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BMC Infectious Diseases Feb 2023Coagulase-negative staphylococci can cause hospital-acquired infections, especially in immunocompromised hosts. Bacterial meningitis is a potentially fatal infection of...
BACKGROUND
Coagulase-negative staphylococci can cause hospital-acquired infections, especially in immunocompromised hosts. Bacterial meningitis is a potentially fatal infection of the central nervous system, causing high mortality and morbidity. In general, the causative agents of meningitis, coagulase-negative staphylococci, are associated with direct implantation of a foreign body and the presence of a cerebrospinal fluid (CSF) shunt. Here, we describe a case of nosocomial meningitis caused by Staphylococcus haemolyticus in a child with neutropenia who had no intracranial foreign devices.
CASE PRESENTATION
A 15-year-old boy with relapsed acute myeloid leukemia undergoing chemotherapy through a central venous catheter developed fever on Day 13 post-initiation of chemotherapy. There was no history of implantation of neurosurgical devices. Two blood cultures obtained on Day 14 were positive for Staphylococcus haemolyticus. Clinical improvement was noted, and treatment with vancomycin and removal of the central venous catheter resulted in negative repeat blood cultures on Day 18. However, the patient developed a tendency for somnolence and improper speech, along with persistent fever on Day 26. A lumber puncture was performed on Day 27, resulting in positive culture of Staphylococcus haemolyticus. He was diagnosed with meningitis and the dosage of vancomycin was increased. A repeat CSF culture was positive for Staphylococcus haemolyticus on Day 40, so oral rifampicin was added. CSF findings on Day 46 revealed a low concentration of vancomycin, and treatment was switched from vancomycin plus rifampicin to linezolid. After Day 46, four subsequent cerebrospinal fluid tests of the CSF showed no growth of Staphylococcus haemolyticus. The patient's symptoms were improved on Day 52. Brain and spinal magnetic resonance images was taken and it showed no abnormalities. Linezolid was continued until Day 72. The patient was discharged without any complications on Day 72.
CONCLUSIONS
To the best of our knowledge, this is the first reported case of Staphylococcus haemolyticus meningitis in a patient without a neurosurgical device. Typical symptoms or signs may be absent in a patient with meningitis who also has neutropenia. Repeated tests of the CSF, and prolonged duration of antibiotics should be considered if atypical pathogens are detected in immunocompromised hosts.
Topics: Male; Humans; Child; Adolescent; Linezolid; Vancomycin; Staphylococcus haemolyticus; Cross Infection; Rifampin; Coagulase; Anti-Bacterial Agents; Staphylococcus; Neutropenia; Meningitis, Bacterial; Hospitals; Staphylococcal Infections
PubMed: 36788492
DOI: 10.1186/s12879-023-08059-5 -
Cureus Dec 2022() is a common nosocomial pathogen. However, associated meningitis and brain abscess formation are extremely rare in the United States. We present a case of a...
() is a common nosocomial pathogen. However, associated meningitis and brain abscess formation are extremely rare in the United States. We present a case of a 73-year-old male who initially presented for a tonsillar abscess of unknown etiology. While awaiting an abscess biopsy, the patient underwent molar extraction for chronic periodontitis and decay. The patient subsequently developed bacteremia and meningitis. As he clinically declined, repeat imaging revealed a brain abscess with eventual hemorrhagic transformation. Notably, the patient had underlying hypogammaglobulinemia from chronic lymphocytic leukemia (CLL), which we believe contributed to the invasive disease. Given the global spread of virulent strains of (such as hypervirulent or hypermucoviscous ), clinicians must bear this pathogen in mind while treating critically ill and immunocompromised patients.
PubMed: 36644065
DOI: 10.7759/cureus.32479 -
British Journal of Haematology May 2023The effective prophylaxis and treatment of central nervous system (CNS) involvement in acute lymphoblastic leukaemia (ALL) remains a significant clinical challenge....
