1
|
Bechmann L, Bauer K, Zerban P, Esser T, Tersteegen A, Fuchs SA, Kaasch AJ, Wolleschak D, Schalk E, Fischer T, Mougiakakos D, Geginat G. Prevention of legionella infections from toilet flushing cisterns. J Hosp Infect 2024; 146:37-43. [PMID: 38224856 DOI: 10.1016/j.jhin.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Immunocompromised patients are at an increased risk of severe legionella infections. We present the results of an outbreak investigation initiated following a fatal case of hospital-acquired legionellosis linked to contaminated water from a toilet-flushing cistern. Additionally, we provide experimental data on the growth of Legionella spp. in flushing cisterns and propose a straightforward protocol for prevention. METHODS We monitored the growth of Legionella spp. in the building's hot- and cold-water systems using quantitative bacterial culture on selective agar. Molecular typing of Legionella pneumophila isolates from the infected patient and the water system was conducted through core-genome multi-locus sequence typing (cgMLST). RESULTS Legionella contamination in the hospital building's cold-water system was significantly higher than in the hot-water system and significantly higher in toilet flushing cistern's water compared with cold water from bathroom sinks and showers. Isolates from the patient and from the flushing cistern of the patient's bathroom were identical by cgMLST. In an experimental setting, daily toilet flushing for a period of 21 days resulted in a 67% reduction in the growth of Legionella spp. in the water of toilet flushing cisterns. Moreover, a one-time disinfection of cisterns with peracetic acid, followed by daily flushing, decreased legionella growth to less than 1% over a period of at least seven weeks in these setting. CONCLUSIONS One-time disinfection of highly contaminated cisterns with peracetic acid and daily toilet flushing as short-term measure can significantly reduce legionella contamination in flushing cisterns. These measures may aid in preventing legionella infection among immunocompromised patients.
Collapse
Affiliation(s)
- L Bechmann
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
| | - K Bauer
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - P Zerban
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - T Esser
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - A Tersteegen
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - S A Fuchs
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - A J Kaasch
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - D Wolleschak
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - E Schalk
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - T Fischer
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - D Mougiakakos
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - G Geginat
- Department of Medical Microbiology and Infection Control, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| |
Collapse
|
2
|
Grünwald V, Pink D, Egerer G, Schalk E, Augustin M, Deinzer C, Kob V, Reichert D, Kebenko M, Brandl S, Hahn D, Lindner L, Hoiczyk M, Ringsdorf U, Hanker L, Hempel D, Pontes M, Wismann T, Ivanyi P. 1496P Trabectedin for patients with advanced soft tissue sarcoma: A non-interventional, prospective, multicenter study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
3
|
Kochanek M, Schalk E, von Bergwelt-Baildon M, Beutel G, Buchheidt D, Hentrich M, Henze L, Kiehl M, Liebregts T, von Lilienfeld-Toal M, Classen A, Mellinghoff S, Penack O, Piepel C, Böll B. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2019; 98:1051-1069. [PMID: 30796468 PMCID: PMC6469653 DOI: 10.1007/s00277-019-03622-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023]
Abstract
Sepsis and septic shock are major causes of mortality during chemotherapy-induced neutropenia for malignancies requiring urgent treatment. Thus, awareness of the presenting characteristics and prompt management is most important. Improved management of sepsis during neutropenia may reduce the mortality of cancer therapies. However, optimal management may differ between neutropenic and non-neutropenic patients. The aim of the current guideline is to give evidence-based recommendations for hematologists, oncologists, and intensive care physicians on how to manage adult patients with neutropenia and sepsis.
