulocytopenia. Fungal infection is an increasingly frequent cause of mor
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response to empiric amphotericin b during antileukemic therapy induced Granulocytopenia
Clinical Infectious Diseases, 1991Co-Authors: Judith E. Karp, William G. Merz, Patricia CharacheAbstract:We analyzed the initial and overall responses to empiric therapy with amphotericin B as they related to the rate of occurrence and the type of fungal infection and colonization during 264 consecutive episodes of prolonged, profound, chemotherapy-induced bone marrow aplasia (greater than 30 days, less than 100 polymorphonuclear leukocytes/mm3) in 160 adults with acute leukemia. Amphotericin B was administered during 248 (94%) of these granulocytopenic episodes; in 68 cases the drug was given because of documented infection with yeasts or filamentous fungi (DFI), and in 180 cases it was given because of refractory fever without DFI. The frequency of an initial response in patients with DFI (60%) was similar to that in non-DFI-infected patients (61%). Both the initial response rate and the overall survival rate were significantly decreased when therapy with amphotericin B was not initiated empirically before documentation of filamentous DFI. Given the comparatively high rates of initial and overall response (the latter being 74% and 71% for DFI and non-DFI, respectively) and the lack of alternative fungicidal agents, our data support prompt empiric treatment with amphotericin B for refractory fever in adults with acute leukemia who are compromised by severe, therapy-induced Granulocytopenia.
Sang Jong Lee - One of the best experts on this subject based on the ideXlab platform.
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A Case of Transient Granulocytopenia during Treatment of a Patient with Graves' Disease and Type 1 Diabetes Mellitus - Differential Diagnosis from Agranulocytosis by a Single Injection of G-CSF
Endocrinology and Metabolism, 2002Co-Authors: Jin Kyeong Park, Jeong Hun Seong, Jun Lee, Seon Nyo Chu, Hun Jeong, Yoo Lee Kim, Seok Won Park, Yong Wook Cho, Sang Jong LeeAbstract:Granulocytopenia, which can be seen in patients with Graves' disease during treatment with antithyroid agents, could be a self resolving transient episode or can imply the beginning of life threatening agranulocytosis requiring a change in treatment modality. Transient Granulocytopenia could be a manifestation of hyperthyroidism itself, or a mild side effect of antithyroid drugs. Aganulocytosis is a rare, but major complications of the termination drug, propylthiouracil (PTU), requiring prompt termination of the medication, and intensive care. Therefore, differentiation of agranulocytosis and transient Granulocytopenia, is important, but is not practically easy. We introduce a case of transient Granulocytopenia, which was detected in a patient with Graves' Disease, accompanied by underlying type 1 diabetes mellitus, during treatment with PTU. Diagnosis of transient Granulocytopenia was made by a normal granulocyte count following a single injection of G-SCF*, and the patient was treated with conservative therapy. This case confirms a diagnostic tool for differentiating transient Granulocytopenia and PTU-induced agranulocytosis.
Mary E. King - One of the best experts on this subject based on the ideXlab platform.
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CASE REPORT Granulocytopenia secondary to acute infection with the Human Immunodeficiency Virus
1994Co-Authors: Daniel J. Skiest, Mary E. KingAbstract:Summary Acute infection with the human immunodeficiency virus (HIV) is often characterised by a mononucleosis-like syndrome. We describe a patient who presented with the typical febrile syndrome associated with acute HIV infection, who also had significant Granulocytopenia. Although Granulocytopenia is relatively common in the later stages of HIV infection, it has only been described once before in the acute stage. The mechanism may be immune mediated, although data are limited. Clinicians should be aware of acute HIV infection as a possible cause of Granulocytopenia.
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Granulocytopenia secondary to acute infection with the human immunodeficiency virus
The Journal of infection, 1994Co-Authors: Daniel J. Skiest, Mary E. KingAbstract:Summary Acute infection with the human immunodeficiency virus (HIV) is often characterised by a mononucleosis-like syndrome. We describe a patient who presented with the typical febrile syndrome associated with acute HIV infection, who also had significant Granulocytopenia. Although Granulocytopenia is relatively common in the later stages of HIV infection, it has only been described once before in the acute stage. The mechanism may be immune mediated, although data are limited. Clinicians should be aware of acute HIV infection as a possible cause of Granulocytopenia.
Thomas J. Walsh - One of the best experts on this subject based on the ideXlab platform.
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pathogenesis of pulmonary aspergillosis Granulocytopenia versus cyclosporine and methylprednisolone induced immunosuppression
American Journal of Respiratory and Critical Care Medicine, 1995Co-Authors: Juan Berenguer, James W. Lee, John Bacher, Philip A Pizzo, M C Allende, K Garrett, Caron A Lyman, Nasr M Ali, Thomas J. WalshAbstract:Patients with chemotherapy-induced Granulocytopenia for neoplastic diseases and those receiving cyclosporin A plus corticosteroids for prevention and treatment of organ transplant rejection are two immunologically distinct patient populations with high risks for development of invasive pulmonary aspergillosis. In order to compare the pathogenesis of aspergillosis in these two high-risk populations and to further characterize the role of cyclosporin A in development of pulmonary aspergillosis, we studied the patterns of infection and inflammation in two clinically applicable rabbit models of invasive pulmonary aspergillosis. There were striking differences in the patterns of infection and inflammation of invasive pulmonary aspergillosis according to the type of underlying immune defect. Among rabbits challenged with the same intratracheal inoculum, there was a 100% mortality for invasive pulmonary aspergillosis in profoundly granulocytopenic rabbits in comparison with a 100% mortality for invasive pulmonary aspergillosis in profoundly granulocytopenic rabbits in comparison with a 100% survival in rabbits immunosuppressed with cyclosporin A plus methylprednisolone (CsA+MP). Lesions of pulmonary aspergillosis in granulocytopenic rabbits consisted predominantly of coagulative necrosis, intraalveolar hemorrhage, and scant mononuclear inflammatory infiltrate. By comparison, pulmonary foci in rabbits immunosuppressed by CsA+MP consisted mainly of neutrophilic and monocytic infiltrates, inflammatory necrosis, and scant intraalveolar hemorrhage. There was extensive infiltration by hyphae with angioinvasion in granulocytopenic rabbits, whereas conidia in various stages of germination predominated in CsA+MP treated animals in which there was a paucity of hyphae or angioinvasion. Extrapulmonary disease predominated in granulocytopenic rabbits. Methylprednisolone was the major immunosuppressive drug in rabbits treated with CsA+MP. Cyclosporin A alone did not increase the progression of pulmonary aspergillosis and did so only when used chronically with methylprednisolone.
