Evaluation of a score system for the severity and outcome of cytomegalovirus interstitial pneumonia in allogeneic bone marrow recipients

We verified whether a clinical score system developed for renal transplant patients predicts the severity and outcome of cytomegalovirus interstitial pneumonia (CMV IP) in allogeneic bone marrow (BMT) recipients. The score system was retrospectively applied to 20 patients at the estimated date of onset of IP and 10-14 days later. Seven patients received ganciclovir (GCV), seven received GCV plus intravenous immunoglobulin (i.v. Ig), and six received only supportive care. Nine out of 14 patients who received GCV with or without i.v. Ig survived the episode of IP (the median score of these patients at diagnosis of CMV IP was 5 (range 3-8)), while the remaining five patients died of respiratory failure during IP and at the diagnosis had a median score of 10 (range 9-11) (P=0.01). The six patients who received only supportive care survived for a median time of 21 days (range 10-24 days) from the estimated onset of CMV IP, and the median score at the diagnosis of IP was 10 (range 8-12). The overall survival correlates strongly with low initial severity of IP as measured by this score system: 11 out of 20 patients who died of respiratory failure during IP had at the estimated onset of IP a score >8, while of the nine patients who survived IP, eight had at the onset a score <7 and the remaining one a score of 8 (P=0.0007). The sensibility, specificity, predictive positive value and predictive negative value of the score system (with a threshold value of 8) to identify patients who survived IP was: 100%, 88%, 91% and 100%, respectively. The use of ganciclovir alone or in combination was the most important determinant of outcome. These data support the relevance of this score system with a threshold value of 8; if prospective and controlled studies confirm our observations, it would help physicians to identify BMT recipients during CMV IP with high vs. low risk of poor outcome.

Pneumonia in allogenic and autologous bone marrow recipients. A retrospective study

Pulmonary infections, which frequently occur during the early and late period following bone marrow transplantation for hematologic malignancies, are associated with significant morbidity and mortality. In this study the incidence, the infectious causes of pneumonia and the mortality related to pneumonia in 130 allogeneic and 290 autologous bone marrow recipients are reviewed. Both the incidence and the mortality by pneumonia were far lower in autologous than in allogeneic bone marrow recipients.

Species identification and detection of oxacillin resistance in coagulase-negative Staphylococcus blood isolates from neutropenic patients

One hundred coagulase-negative staphylococcal isolates from septicemic neutropenic patients with hematologic malignancies were identified to a species level by means of the French API STAPH strip system and by the Automicrobic VITEK system. According to these two methods, which concurred in 95% of cases, S. epidermidis (80-82% of the isolates) was the most frequently identified species, followed by S. haemolyticus (6-7% of the isolates). The susceptibility to oxacillin was also evaluated by macrodilution MIC, Automicrobic VITEK system and agar screen, and 76, 78 and 79 of the 100 isolates, respectively, were found resistant to this antibiotic. All oxacillin-resistant isolates according to Automicrobic VITEK were confirmed resistant by agar screen. A 48h incubation was required to determine oxacillin resistance in 11 of 79 isolates with agar screen and in 10 of 76 isolates with macrodilution MIC. Automicrobic VITEK system may represent a useful method for rapid identification to a species level and early recognition of oxacillin resistance in coagulase-negative staphylococci.

Ganciclovir and standard high-dose immunoglobulins for the treatment of cytomegalovirus interstitial pneumonia in a bone marrow recipient

A 47-year-old woman received an allogeneic bone marrow infusion because of chronic myeloid leukemia. Two months after the transplant she developed an interstitial pneumonia: bronchoalveolar lavage yielded cytomegalic cells with intranuclear bodies, and cytomegalovirus DNA was detected by in situ hybridization techniques. Ganciclovir and standard high-dose immunoglobulins were administered to the patient with resolution of the pneumonia. No relapse of pneumonia was observed after a 4-month follow-up. It seems that the favorable outcome of the potentially fatal pneumonia observed in this patient might be related to early diagnosis, and prompt administration of ganciclovir and standard high-dose immunoglobulins.