Collapse
Affiliation(s)
- Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany.
| | - E Schalk
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - M von Bergwelt-Baildon
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Medical Department III, University Medical Center & Comprehensive Cancer Center Munich, Munich, Germany
| | - G Beutel
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department for Hematology, Hemostasis, Oncology and Stem Cell Transplantation Hannover Medical School, Hannover, Germany
| | - D Buchheidt
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Hematology and Oncology, Mannheim University Hospital, Mannheim, Germany
| | - M Hentrich
- Department of Medicine III - Hematology and Oncology, Red Cross Hospital, Munich, Germany
| | - L Henze
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - M Kiehl
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Internal Medicine I, Clinic Frankfurt (Oder), Frankfurt, Germany
| | - T Liebregts
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - M von Lilienfeld-Toal
- Department for Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
| | - A Classen
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - S Mellinghoff
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - O Penack
- Department for Hematology, Oncology and Tumorimmunology, Campus Virchow Clinic, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - C Piepel
- Department of Hematology, Oncology and Infectious Diseases, Klinikum Bremen-Mitte, Bremen, Germany
| | - B Böll
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
| |
Collapse
|
4
|
Kiehl MG, Beutel G, Böll B, Buchheidt D, Forkert R, Fuhrmann V, Knöbl P, Kochanek M, Kroschinsky F, La Rosée P, Liebregts T, Lück C, Olgemoeller U, Schalk E, Shimabukuro-Vornhagen A, Sperr WR, Staudinger T, von Bergwelt Baildon M, Wohlfarth P, Zeremski V, Schellongowski P. Consensus statement for cancer patients requiring intensive care support. Ann Hematol 2018; 97:1271-1282. [PMID: 29704018 PMCID: PMC5973964 DOI: 10.1007/s00277-018-3312-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/19/2018] [Indexed: 02/06/2023]
Abstract
This consensus statement is directed to intensivists, hematologists, and oncologists caring for critically ill cancer patients and focuses on the management of these patients.
Collapse
Affiliation(s)
- M G Kiehl
- Department of Internal Medicine I, Clinic Frankfurt/Oder GmbH, Müllroser Chaussee 7, 15236, Frankfurt (Oder), Germany.
| | - G Beutel
- Hannover Medical School (MHH) Clinic for Hematology, Coagulation, Oncology and Stem Cell Transplantation, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - B Böll
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - D Buchheidt
- III. Medical Clinic, Medical Faculty Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - R Forkert
- Johanniter-Hospital, Johanniterstr. 3-5, 53113, Bonn, Germany
| | - V Fuhrmann
- Clinic for Intensive Care Medicine, University Hamburg, Martinistr. 52, 20246, Hamburg, Germany
| | - P Knöbl
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M Kochanek
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - F Kroschinsky
- Department of Internal Medicine I, University Hospital, Fetschertstr. 74, 01307, Dresden, Germany
| | - P La Rosée
- Department of Internal Medicine III, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen-Schwenningen, Germany
| | - T Liebregts
- Clinic for Stem Cell Transplantation, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - C Lück
- Hannover Medical School (MHH) Clinic for Hematology, Coagulation, Oncology and Stem Cell Transplantation, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - U Olgemoeller
- Department of Cardiology and Pulmonary Medicine, University Hospital, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - E Schalk
- Department of Hematology and Oncology, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - A Shimabukuro-Vornhagen
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - W R Sperr
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - T Staudinger
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - M von Bergwelt Baildon
- Department of Internal Medicine I, University Hospital, Kerpener Str. 62, 50937, Cologne, Germany
| | - P Wohlfarth
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - V Zeremski
- Department of Hematology and Oncology, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - P Schellongowski
- Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | |
Collapse
|
5
|
Schmidt-Hieber M, Bierwirth J, Buchheidt D, Cornely OA, Hentrich M, Maschmeyer G, Schalk E, Vehreschild JJ, Vehreschild MJGT. Diagnosis and management of gastrointestinal complications in adult cancer patients: 2017 updated evidence-based guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2017; 97:31-49. [PMID: 29177551 PMCID: PMC5748412 DOI: 10.1007/s00277-017-3183-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/11/2017] [Indexed: 12/15/2022]
Abstract
Cancer patients frequently suffer from gastrointestinal complications. In this manuscript, we update our 2013 guideline on the diagnosis and management of gastrointestinal complications in adult cancer patients by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). An expert group was put together by the AGIHO to update the existing guideline. For each sub-topic, a literature search was performed in PubMed, Medline, and Cochrane databases, and strengths of recommendation and the quality of the published evidence for major therapeutic strategies were categorized using the 2015 European Society for Clinical Microbiology and Infectious Diseases (ESCMID) criteria. Final recommendations were approved by the AGIHO plenary conference. Recommendations were made with respect to non-infectious and infectious gastrointestinal complications. Strengths of recommendation and levels of evidence are presented. A multidisciplinary approach to the diagnosis and management of gastrointestinal complications in cancer patients is mandatory. Evidence-based recommendations are provided in this updated guideline.