The effective prophylaxis and treatment of central nervous system (CNS) involvement in acute lymphoblastic leukaemia (ALL) remains a significant clinical challenge. Developing novel and more effective CNS-directed therapies has been hampered, in part, by our limited understanding of the leukaemia niche in the CNS relative to the bone marrow. Accordingly, defining the molecular and cellular components critical for the establishment and maintenance of the CNS leukaemia niche may lead to new therapeutic opportunities. In prior work we showed that direct intercellular interactions between leukaemia and meningeal cells enhance leukaemia chemoresistance in the CNS. Herein, we show that the CXCR4/CXCL12 chemokine axis contributes to leukaemia-meningeal cell adhesion. Importantly, clinically tested CXCR4 antagonists, which are likely to cross the blood-brain and blood-cerebral spinal fluid barriers and penetrate the CNS, effectively disrupted leukaemia-meningeal cell adhesion. Moreover, by disrupting these intercellular interactions, CXCR4 antagonists attenuated leukaemia chemoresistance in leukaemia-meningeal cell co-culture experiments and enhanced the efficacy of cytarabine in targeting leukaemia cells in the meninges in vivo. This work identifies the CXCR4/CXCL12 axis as an important regulator of intercellular interactions within the CNS leukaemia niche and supports further testing of the therapeutic efficacy of CXCR4 antagonists in overcoming CNS niche-mediated chemoresistance.
Topics: Humans; Cell Adhesion; Drug Resistance, Neoplasm; Leukemia; Signal Transduction; Receptors, CXCR4; Chemokine CXCL12; Meninges
PubMed: 36535585
DOI: 10.1111/bjh.18607 -
Journal of Adolescent and Young Adult... Aug 2023This study was undertaken to describe the Adolescents and Young Adults' (AYA-aged patients') neuro-oncology care pathways at Grenoble Alpes University Hospital... (Observational Study)
Observational Study
This study was undertaken to describe the Adolescents and Young Adults' (AYA-aged patients') neuro-oncology care pathways at Grenoble Alpes University Hospital according to the French health recommendations. A retrospective monocentric observational study was conducted between 2020 and 2021, on patients 13-29 years of age, diagnosed from January 2013 to 2019 in our institute with a primary brain tumor, excluding meningiomas, schwannomas, and neurinomas. The detailed analysis took into account the type of care unit (adult or pediatric), whether or not a dedicated AYA support team was involved, and various pretherapeutic actions. Sixty patients were included in this study. Three of the 9 key stages of the care process were completed regardless of the type of management. Management in a pediatric oncology department seems to improve multidisciplinary discussions and access to the AYA team. Collaboration with an AYA team seems to improve the recourse to pediatric advice and supportive care. Increased vigilance at all key steps as defined in the recommendations of the Directorate General of Healthcare Services would significantly improve the overall quality of care for this specific population. In the absence of a dedicated AYA hospitalization unit, interdisciplinary cooperation between the different professionals of the adult and pediatric services is essential, and the involvement of the AYA mobile team is a factor that favors links and exchanges and ultimately an overall improvement in patient care and life. We propose our vision of an ideal AYA neuro-oncology care pathway.
Topics: Humans; Adolescent; Young Adult; Child; Aged; Neoplasms; Critical Pathways; Retrospective Studies; Neurilemmoma; Meningeal Neoplasms; Brain Neoplasms
PubMed: 36409519
DOI: 10.1089/jayao.2022.0061 -
Pediatric Neurosurgery 2022Following cranial irradiation, there is an increased risk of developing secondary neoplasms, especially meningiomas. Despite childhood cancer survivors who have... (Review)
Review
INTRODUCTION
Following cranial irradiation, there is an increased risk of developing secondary neoplasms, especially meningiomas. Despite childhood cancer survivors who have undergone cranial irradiation having an increased risk of acquiring radiation-induced meningioma (RIM), there is no widely used standard guideline for meningioma screening.
