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Infections complicating bone marrow transplantation
638
Pathology (1981), 13, July
ROYAL COLLEGE OF PATHOLOGISTS OF AUSTRALASIA INFECTIONS COMPLICATING BONE MARROW TRANSPLANTATION
J. L. HARKNESS. D. MA& J. C. BIGGS Deparrments qfMicrohiology and Huematology. St. Vincent’s Hospital. Svdnej Sixteen patients have undergone allogeneic bone marrow transplantation since October 1975. 5/7 (71%) patients with aplastic anaemia have survived between 4 and 44 mth and 2!9 (22O.J patients with acute leukaemia have survived 12 and 20 mth later. The most important infective complications have been due to Cytoniegalovirus (CMV) in 11/16 (69%), Herpes simple.\- virus (HSV) in 9 16 (560,,), Candida alhicans in 6:16 (374,) and bacterial septicaemia in 3/16 (19%). All patients had febrile episodes post transplant requiring empirical use ofantibiotics; cultures were negative. Episodes of infection due to Aspergillus .%p. Fusariunl sp. Mycnhactzrium tuberculosis, Salmonella hovis morh$cans, Pseudomonas malropiiiliu and Pneuniocjsstis carinii were also documented. Diagnostic methods and the management of these patients will be discussed. Infections, particularly due to CMV and HSV contributed significantly to the mortality of 8!9 patients who died following bone marrow transplantation. ACTIVITY OF AMINOGLYCOSIDES AND CARBENICILLIN-LIKE PENICILLINS ALONE AND IN COMBINATION AGAINST PSEUDOMONAS AERUGlNOSA ALISENELSOX& DAVID HANSMASDeprirtnzenr of Microbiology, Adeluide Children’s Hospilal
In bacteraeniic and other severe infections caused by Pseudomonas aeruginosu combined therapy with an aminoglycoside + carbenicillin (or a related penicillin) is the chemotherapy of choice. We tested the sensitivity of 25 isolates of P. aeruginosa to carbenicillin. ticarcillin and azlocillin, and to gentamicin. tobrdmycin, amikaciin ‘and sisomicin. Tests were done by plate titration using Mueller-Hinton agar containing added calcium chloride and magnesium chloride, in a final concentration of Ca’ 56 mg:l and Mg+ 22.8 mg/l before the addition of agar. The replica-plating device used delivered an inoculum of about lo4colony forming units in a drop volume of 3 pl. The order of activity was tobramycin > sisomicin > amikacin > gentamicin; and azlocillin > ticarcillin > carbenicillin. The median minimal inhibitory concentration (MIC)of tobrdmycin was 2 pg per ml (range 0.2 to 5 pg per mi):the median MIC of azlocillin was S fig per ml (range 0.2 to 25 pg per ml). Tests were also done with 12 different combinations of a carbenicillin-like drug plus an aminoglycoside, using an isolate of Ps. aeruginosa from a child with bacteraemia. The most active combinations included either sisomicin or tobramycin; for example, the MIC of azlocillin alone was 5 pg per ml: in the presence of tobramycin 2 pg per ml it was reduced to G0.2 pg azlocillin per ml. +
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ACUTE OSTEOMYELITIS IN CHILDREN (ADELAIDE) 1975 THROUGH 1979
SYLVIA MORRIS & DAVIDHANSMANDepartmeni of Microhinlngy, Adeluide Children’s Hospilal All cases of acute ostemomyelitis amongst children without pre-existing bone disease at the Adelaide Children’s Hospital were analysed for the 5-yr period 1975 through 1979. There were 104cases. The children had a median age of 7 yr, age range 6 wk to 16 yr. There were more than twice as many cases in summer (41) as in winter (16) with an almost equal prevalence in autumn (23) and in spring (24). Boys outnumbered girls 2:l. The commonest site affected was the foot (25 cases) followed by the tibia (21) and the femur (19). Lower limb sites totalled 76 (73”,,of all cases). Next in order of prevalence were the upper limb (10 including humerus 5), pelvis (8), spine (6) and skull (2). In 2 children 2 sites were affected. Blood or bone cultures (or both) were collected from 88 children. Of these 59 (67%) yielded a pathogen: 49 Staphylococcus aureus. 4 Sireprococcus p>.ogenes, 3 Pseudomonas aeruginosn (one with Stuphylococcus aureus as well), 2 a pneumococcus and one Mxcohacferiurn /uherculosis(froma Vietnamese orphan). The remaining 29 (33%) failed to yield a pathogen. Osteomyelitis caused by Haemophilus inyuenzae was not encountered. HISTOPATHOLOGY
AUTOPSY FINDINGS IN BONE MARROW TRANSPLANTATION
D. H. MOIRFOR
THE ST.VINCENT’S HOSPITAL BONEMARROW TRANSPLANT TEAM* Department qf
Anatomical Pathologj,, St. 17incenr’s Hospital. Sydttej,
Autopsies were performed on the9 patients dying after bone marrow transplantation at St. Vincent’s Hospital. Two patients had aplastic anaemia (2’6 patients transplanted) and 7 had acute leukaemia (7/9 transplanted). Three patients with leukaemia died at 6,7 and 17 d post-transplant without marrow engraftment occurring. Two of these
