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Volume 97 / No. 11 / 1996
IMIPENEM REZISTENTNA Ps. AERUGINOSA AKO ETIOLOGICKY POVODCA BAKTERIEMII U ONKOLOGICKYCH PACIENTOV: RIZIKOVE FAKTORY, KLINICKE PRIZNAKY A VYSLEDOK LIECBY
KRCMERY Jr. V., TRUPL J., KUNOVA A., SPANIK S., ILAVSKA I., HELPIANSKA L., BEZAKOVA I., DRGONA L., ORAVCOVA E., STUDENA M., LACKA J., SEVCIKOVA L., KOREN P., KUKUCKOVA E., STOPKOVA K., KRUPOVA I., GRAUSOVA S., SVEC J.
Ninety nine patients with 101 bacteraemic episodes due to Ps. aeruginosa
(PA) within 6 years were divided into two groups according to their
resistance to imipenem – 91 due to imipenem sensitive (ISPA) and 10 due
to resistant (IRPA). Risk factors, the clinical course and the outcome
were evaluated and compared. Acute leukaemia, prolonged neutropenia, previous
therapy with amikacin, third generation of cephalosporins, imipenem and
prophylaxis by quinolones were significantly more frequently associated
with IRPA.
Imipenem resistant PA bacteraemia were associated with higher incidence
of septic shock (40 % vs 19.8 %, p<0.02) and death (33.3 %) than ISPA
bacteraemias. Since 1992, when first IRPA appeared, the incidence of imipenem
resistance increased tenfold, and in 1994, up to 10 % of PA causing bloodstream
infections in cancer patients in our center were imipenem resistant. (Tab.
3, Ref. 8.)
Key words: imipenem, Ps. aeruginosa, bacteraemia, cancer
patient, infection.
Bratisl Lek Listy 1996; 96: 647–651
"BREAKTHROUGH" BAKTERIEMIE A FUNGEMIE POCAS ANTIMIKROBIALNEJ PROFYLAXIE A TERAPIE U ONKOLOGICKYCH PACIENTOV: ANALYZY RIZIKOVYCH FAKTOROV, ETIOLOGIA, TERAPIA A VYSLEDOK LIECBY V 123 PRIPADOCH
SPANIK S., KRCMERY JR. V., TRUPL J., ILAVSKA I., HELPIANSKA L., DRGONA L., SALEK T., MARDIAK J., KUKUCKOVA E., STUDENA M., PICHNA P., ORAVCOVA E., GREY E., KOREN P., MINARIK T., LACKA J., SUFLIARSKY J.
One hundred twenty three breakthrough bacteraemias (BB) during 5 years
in a National Cancer Institute, among 9986 admissions and 979 bacteraemic
episodes were analysed. 123 BB were caused by 323 microbes, only 116 were
resistant (31.5 %) to currently administered antimicrobials. Sixty seven
of 123 bacteraemic episodes were catheter associated confirmed by isolation
of the same organisms from the blood and catheter tip. 77/123 BE were polymicrobial.
The most frequently isolated strains were coagulase negative staphylococci
(30.5 %), Corynebacteria (10 %), Ps. aeruginosa (10 %), Str.
faecalis (9 %) and Viridans streptococci (8.5 %). Gram-positive
aerobes accounted for two-thirds of all organisms isolated during breakthrough
bacteraemic and fungaemic episodes. Mixed polymicrobial breakthrough bacteraemic
and fungaemic episodes were more frequently associated with vascular catheter
insertion and neutropenia, and had a less favourable outcome in comparison
to monomicrobial infections. The relapse was associated more frequently
with catheter related bacteraemic and fungaemic episodes, but the overall
mortality rate was similar independently from catheter insertion. Breakthrough
bacteraemic and fungaemic episodes were associated more frequently with
acute leukaemia. Polymicrobial breakthrough bacteraemic and fungaemic episodes
were associated more frequently in neutropenic episodes and in venous catheters.
Regarding the outcome, an extraction of the catheter with no dependence
on variable and modification of antimicrobial therapy were essential for
the improvement in the prognosis. (Tab. 5, Ref. 20.)