Collapse
Affiliation(s)
- M Schmidt-Hieber
- Clinic for Hematology, Oncology, Tumor Immunology and Palliative Care, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - J Bierwirth
- Deutsches Beratungszentrum für Hygiene, BZH GmbH, Freiburg, Germany
| | - D Buchheidt
- 3rd Department of Internal Medicine - Hematology and Oncology - Mannheim University Hospital, University of Heidelberg, Heidelberg, Germany
| | - O A Cornely
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.,Clinical Trials Centre Cologne, ZKS Köln, University of Cologne, Cologne, Germany
| | - M Hentrich
- Department III for Internal Medicine, Hematology and Oncology, Rotkreuzklinikum München, Munich, Germany
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Ernst-von-Bergmann Klinikum, Potsdam, Germany
| | - E Schalk
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| | - J J Vehreschild
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Maria J G T Vehreschild
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany. .,German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany. .,1st Department of Internal Medicine, Hospital of the University of Cologne, Kerpener Str. 62, 50937, Köln, Germany.
| | | |
Collapse
|
6
|
|
7
|
Hermann B, Lehners N, Brodhun M, Boden K, Hochhaus A, Kochanek M, Meckel K, Mayer K, Rachow T, Rieger C, Schalk E, Weber T, Schmeier-Jürchott A, Schlattmann P, Teschner D, von Lilienfeld-Toal M. Influenza virus infections in patients with malignancies -- characteristics and outcome of the season 2014/15. A survey conducted by the Infectious Diseases Working Party (AGIHO) of the German Society of Haematology and Medical Oncology (DGHO). Eur J Clin Microbiol Infect Dis 2016; 36:565-573. [PMID: 27838792 PMCID: PMC5309266 DOI: 10.1007/s10096-016-2833-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 10/26/2016] [Indexed: 12/03/2022]
Abstract
Influenza virus infections (IVI) may pose a vital threat to immunocompromised patients such as those suffering from malignancies, but specific data on epidemiology and outcome in these patients are scarce. In this study, we collected data on patients with active cancer or with a history of cancer, presenting with documented IVI in eight centres in Germany. Two hundred and three patients were identified, suffering from haematological malignancies or solid tumours; 109 (54 %) patients had active malignant disease. Influenza A was detected in 155 (77 %) and Influenza B in 46 (23 %) of patients (genera not determined in two patients). Clinical symptoms were consistent with upper respiratory tract infection in 55/203 (27 %), influenza-like illness in 82/203 (40 %), and pneumonia in 67/203 (33 %). Anti-viral treatment with oseltamivir was received by 116/195 (59 %). Superinfections occurred in 37/203 (18 %), and admission on an intensive care unit was required in 26/203 (13 %). Seventeen patients (9 %) died. Independent risk factors for death were delayed diagnosis of IVI and bacterial or fungal superinfection, but not underlying malignancy or ongoing immunosuppression. In conclusion, patients with IVI show high rates of pneumonia and mortality. Early and rapid diagnosis is essential. The high rate of pneumonia and superinfections should be taken into account when managing IVI in these patients.