METHODS
At a single institution, we reviewed three adult survivors of childhood cancer who were treated for RIM between 2010 and 2020. We recorded age at diagnosis for the primary lesion, the radiation dose, age at RIM diagnosis, and tumor characteristics including treatment, pathology, and outcome. Two had had T-cell acute lymphocytic leukemia and one a rhabdomyosarcoma. The age of diagnosis of the RIM ranged from 20 to 40 years, with latencies ranging from 18 to 33 years. All lesions were classified as WHO Grade I meningiomas, and only 1 patient had a subsequent recurrence. A literature search identified articles that address RIM: a total of 684 cases were identified in 36 publications.
RESULTS
Mean radiation doses ranged from 1.4 gray to 70 gray. Mean age of diagnosis for secondary meningioma ranged from 8 to 53.4 years old, with latency periods ranging from 2.8 to 44 years. Given variability in the way that investigators have published their results, it is difficult to make a single recommendation for RIM screening. Using our experience and the literature, we devised two different screening protocols and calculated their expense.
CONCLUSIONS
We recommend that data be standardized in a registry to provide greater insight into the clinical and resource allocation questions, especially as long-term survival of children with pediatric cancer into full adulthood becomes more commonplace worldwide.
Topics: Child; Adult; Humans; Adolescent; Young Adult; Middle Aged; Meningioma; Neoplasms, Radiation-Induced; Cranial Irradiation; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Meningeal Neoplasms
PubMed: 36252549
DOI: 10.1159/000527565 -
Turkish Journal of Haematology :... Dec 2022
Topics: Child; Humans; Methotrexate; Arachnoiditis; Precursor Cell Lymphoblastic Leukemia-Lymphoma
PubMed: 36172826
DOI: 10.4274/tjh.galenos.2022.2022.0379 -
International Journal of Applied &... 2022The central nervous system is often a site of spread for patients with acute lymphoblastic leukemia (ALL). ALL is often treated with ongoing intrathecal chemotherapy...
The central nervous system is often a site of spread for patients with acute lymphoblastic leukemia (ALL). ALL is often treated with ongoing intrathecal chemotherapy with the most common regimens including methotrexate and/or cytarabine. Uncommonly, intrathecal methotrexate has been associated with stroke-like symptoms. To the author's knowledge, we present the first reported case of a patient who developed symptoms more akin to bacterial meningitis than stroke-like symptoms as a consequence of intrathecal methotrexate chemotherapy.
PubMed: 36131864
DOI: 10.4103/ijabmr.ijabmr_729_21 -
Journal of Neuro-oncology Oct 2022Leptomeningeal metastatic disease (LMD) from advanced malignancies has poor prognoses and limited treatments. Intrathecal therapy (ITT) protocols are available, showing... (Review)
Review
PURPOSE
Leptomeningeal metastatic disease (LMD) from advanced malignancies has poor prognoses and limited treatments. Intrathecal therapy (ITT) protocols are available, showing variable outcomes. We reviewed the therapeutic and toxicity profiles of ITT in LMD.
METHODS
PubMed, EMBASE, Web-of-Science, and Scopus were searched following the PRISMA-ScR guidelines to include studies reporting ITT for LMD.
CLINICALTRIAL
gov and Cochrane were searched to identify ongoing clinical trials.
RESULTS
We included 27 published studies encompassing 2161 patients and 4 ongoing trials. LMD originated from brain metastases (85.5%), lymphomas (5.4%), high-grade gliomas (4.6%), medulloblastomas (2.3%), and leukemias (2.1%). LMD was mostly diagnosed with the co-presence of neurological-related symptoms and positive imaging and/or cerebrospinal fluid cytology (60.8%). The most common ITT agents were methotrexate (35.9%), cytarabine (21.9%), and thiotepa (8.2%), standalone or combined. Patients received a median of 6.5 ITT cycles (range, 1.0-71.0) via intraventricular (58.8%) or lumbar intrathecal (41.2%) routes. The Ommaya reservoir was implanted in 38.5% cases. Concurrent systemic chemotherapy (45.2%) and/or radiotherapy (30.6%) were used. After 1-3 cycles, 44.7% patients had improved clinical status and 29.9% converted into negative cerebrospinal fluid cytology. The most common ITT-related severe adverse events were neutropenia (6.5%), meningitis (5.2%) and encephalopathy (4.5%). Median freedom from progression was 2.4 months (range, 0.1-59.5) and median overall survival 5.5 months (range, 0.1-148.0).
