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Abstract
The management of febrile neutropenia is a backbone of treating patients with hematologic malignancies and has evolved over the past decades. This article reviews my approach to the evaluation and treatment of febrile neutropenic patients. Key topics discussed include antibacterial and antifungal prophylaxis, the initial workup for fever, the choice of the empiric antibiotic regimen and its modifications, and criteria for discontinuation. For each of these questions, I review the literature and present my perspective.
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Bitterman R, Hardak E, Guralnik L, Paul M, Oren I. Reply to Nucci. Clin Infect Dis 2020; 70:347-349. [PMID: 31075162 DOI: 10.1093/cid/ciz382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Roni Bitterman
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Emilia Hardak
- Pulmonary Medicine, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israeli Institute of Technology, Israel
| | - Luda Guralnik
- Radiology Department, Rambam Health Care Campus, Haifa, Israel
| | - Mical Paul
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israeli Institute of Technology, Israel
| | - Ilana Oren
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israeli Institute of Technology, Israel.,Hematology Department and Bone Marrow Transplantation Unit, Rambam Health Care Campus, Haifa, Israel
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Liu Z, Li Y, Tian X, Liu Q, Li E, Gu X, Liu M, Xu J, He Z, Huang Y, Xu S, Lai G, Chen Y, Zhang X, Zhang T, Xu J, Zhu L, Qu J, Cao B. Airway-invasion-associated pulmonary computed tomography presentations characteristic of invasive pulmonary Aspergillosis in non-immunocompromised adults: a National Multicenter Retrospective Survey in China. Respir Res 2020; 21:173. [PMID: 32635916 PMCID: PMC7341597 DOI: 10.1186/s12931-020-01424-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022] Open
Abstract
Background The European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria are widely used in the diagnosis of invasive pulmonary aspergillosis (IPA), but they only apply to immunocompromised patients. We here aimed to identify clinical characteristics helpful to the diagnosis of IPA in non-immunocompromised patients. Methods This is a multicenter retrospective study. Data were collected from adult patients with IPA admitted to 15 tertiary hospitals in China from 2010 to 2016. Results We included 254 patients in the study, of whom 66 (26.0%) were immunocompromised, and 188 (74.0%) were not. Airway-invasion-associated computed tomography (CT) signs including patchy exudation along the airway (67.6% vs. 45.5%, P = 0.001) and thickened airway wall (42.0% vs. 16.7%, P < 0.001) were more common in non-immunocompromised patients than in immunocompromised ones, and angio-invasive CT signs were more common in immunocompromised patients (55.3% vs.72.7%, P = 0.013). Typical angio-invasive CT signs were delayed in non-immunocompromised IPA patients, whereas airway-invasive signs appear earlier. Host immunocompromised condition was associated with ICU admission and/or intubation (OR 1.095; 95% CI 1.461–6.122; P = 0.003). Poor prognosis (35.5% vs. 21.1%, P = 0.005) was more common in immunocompromised patients. Conclusion Airway-invasion-associated CT presentations at early stages of the disease are characteristic of IPA in non-immunocompromised hosts.
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Affiliation(s)
- Zhibo Liu
- Department of Respiratory and Critical Care Medicine, Clinical Microbiology and Infectious Disease Lab, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Yuping Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinlun Tian
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinghua Liu
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Erran Li
- Institute of Respiratory Disease, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiaoying Gu
- Department of Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Min Liu
- The department of radiology, China-Japan Friendship Hospital, Beijing, China
| | - Jiuyang Xu
- Tsinghua University School of Medicine, Beijing, China
| | - Zhiyi He
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yi Huang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Shuyun Xu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoxiang Lai
- Department of Respiratory and Critical Care Medicine, Fuzhou General Hospital of Fujian Medical University, Fuzhou, China
| | - Yusheng Chen
- Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Provincial Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Xiangyan Zhang
- Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, Guizhou Province, China
| | - Tiantuo Zhang
- Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, Guangzhou, China
| | - Jinfu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lanyan Zhu
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central-South University, Changsha, China
| | - Jieming Qu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China.
| | - Bin Cao
- Department of Respiratory and Critical Care Medicine, Clinical Microbiology and Infectious Disease Lab, China-Japan Friendship Hospital, Beijing, 100029, China.
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