Collapse
Affiliation(s)
- B Hermann
- Leibniz Institut für Naturstoff-Forschung und Infektionsbiologie, Hans-Knöll-Institut, 07745 , Jena, Germany.
| | - N Lehners
- Department of Haematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Brodhun
- Medizinische Klinik II, Abteilung für Haematologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - K Boden
- Institut für Klinische Chemie und Laboratoriumsmedizin, University Hospital Jena, Jena, Germany
| | - A Hochhaus
- Medizinische Klinik II, Abteilung für Haematologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - M Kochanek
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - K Meckel
- Medizinische Klinik II, Abteilung für Haematologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - K Mayer
- Medizinische Klinik III, University Hospital Bonn, Bonn, Germany
| | - T Rachow
- Medizinische Klinik II, Abteilung für Haematologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - C Rieger
- Internistische Lehrpraxis der Ludwig-Maximilians-Universität München, University of Munich, Munich, Germany
| | - E Schalk
- Otto-von-Guericke University Magdeburg, Medical Centre, Department of Haematology and Oncology, Magdeburg, Germany
| | - T Weber
- University Hospital Halle, Halle, Germany
| | - A Schmeier-Jürchott
- University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - P Schlattmann
- Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany
| | - D Teschner
- University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - M von Lilienfeld-Toal
- Leibniz Institut für Naturstoff-Forschung und Infektionsbiologie, Hans-Knöll-Institut, 07745 , Jena, Germany.,Medizinische Klinik II, Abteilung für Haematologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany.,Forschungscampus InfectoGnostics, Jena, Germany.,Integriertes Forschungs- und Behandlungszentrum Sepsis und Sepsisfolgen (CSCC), Universitätsklinikum Jena, Jena, Germany
| |
Collapse
|
8
|
Schmidt-Hieber M, Silling G, Schalk E, Heinz W, Panse J, Penack O, Christopeit M, Buchheidt D, Meyding-Lamadé U, Hähnel S, Wolf HH, Ruhnke M, Schwartz S, Maschmeyer G. CNS infections in patients with hematological disorders (including allogeneic stem-cell transplantation)-Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Oncol 2016; 27:1207-25. [PMID: 27052648 PMCID: PMC4922317 DOI: 10.1093/annonc/mdw155] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/24/2016] [Indexed: 12/22/2022] Open
Abstract
Diagnosis of CNS infections remains a great challenge in patients with hematological disorders since symptoms might both be masked and be mimicked by other conditions such as metabolic disturbances or consequences from antineoplastic treatment. Thus, awareness of this complication is crucial and any suspicion of a CNS infection should lead to timely and adequate diagnostics and treatment to improve the outcome in this population. Infections of the central nervous system (CNS) are infrequently diagnosed in immunocompetent patients, but they do occur in a significant proportion of patients with hematological disorders. In particular, patients undergoing allogeneic hematopoietic stem-cell transplantation carry a high risk for CNS infections of up to 15%. Fungi and Toxoplasma gondii are the predominant causative agents. The diagnosis of CNS infections is based on neuroimaging, cerebrospinal fluid examination and biopsy of suspicious lesions in selected patients. However, identification of CNS infections in immunocompromised patients could represent a major challenge since metabolic disturbances, side-effects of antineoplastic or immunosuppressive drugs and CNS involvement of the underlying hematological disorder may mimic symptoms of a CNS infection. The prognosis of CNS infections is generally poor in these patients, albeit the introduction of novel substances (e.g. voriconazole) has improved the outcome in distinct patient subgroups. This guideline has been developed by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) with the contribution of a panel of 14 experts certified in internal medicine, hematology/oncology, infectious diseases, intensive care, neurology and neuroradiology. Grades of recommendation and levels of evidence were categorized by using novel criteria, as recently published by the European Society of Clinical Microbiology and Infectious Diseases.