Pathology (1981), 13, July
ROYAL COLLEGE OF PATHOLOGISTS OF AUSTRALASIA INFECTIONS COMPLICATING BONE MARROW TRANSPLANTATION
J. L. HARKNESS. D. MA& J. C. BIGGS Deparrments qfMicrohiology and Huematology. St. Vincent’s Hospital. Svdnej Sixteen patients have undergone allogeneic bone marrow transplantation since October 1975. 5/7 (71%) patients with aplastic anaemia have survived between 4 and 44 mth and 2!9 (22O.J patients with acute leukaemia have survived 12 and 20 mth later. The most important infective complications have been due to Cytoniegalovirus (CMV) in 11/16 (69%), Herpes simple.\- virus (HSV) in 9 16 (560,,), Candida alhicans in 6:16 (374,) and bacterial septicaemia in 3/16 (19%). All patients had febrile episodes post transplant requiring empirical use ofantibiotics; cultures were negative. Episodes of infection due to Aspergillus .%p. Fusariunl sp. Mycnhactzrium tuberculosis, Salmonella hovis morh$cans, Pseudomonas malropiiiliu and Pneuniocjsstis carinii were also documented. Diagnostic methods and the management of these patients will be discussed. Infections, particularly due to CMV and HSV contributed significantly to the mortality of 8!9 patients who died following bone marrow transplantation. ACTIVITY OF AMINOGLYCOSIDES AND CARBENICILLIN-LIKE PENICILLINS ALONE AND IN COMBINATION AGAINST PSEUDOMONAS AERUGlNOSA ALISENELSOX& DAVID HANSMASDeprirtnzenr of Microbiology, Adeluide Children’s Hospilal
In bacteraeniic and other severe infections caused by Pseudomonas aeruginosu combined therapy with an aminoglycoside + carbenicillin (or a related penicillin) is the chemotherapy of choice. We tested the sensitivity of 25 isolates of P. aeruginosa to carbenicillin. ticarcillin and azlocillin, and to gentamicin. tobrdmycin, amikaciin ‘and sisomicin. Tests were done by plate titration using Mueller-Hinton agar containing added calcium chloride and magnesium chloride, in a final concentration of Ca’ 56 mg:l and Mg+ 22.8 mg/l before the addition of agar. The replica-plating device used delivered an inoculum of about lo4colony forming units in a drop volume of 3 pl. The order of activity was tobramycin > sisomicin > amikacin > gentamicin; and azlocillin > ticarcillin > carbenicillin. The median minimal inhibitory concentration (MIC)of tobrdmycin was 2 pg per ml (range 0.2 to 5 pg per mi):the median MIC of azlocillin was S fig per ml (range 0.2 to 25 pg per ml). Tests were also done with 12 different combinations of a carbenicillin-like drug plus an aminoglycoside, using an isolate of Ps. aeruginosa from a child with bacteraemia. The most active combinations included either sisomicin or tobramycin; for example, the MIC of azlocillin alone was 5 pg per ml: in the presence of tobramycin 2 pg per ml it was reduced to G0.2 pg azlocillin per ml. +
+
ACUTE OSTEOMYELITIS IN CHILDREN (ADELAIDE) 1975 THROUGH 1979
SYLVIA MORRIS & DAVIDHANSMANDepartmeni of Microhinlngy, Adeluide Children’s Hospilal All cases of acute ostemomyelitis amongst children without pre-existing bone disease at the Adelaide Children’s Hospital were analysed for the 5-yr period 1975 through 1979. There were 104cases. The children had a median age of 7 yr, age range 6 wk to 16 yr. There were more than twice as many cases in summer (41) as in winter (16) with an almost equal prevalence in autumn (23) and in spring (24). Boys outnumbered girls 2:l. The commonest site affected was the foot (25 cases) followed by the tibia (21) and the femur (19). Lower limb sites totalled 76 (73”,,of all cases). Next in order of prevalence were the upper limb (10 including humerus 5), pelvis (8), spine (6) and skull (2). In 2 children 2 sites were affected. Blood or bone cultures (or both) were collected from 88 children. Of these 59 (67%) yielded a pathogen: 49 Staphylococcus aureus. 4 Sireprococcus p>.ogenes, 3 Pseudomonas aeruginosn (one with Stuphylococcus aureus as well), 2 a pneumococcus and one Mxcohacferiurn /uherculosis(froma Vietnamese orphan). The remaining 29 (33%) failed to yield a pathogen. Osteomyelitis caused by Haemophilus inyuenzae was not encountered. HISTOPATHOLOGY
AUTOPSY FINDINGS IN BONE MARROW TRANSPLANTATION
D. H. MOIRFOR
THE ST.VINCENT’S HOSPITAL BONEMARROW TRANSPLANT TEAM* Department qf
Anatomical Pathologj,, St. 17incenr’s Hospital. Sydttej,
Autopsies were performed on the9 patients dying after bone marrow transplantation at St. Vincent’s Hospital. Two patients had aplastic anaemia (2’6 patients transplanted) and 7 had acute leukaemia (7/9 transplanted). Three patients with leukaemia died at 6,7 and 17 d post-transplant without marrow engraftment occurring. Two of these