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Efficacy of unilamellar liposomal amphotericin b in treatment of pulmonary aspergillosis in persistently granulocytopenic rabbits: The potential role of bronchoalveolar d-mannitol and serum galactomannan as markers of infection
Journal of Infectious Diseases, 1994Co-Authors: Peter Francis, Alan Hoffman, James Shelhamer, Andrea Francesconi, James W. Lee, Phillip A. Pizzo, Joanne Peter, John D. Bacher, Thomas J. WalshAbstract:A model of primary pulmonary aspergillosis in rabbits was developed to reproduce the persistent levels of profound Granulocytopenia and the histopathologic features of bronchopneumonia, vascular invasion, and hemorrhagic infarction encountered in humans. D-mannitol was detectable in bronchoalveolar lavage fluid by gas-liquid chromatography/mass spectroscopy, and galactomannan was measurable in serum by latex agglutination immunoassay. A pharmacokinetically distinctive unilamellar vesicle formulation of liposomal amphotericin B, 5 mg/kg/day intravenously, compared with high-dose conventional desoxycholate amphotericin B, 1 mg/kg/day intravenously, was more effective in preventing nephrotoxicity, increasing survival, reducing the number of viable organisms, and decreasing tissue injury due to Aspergillus organisms. Thus, D-mannitol in lavage fluid and galactomannan in serum may be useful markers of pulmonary aspergillosis, and liposomal amphotericin B was significantly more effective and safer than desoxycholate amphotericin B for treatment of pulmonary aspergillosis in profoundly granulocytopenic rabbits.
Jai H. Joshi - One of the best experts on this subject based on the ideXlab platform.
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empiric antimicrobial regimens for fever when profound 100 μl Granulocytopenia persists
Journal of Clinical Oncology, 2014Co-Authors: Jai H. JoshiAbstract:TO THE EDITOR: There have been many trials evaluating empiric antimicrobial regimens for efficacy in granuloctopenic patients with cancer experiencing fever. The most difficult to treat febrile episodes are seen when profound ( 100/ L) Granulocytopenia persists for the duration of antimicrobial therapy. In that circumstance, in which numbers of patients are usually inadequate to determine statistical significance, our premise for using two synergistic antibiotics empirically for all febrile episodes was based on the significantly better responses we saw for Gram-negative bacteremia in those with persistent profound Granulocytopenia. It is in this setting that comparative efficacy should be determined. Only then can investigators claim first-line empiric antibiotic status for their study regimen (even for epidemiologic settings characterized by a high prevalence of infections caused by MDR microorganisms). Superiority must be shown for infections when profound ( 100/ L) Granulocytopenia does not remit. At the onset of a febrile episode in the setting of profound Granulocytopenia, neither the infecting pathogen nor the duration of Granulocytopenia is known, but the choice of antibiotics is crucial. For episodes in which fever almost always resolves with granulocyte recovery and antibiotics can be discontinued, the choice of antibiotics is not crucial. The same is also true for episodes where antimicrobial therapy can be prudently discontinued even when both fever and profound Granulocytopenia persist but an infection has not been documented. The subgroup for whom the choice is crucial is patients in whom a potentially severe, life-threatening infection can occur and profound Granulocytopenia does not resolve.
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Empiric Antimicrobial Regimens for Fever When Profound (< 100/μL) Granulocytopenia Persists
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014Co-Authors: Jai H. JoshiAbstract:TO THE EDITOR: There have been many trials evaluating empiric antimicrobial regimens for efficacy in granuloctopenic patients with cancer experiencing fever. The most difficult to treat febrile episodes are seen when profound ( 100/ L) Granulocytopenia persists for the duration of antimicrobial therapy. In that circumstance, in which numbers of patients are usually inadequate to determine statistical significance, our premise for using two synergistic antibiotics empirically for all febrile episodes was based on the significantly better responses we saw for Gram-negative bacteremia in those with persistent profound Granulocytopenia. It is in this setting that comparative efficacy should be determined. Only then can investigators claim first-line empiric antibiotic status for their study regimen (even for epidemiologic settings characterized by a high prevalence of infections caused by MDR microorganisms). Superiority must be shown for infections when profound ( 100/ L) Granulocytopenia does not remit. At the onset of a febrile episode in the setting of profound Granulocytopenia, neither the infecting pathogen nor the duration of Granulocytopenia is known, but the choice of antibiotics is crucial. For episodes in which fever almost always resolves with granulocyte recovery and antibiotics can be discontinued, the choice of antibiotics is not crucial. The same is also true for episodes where antimicrobial therapy can be prudently discontinued even when both fever and profound Granulocytopenia persist but an infection has not been documented. The subgroup for whom the choice is crucial is patients in whom a potentially severe, life-threatening infection can occur and profound Granulocytopenia does not resolve.