Collapse
Affiliation(s)
- M Schmidt-Hieber
- Department of Hematology, Oncology and Tumor Immunology, HELIOS Clinic Berlin-Buch, Berlin
| | - G Silling
- Department of Hematology, Oncology and Stem Cell Transplantation, University Hospital, Aachen, Medical Faculty, RWTH Aachen, Aachen
| | - E Schalk
- Department of Hematology and Oncology, Otto-von-Guericke University Hospital Magdeburg, Magdeburg
| | - W Heinz
- Department of Internal Medicine II, University Hospital Würzburg, Center of Internal Medicine, Würzburg
| | - J Panse
- Department of Hematology, Oncology and Stem Cell Transplantation, University Hospital, Aachen, Medical Faculty, RWTH Aachen, Aachen
| | - O Penack
- Department of Hematology, Oncology and Tumor Immunology, Charité University Medicine, Campus Virchow Clinic, Berlin
| | - M Christopeit
- Department of Stem Cell Transplantation, University Medical Center Hamburg Eppendorf, Hamburg
| | - D Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Mannheim
| | - U Meyding-Lamadé
- Department of Neurology, Hospital Nordwest Frankfurt, Frankfurt/M., Germany Brunei Neuroscience Stroke and Rehabilitation Centre, Jerudong, Brunei Darussalam Department of Neuroinfectiology, Otto-Meyerhof-Centre, University of Heidelberg, Heidelberg
| | - S Hähnel
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg
| | - H H Wolf
- Department of Hematology and Oncology, University Hospital Halle, Halle
| | - M Ruhnke
- Paracelsus Clinic Osnabrück, Osnabrück
| | - S Schwartz
- Department of Hematology and Oncology, Charité University Medicine, Campus Benjamin Franklin, Berlin
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Ernst von Bergmann Clinic, Potsdam, Germany
| |
Collapse
|
9
|
Friedmann B, Keck E, Schalk E, Schmitz D. Nub Status - A 2014 Situation Analysis for Drugs: Oncology As Leading Therapeutic Area. Value Health 2014; 17:A406. [PMID: 27200982 DOI: 10.1016/j.jval.2014.08.941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - E Keck
- Healthcare Manufaktur, Cologne, Germany
| | | | - D Schmitz
- Healthcare Manufaktur, Cologne, Germany
| |
Collapse
|
10
|
Hentrich M, Schalk E, Schmidt-Hieber M, Chaberny I, Mousset S, Buchheidt D, Ruhnke M, Penack O, Salwender H, Wolf HH, Christopeit M, Neumann S, Maschmeyer G, Karthaus M. Central venous catheter-related infections in hematology and oncology: 2012 updated guidelines on diagnosis, management and prevention by the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology. Ann Oncol 2014; 25:936-47. [PMID: 24399078 DOI: 10.1093/annonc/mdt545] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cancer patients are at increased risk for central venous catheter-related infections (CRIs). Thus, a comprehensive, practical and evidence-based guideline on CRI in patients with malignancies is warranted. PATIENTS AND METHODS A panel of experts by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) has developed a guideline on CRI in cancer patients. Literature searches of the PubMed, Medline and Cochrane databases were carried out and consensus discussions were held. RESULTS Recommendations on diagnosis, management and prevention of CRI in cancer patients are made, and the strength of the recommendation and the level of evidence are presented. CONCLUSION This guideline is an evidence-based approach to the diagnosis, management and prevention of CRI in cancer patients.