Key words: bacteraemia, fungaemia, antimicrobial prophylaxis, therapy
in cancer patients, cancer.
Bratisl Lek Listy 1996; 97: 652–659
IMMUNOPATHOGENIC MECHANISMS OF AUTOIMMUNE PROCESSES: BREAKDOWN OF REGULATORY MECHANISMS OF IMMUNITY, GENETIC DETERMINATION OF AUTOIMMUNITY, EFFECTOR MECHANISMS OF AUTOIMMUNE PROCESSES AND THEIR THERAPY
BUC M.
Autoimmune diseases represent a great social and medical problem.
5 to 7 % of population suffer from these chronic debilitating disorders.
Our knowledge about the immune system and the genetic determination of
its components and processes has considerably increased in the fast few
years. The purpose of the two articles on autoimunity published in the
previous and this issue is to offer a reader a topical status
of the development in this field. Autoantigens, their presentation to T
lymphocytes and superantigens were discussed in the first article. The
breakdown of regulatory mechanisms of immunity, the genetic basis of autoimmunity,
the effector mechanisms responsible for tissue damages and their therapy
are reviewed in the presented article. (Tab. 4, Fig. 1.)
Key words: apoptosis, autoimmunity, cytokines, HLA complex, hormones
and immunity, immunocomplexes, subpopulations of T and B lymphocytes, T-cell
vaccination.
Bratisl Lek Listy 1996; 97: 660–668
INTRACAVITARY THROMBOSIS – AN UNUSUAL COMPLICATION OF CROHN'S DISEASE
SASVARY F., MURIN J., DURIS I., PONTUCH P., SEDLAK T., LABAS P.
The statement of echocardiographic differential diagnosis of intracavitary
masses is not simple even for an experienced echocardiographist. It is
mainly caused by the resemblance in echo-densities of thrombi and myxoma.
Atypical localization of masses makes the differential diagnosis even more
difficult.
Authors report a case of a 30 year-old man with the history
of ulcerative colitis, in whom sepsis occured as a complication of
an inflammatory bowel disease. They report the diagnosis of thrombus in
the right atrium, probably of infectious genesis, formed on the endocardium
which had been damaged by a catheter tip and potenciated by activated
coagulatory system.
In the documented period, histological examinations of colonoscopic
and peroperative biopsies were performed repetitively. Neither these examinations
answered the question of differential diagnosis between ulcerative colitis
and Crohn's disease.
The authors report an echocardiographic diagnosis and they follow-up
the genesis and subsequent disappearance of the pathological mass in the
right atrium which was finally diagnosed as a thrombus. The final
diagnosis was based on the clinical follow-up and disappearance of the
mass. (Fig. 3, Ref. 7.)
Key words: inflammatory bowel disease, thrombosis, echocardiography,
parenteral nutrition.
Bratisl Lek Listy 1996; 97: 669–672
THE ROLE OF PENICILLINS IN THE THERAPY OF RESPIRATORY TRACT INFECTIONS
LACKA J., STRAKOVA A., GREY E., KRALOVICOVA K., KRCMERY Jr. V.
The development of antimicrobial resistance in main pathogens of respiratory
system infections (S. pneumoniae, H. Influenzae, B. catarrhalis) reduces
the range of unprotected penicillins indications. The inhibitors of beta-lactamase
rendered back the original spectrum of antimicrobial activity to aminopenicillins
and ureidopenicillins, and withheld them within the most frequently used
armamentarium of antimicrobial drugs for the therapy of more severe infections.
The prescription of penicillins is ruled according to the localization
of infection, most frequent pathogens and by the epidemiologic situation.
A combined antibiotic therapy is indicated in severe infections. An
important indication area is the prophylactic administration of penicillins
in recurring tonsilopharynigitis, recurring otitis media and eradication
of meningococcal carriership. (Tab. 1, Ref. 3.)
Key words: penicillins, beta-lactamase inhibitor, respiratory tract
infections.
Bratisl Lek Listy 1996; 97: 673–674
ETIOLOGIA BAKTERIEMIE PRI ROZNYCH MALIGNYCH OCHORENIACH: EXISTUJE SPOJENIE MEDZI URCITYMI ANTINEOPLASTIKAMI A MIKROORGANIZMAMI?