CONCLUSION
Current ITT protocols are variable but effective and well-tolerated in LMD. Ongoing trials are investigating dose-limiting toxicity profiles and long-term overall survival. Future studies should analyze the therapeutic and safety profiles of ITT compared to newer systemic therapies.
Topics: Humans; Brain Neoplasms; Combined Modality Therapy; Cytarabine; Immunotherapy; Meningeal Carcinomatosis; Meningeal Neoplasms
PubMed: 35999434
DOI: 10.1007/s11060-022-04118-0 -
Hematology Reports Aug 2022The congenital immune system includes neutrophils, which perform a variety of functions. Congenital and acquired neutropenia are rare illnesses with an underestimated...
The congenital immune system includes neutrophils, which perform a variety of functions. Congenital and acquired neutropenia are rare illnesses with an underestimated prevalence in children. The aim of this study is to examine the epidemiology and etiology of febrile neutropenia in children at Haiphong Children's Hospital, Haiphong, Vietnam. A cross-sectional study was carried out on 421 febrile neutropenia children. Clinical and laboratory characteristics were examined. The median age (IQR) was 25.0 (12.5-59.5) months. The male-to-female ratio was 1.35/1. There were twice as many children living in the suburbs (66.98%) as in urban areas (33.02%). The mean (SD) temperature at admission was 38.50 ± 0.59 °C. Diagnosed causes associated with neutropenia included acute respiratory infections 250 (59.45%), gastrointestinal infections 68 (16.1%), erythema 37 (8.79%), acute leukemia 15 (3.56%), urinary tract infection 5 (1.19%), and encephalitis/meningitis 4 (0.95%). Viral etiology accounted for 61.52% (259): -50.19% (130), -31.27% (81), -14.67% (38), 1-93% (5), rotavirus-1.54% (4), and -0.4% (1). Twenty-five patients (5.94%) were found to have bacteria in their cultures, with being the most common (eight patients; 32%). Febrile neutropenia was common in children under 2 years old. Primary clinical manifestations were acute upper respiratory tract infections, and viruses most commonly caused febrile neutropenia. Further studies with larger sample sizes are needed to determine the cause of febrile neutropenia.
PubMed: 35997401
DOI: 10.3390/hematolrep14030034 -
The Permanente Journal Jun 2022Introduction Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in Western countries. Extramedullary involvement in the central nervous system (CNS) is...
Introduction Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in Western countries. Extramedullary involvement in the central nervous system (CNS) is a rare complication of the disease, and less than 200 cases have been reported. We report a case of leptomeningeal involvement of CLL that presented as an acute encephalopathy. Case presentation A 76-year-old man with treatment-naïve, Rai stage 0 CLL presented with altered mental status. Cerebrospinal-fluid studies, including flow cytometry, confirmed the leptomeningeal involvement of the previously diagnosed CLL. Surveillance imaging and lab studies showed no evidence of disease progression or Richter's transformation. One-time intrathecal methotrexate resulted in transient improvement of his mental status. Conclusion CLL patients with new-onset neurologic manifestations should be evaluated for the CNS involvement of the neoplasm via brain imaging and cerebrospinal-fluid flow cytometry. This CNS involvement of CLL is associated with poor clinical outcomes. Intrathecal treatment with methotrexate, cytarabine, and steroid may improve neurologic symptoms.
Topics: Adult; Aged; Brain Diseases; Disease Progression; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Meninges; Methotrexate
PubMed: 35933656
DOI: 10.7812/TPP/21.081