Collapse
Affiliation(s)
- M Hentrich
- Department of Hematology, Oncology and Palliative Care, Harlaching Hospital and Neuperlach Hospital, Munich
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Vehreschild MJGT, Vehreschild JJ, Hübel K, Hentrich M, Schmidt-Hieber M, Christopeit M, Maschmeyer G, Schalk E, Cornely OA, Neumann S. Diagnosis and management of gastrointestinal complications in adult cancer patients: evidence-based guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Oncol 2013; 24:1189-202. [PMID: 23401037 DOI: 10.1093/annonc/mdt001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cancer patients frequently suffer from gastrointestinal complications. However, a comprehensive, practical and evidence-based guideline on this issue is not yet available. PATIENTS AND METHODS An expert group was put together by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO) to develop a guideline on gastrointestinal complications in cancer patients. For each subtopic, a literature search was carried out in PubMed, Medline and Cochrane databases and the strength of recommendation and the quality of the published evidence for major therapeutic strategies were categorized using a modification of the 'Infectious Diseases Society of America' criteria. Consensus discussions were held on each of the topics. RESULTS Recommendations were made with respect to non-infectious and infectious gastrointestinal complications. For all recommendations, the strength of the recommendation and the level of evidence are presented. CONCLUSION This guideline is an evidence-based approach to the diagnosis and management of gastrointestinal complications in cancer patients.
Collapse
|
12
|
Abstract
BACKGROUND AND OBJECTIVES Capillary samples can provide blood for cell counts in haematologic patients and blood donors. However, some accept only values from venous blood. This study compares capillary and venous blood counts to verify the hypothesis that they are equivalent. MATERIALS AND METHODS We analysed 463 capillary (fingerstick) and venous blood samples from 428 adults of both sexes (71% haematologic patients, 29% potential blood and apheresis donors). Both samples were taken at the same time from each subject. Haemoglobin (Hb), haematocrit (Hct), white blood cells (WBC), platelets, red blood cells (RBC), mean corpuscular volume (MCV), mean corpuscular Hb (MCH) and mean corpuscular Hb concentration (MCHC) were measured using a haematology analyser (Advia 120, Bayer). RESULTS Capillary Hb, Hct, WBC, RBC, MCV and MCH were all significantly higher than the venous values [+0.2 mmol/l (+0.3 g/dl), +0.02 l/l (+2%), +0.2 x 10(9)/l, +0.1 x 10(12)/l, +3.1 fl and +0.01 fmol, respectively], whereas the capillary MCHC was lower (-0.6 mmol/l). There was no difference in platelets (-1 x 10(9)/l). Capillary Hb and Hct values were higher in patients with anaemia and polycythaemia, respectively. However, no significant differences occurred in severe thrombocytopenia. CONCLUSION In adult haematologic patients, however, only the differences in Hb and Hct values may be of clinical relevance. For potential blood and apheresis donors, Hb and platelet screening are equivalent with either capillary and venous blood using a haematology analyser.
Collapse
Affiliation(s)
- E Schalk
- Division of Haematology/Oncology, Department of Internal Medicine, University Hospital of Magdeburg, D-39120 Magdeburg, Germany.
| | | | | | | |
Collapse
|
13
|
Scheinpflug K, Schalk E, Reschke K, Franke A, Mohren M. Diabetes insipidus due to herpes encephalitis in a patient with diffuse large cell lymphoma. A case report. Exp Clin Endocrinol Diabetes 2006; 114:31-4. [PMID: 16450314 DOI: 10.1055/s-2005-873014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The major causes of central diabetes insipidus are neoplastic or infiltrative lesions of the hypothalamus or pituitary, severe head injuries and pituitary or hypothalamic surgery. Central diabetes insipidus caused by viral infections has been rarely reported in immunosuppressed patients, such as those with acquired immunodeficiency syndrome or Cushing's syndrome. We report the case of a 48-year-old woman suffering from diffuse large cell lymphoma, who developed hypotonic polyuria, hypernatriaemia and somnolence after the first course of chemotherapy with CHOEP and rituximab. Diabetes insipidus was diagnosed by low urine osmolarity and an undetectable vasopressin concentration. MRI revealed no pituitary abnormalities but encephalitis, and lumbar punction confirmed herpes zoster infection. To the best of our knowledge this is the first description of central diabetes insipidus in a lymphoma patient caused by an opportunistic CNS-infection.