BALAZ M., DEMITROVICOVA A., SPANIK S., DRGONA L., KRUPOVA I., GRAUSOVA S., KRALOVICOVA K., KRCHNAKOVA A., TRUPL J., KUNOVA A., KRCMERY Jr. V.
The authors studied a relationship between particular bacterial
or fungal organisms isolated from blood cultures and type of malignancy
and antineoplastic drugs in 237 cancer patients. Sixty four had acute myelogenous
leukemia (AML), 43 non-Hodgkin's lymphoma (NHL) and 140 solid tumors (ST).
All patients had at least one positive blood cultures for one or more microorganism
drawn during 1–10 days after cytotoxic chemotherapy. viridans streptococcal
bacteremia was more frequently observed in patients with AML (12.5 %) and
NHL (27.9 %) than ST (4.3 %, p<0.01 and 0.03). The incidence of anaerobic
bacteria was similar in patients with NHL and ST, and in both groups significantly
higher (p<0.05) than in AML. Enterobacteriaceae caused bacteremia less
frequently in patients with AML than in those with ST (12.5 vs 27.8 %,
p<0.05) . However, the highest incidence of Stenotrophomonas maltophilia
bacteremia was seen in patients with AML (6.3 % vs 2.3 %, p<0.04
and 0.03). Concerning fungemia, Candida albicans occurred significantly
more frequently in blood cultures in patients with NHL, and molds in patients
with AML. Cytarabine and metothrexate seems to be more frequently associated
with viridans streptococci, cytarabine and mitoxanthrone with Stenotrophomonas
maltophilia, B. fragilis with cisplatin and 5-fluorouracil, Fusarium
spp., Mucorales and Aspergillus spp. with acute leukaemia (AL)
treated with cytarabine and mitoxantrone. The association of other pathogens
with an underlying disease or chemotherapeutic regimen could not be documented.
(Tab. 1, Ref. 19.)
Key words: bacteramia, various malignancies, antineoplastic drugs,
microorganism.
Bratisl Lek Listy 1996; 97: 675–679
MOZNO PREDPOVEDAT NEUSPESNOST TERAPIE VANKOMYCINOM U NEUTROPENICKYCH ONKOLOGICKYCH PACIENTOV NA ZAKLADE NIZKYCH HLADIN VANKOMYCINU V SERE?
NETRIOVA J., HALKO J., STUDENA-MRAZOVA M., KUKUCKOVA E., STOPKOVA K., KRALOVICOVA K., DEMITROVICOVA A., GRAUSOVA S., KRUPOVA I., TRUPL J., KRCMERY Jr. V.
Vancomycine serum levels were measured in 198 cancer patients with documented
grampositive bacteremia and twenty two failed. Failures were analyzed for
risk factors of therapy failure. Only 8 of 22 showed low serum peak or
through vancomycin levels. One patient was treated less than 7 days, 9
had persisting and 4 catheter associated bacteremia. Bacteremias due to
VAN resistant strains were excluded.
In 14 out of 22 patients, multiple or one risk factor could be determined,
but in 8 patients, no risk factor was found. Hence the, case control study
was conducted to compare the group of failures in 22 patients with a group
of patients with underlying disease and neutropenia treated successfully
within the same period and same antibiotic policy at the same cancer center,
by VAN for gram-positive bacteremia. Persisting, catheter associated and
enterococcal bacteremias were the only statistical significant risk factors
predicting a therapy failure in cancer patients. Neither Vancomycine
serum peak nor through levels predicted the outcome: failure or cure of
gram-positive bacteremia in cancer patients. (Tab. 1, Ref. 5.)
Key words: Vancomycine, serum level, bacteraemia, cancer, neutropenic
cancer patients.
Bratisl Lek Listy 1996; 97: 680–683
BAKTERIEMIA U ONKOLOGICKYCH PACIENTOV SO SOLIDNYMI NADORMI PODROBENYCH CHEMOTERAPII VERSUS CHIRURGICKEJ LIECBE: RIZIKOVE FAKTORY, ETIOLOGIA A VYSLEDKY LIECBY U 276 PACIENTOV
GRAUSOVA S., KRCMERY Jr. V., STOPKOVA K., KOREN P., SEPESI J.
Risk factors, etiology, symptomatology and outcome of bacteremia in
276 patients with solid tumors were evaluated. A group of 78 patients
with solid tumors and surgical therapy was compared with 172 patients with
solid tumors but treated solely by chemotherapy. The most frequently observed
risk factors of bacteremia in patients after surgery were the vascular
and urinary catheter insertions, wound as source of bacteremia, staphylococci,
enterococci and Enterobacteriaceae as etiologic agents. Comparing the group
of therapeutically treated patients with solid tumors, with the group of
those treated only by chemotherapy, a statistically significant difference
in risk factors between both groups was observed only in the incidence
of catheter insertion (more frequently in surgically treated patients),
neutropenia (more frequently in those treated by chemotherapy). Wound as
source of bacteremia was more frequently observed in those after surgery.
Enterobacteriaceae and enterococci were significantly more frequently observed
in patients with solid tumors treated by surgery. Surprisingly, patients
after surgery the mortality due to septic shock was lower in (6.4 % vs
16.9 %, p<0.03) than in the control group of patients with solid tumors
treated solely by chemotherapy. (Tab. 1, Ref. 5.)
Key words: chemotherapy, bacteraemia, cancer patients, solid tumor,
surgery.
Bratisl Lek Listy 1996; 97: 684–687
MELANOCYTOSIS NEUROCUTANEA
KOPECKY S., BOLDISOVA O.
An 11-month-old girl with a large "swimming-suit" neavus
whose head began to enlarge at the age of 3 months was subdued to sonographic
and computer tomographic examinations. The latter revealed a complete
obstructive hydrocephalus of all brain ventricles. The section and histologic
examinations indicated that the obstruction was caused by extensive melanocytosis
of leptomeninges at the cerebellar base, pons and spinal cord thus blocking
out the outlets of the IVth brain ventricle. (Fig. 8, Ref. 8.)
Key words: melanocytosis neurocutanea, hydrocephalus, brain, brain
ventricle, central nervous system.
Bratisl Lek Listy, 1996: 97: 688–692
APPLICATION OF THE DOMINANT LETHAL MUTATION TEST IN THE STUDY OF GENETIC RISKS OF CONTINUOUS EXPOSITION TO LOW DOSE RATE IONIZING RADIATION
BREZANI P.
Background: Dissension in data on the effectivity of ionizing
radiation at a low-dose rate do not enable to judge the extent of
the genetic risk of such exposition. This estimation, however, is especially
important in cases of irradiation of female germ cells in which the lesions
can cumulate and persist for a long period.
Objectives: The aim of this study is to judge the mutagenic
effectivity of continuous irradiation on the basis of a model experiment
founded on the test of dominantly lethal mutations.
Methods: Sexually mature female ICR mice were continuously irradiated
by gama rays at daily dose rates 0.01 and 0.05 Gy to a total accumulated
dose of 1 Gy. The frequency of genetic lesions induced by irradiation in
dictyotene oocytes was evaluated by means of the test of dominantly lethal
mutations within the periods of 1–2 and 21–22 weeks after the ultimation
of irradiation.
Results: Continuous irradiation significantly increased the
frequency of dominantly lethal mutations in germ cells of female mice.
Induced lesions manifest themselves mostly in form of increased values
of preimplantation lethality. The level of dominantly lethal mutations
persists on a significantly increased level also in the period of
21–22 weeks after the ultimation of irradiation.
Conclusion: Continuous irradiation of female mice represents
a significant risk factor which induces a long-term increase
in frequency of genetic lesions in germ cells. The negative selection of
lesions in the preimplantation period can be subsequently the cause of
decreased reproductive abilities of irradiated animals. (Tab. 1, Fig.
2, Ref. 13.)
Key words: dominant lethal mutations, continuous irradiation, low
dose rate, female mice.
Bratisl Lek Listy 1996; 97: 693–696