Collapse
Affiliation(s)
- K Scheinpflug
- Department of Hematology and Oncology, Otto-von-Guericke-University, Magdeburg, Germany
| | | | | | | | | |
Collapse
|
14
|
Schalk E, Franke A, Koenigsmann M. Akute myeloische Leukämie mit pulmonaler Manifestation. Pneumologie 2005. [DOI: 10.1055/s-2005-919096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
15
|
Abstract
BACKGROUND Extramedullary manifestations of leukemias are often misinterpreted. The prognosis of pulmonary manifested leukemias is poor. CASE REPORT A 57-year-old female patient was admitted to our hospital because of refractory pneumonia and the suspicion of acute leukemia. The diagnosis of acute myeloid leukemia (AML, FAB M5a) was derived from bone marrow aspiration. The radiograph and the computed tomography of the chest showed infiltrations of both lungs. The cytologic aspect of a bronchoalveolar lavage was dominated by leukemic blasts, therefore AML with pulmonary manifestation was diagnosed. Cytotoxic therapy with cytarabine/idarubicin was combined with prednisolone. In the course of treatment the pulmonary function improved and radiographic alterations diminished significantly. After induction therapy complete haematological remission (CR) was shown by bone marrow aspiration. Two consolidation therapies followed. Unfortunately, the patient died four months after CR in a local hospital. CONCLUSIONS The pulmonary manifestation of AML can be diagnosed by bronchoscopy. In contrast to the literature the initial course of the disease in this case was favourable possibly due to the addition of prednisolone to the cytotoxic treatment.
Collapse
Affiliation(s)
- E Schalk
- Klinik für Hämatologie/Onkologie, Otto-von-Guericke-Universität Magdeburg
| | | | | |
Collapse
|
16
|
Majmudar G, Schalk E, Bateman J, Peterkofsky B. Uncoupled expression of mRNAs for alpha 1(I) and alpha 2(I) procollagen chains in chemically transformed Syrian hamster fibroblasts. J Biol Chem 1988; 263:5555-9. [PMID: 3128544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Syrian hamster embryo fibroblasts transformed by 4-nitroquinoline-1-oxide (NQT-SHE cells) failed to synthesize the pro-alpha 1(I) subunit of type I procollagen but continued to synthesize altered forms of the other subunit, pro-alpha 2(I) (Peterkofsky, B., and Prather, W. (1986) J. Biol. Chem. 261, 16818-16826). This was unusual, since synthesis of the two subunits generally is coordinately regulated. Present experiments using cell-free translation and hybridization of RNA from normal and transformed Syrian hamster fibroblasts with labeled pro-alpha 1(I) DNA probes show that mRNA for pro-alpha 1(I) is absent from the transformant. In contrast, dot-blot and Southern blot hybridizations of cellular DNAs with pro-alpha 1(I) DNA probes demonstrated that the transformed cells contained pro-alpha 1(I) gene sequences and that the gross structure of the gene was unchanged by transformation. mRNA for the other type I procollagen subunit, pro-alpha 2(I), was present in transformed cells and the major collagenous polypeptide translated from this RNA migrated like the normal pro-alpha 2 subunit during sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The translated procollagen chain was cleaved to an alpha 2(I)-sized collagen chain by pepsin at 4 degrees C. These studies provide a molecular basis for the observed collagen phenotype of NQT-SHE cells.
Collapse
Affiliation(s)
- G Majmudar
- Laboratory of Biochemistry, National Cancer Institute, Bethesda, Maryland 20892
| | | | | | | |
Collapse
|
17
|
Majmudar G, Schalk E, Bateman J, Peterkofsky B. Uncoupled expression of mRNAs for alpha 1(I) and alpha 2(I) procollagen chains in chemically transformed Syrian hamster fibroblasts. J Biol Chem 1988. [DOI: 10.1016/s0021-9258(18)60600-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
|