PubMed Health⌕ Search

Biomedical subjects

H Funada

Publications and source records attributed to H Funada.

At least 37 records · Page 2Linked to original sources
PubMed1992

Effect of recombinant human granulocyte colony-stimulating factor (G-CSF) in the treatment of Pseudomonas aeruginosa bacteremia complicating hematologic malignancy--a preliminary study.

The efficacy of recombinant human granulocyte colony-stimulating factor (G-CSF) in the treatment of Pseudomonas aeruginosa bacteremia in cancer patients receiving intensive chemotherapy was studied retrospectively. In 14 of the 24 episodes of P. aeruginosa bacteremia, which occurred in 23 severely neutropenic patients with hematologic malignancies during a three-year period, G-CSF was given subcutaneously or intravenously at daily doses of 75 micrograms/body to 200 micrograms/m2 of body surface. Overall, survival at one week after onset was observed in 13 patients (54%). Treatment with G-CSF, however, had no statistically significant association with one-week survival, although a favorable outcome was well correlated with an increase in the neutrophil count during therapy. On the other hand, septic shock and appropriate antibiotic therapy were the major prognostic factors. The frequency of shock was reduced by appropriate therapy, but not by G-CSF treatment. These preliminary findings thus suggested that G-CSF should not be effective in the treatment of neutropenic cancer patients with P. aeruginosa bacteremia. No adverse effects of G-CSF were observed.

Adolescent↗
PubMed1992

[Clinical approach to infection in patients with hematologic malignancy].

Patients with hematologic malignancy are susceptible to infection because of the disease process and its treatment. Profoundly granulocytopenic patients are at increased risk of developing Pseudomonas aeruginosa bacteremia, often with a fatal outcome. Therapy with one or two anti-pseudomonal beta-lactam antibiotics and an aminoglycoside in combination that were effective in vitro against the infecting organism proved to be superior, by one-week survival, to therapy with either one in vitro effective beta-lactam or aminoglycoside or inadequate drugs. On the other hand, treatment with granulocyte colony-stimulating factor had no significant association with longer survival, although a favorable outcome was well correlated with an increase in the granulocyte count during therapy. An active mycobacteriosis was documented in 2% of all patients with hematologic malignancy. Dissemination occurred in half of them. The prognosis of tuberculosis was depended mainly on early diagnosis and treatment, while that for the atypical variety was largely influenced by the underlying disease. The frequency of deep fungal infection in patients with acute leukemia at autopsy increased progressively from 10% in 1970-1974 to 38% in 1983-1986, but it decreased somewhat to 29% in 1987-1989 after the introduction of empiric amphotericin B therapy in 1986. Early empiric antifungal therapy should therefore be started in granulocytopenic patients with fever refractory to antibacterial therapy, because of unreliability of the current serodiagnosis. A total protective isolation for patients undergoing bone marrow transplantation (BMT) was associated with a reduced incidence of pneumonia, especially due to Aspergillus, and to a lesser extent, bacteremia. Cytomegalovirus pneumonia complicating BMT continues to have a poor prognosis, although the frequency has gradually been decreasing with the introduction of effective preventive measures. An early diagnosis and treatment as well as preventive measures is thus necessary for infection control in patients with hematologic malignancy.

Acute Disease↗
PubMed1992

[Bacteremia due to methicillin-resistant Staphylococcus aureus (MRSA)].

Bacteremia due to methicillin-resistant Staphylococcus aureus (MRSA) is most likely to occur in compromised patients with prolonged hospitalization who are receiving antibiotics, particularly beta-lactam ones. The clinical picture of MRSA bacteremia is almost the same as that of bacteremia due to methicillin-sensitive S. aureus. There seems to be no significant difference in prognosis between the two types of staphylococcal bacteremia when patients in the same disease category are considered. Vancomycin is at present the only antibiotic for the treatment of MRSA bacteremia. It is therefore important to use the drug adequately so as to prevent its adverse effects and delay the appearance of resistant organisms.

Bacteremia↗
PubMed1991

Disseminated mycobacteriosis in patients with severe hematologic disorders.

During a 20-year period disseminated mycobacteriosis occurred in 11 (1.1%) of a total of 1006 patients with severe hematologic disorders, with the frequency remaining almost unchanged. The diagnosis in three patients (27%) was made only at autopsy. Tuberculosis accounted for 64% of all cases. Female preponderance was seen with a male-to-female ratio of 3:8. The major factors associated with dissemination included immunosuppression, weight loss, old age, and diabetes mellitus. Fever was the most common clinical symptom. Chest X-ray abnormalities, hypoproteinemia, liver dysfunction, and hypoxemia were noted in most cases. The prognosis of tuberculosis depended mainly on early diagnosis and treatment, while that for the nontuberculous variety was largely influenced by the underlying disease. Thus, our findings indicated that clinicians must suspect disseminated mycobacteriosis especially in any febrile patient with recent pulmonary pathology on chest X-ray, so that an adequate trial of therapy can be provided.

Adult↗
PubMed1989

[Pseudomonas aeruginosa bacteremia associated with hematologic disorders [I]. Predisposing factors and clinical manifestations].

We experienced 57 episodes of Pseudomonas aeruginosa bacteremia in 55 patients with hematologic disorders in a 16-year period. Ninety-five percent of the patients had hematologic malignancies such as acute leukemia. All but one patient received cytotoxic or immunosuppressive therapy at or prior to the onset of bacteremia. Seventy-seven percent of the episodes occurred during profound granulocytopenia of below 100/mm3. All the patients acquired their infection in the hospital, and 96% had received antibiotic therapy during the preceding two weeks. Periodontal, anorectal, lower respiratory tract, and urogenital infections were the sources of bacteremia in about three-quarters of the episodes. Periodontal infection tended to progress to cellulitis of the face or the floor of the mouth, often resulting in bacteremia of the unimicrobial type, while anorectal infection predisposed to abscess formation, frequently leading to bacteremia of the polymicrobial type. Cellulitis at onset was seen in 35% of the episodes. Most sites of infection did not become apparent until one to three days after the onset of fever, probably because of depressed inflammatory response associated with severe granulocytopenia. The majority of patients complained of gastrointestinal symptoms such as nausea and vomiting, abdominal pain, diarrhea, and abdominal fullness at the onset of bacteremia. Major complications included bacteremic shock (63%), impaired consciousness (25%), ecthyma gangrenosum or hemorrhagic gangrenous cellulitis (18%), and jaundice (12%). Furthermore, there were one case each of endocarditis and disseminated intravascular coagulation. It was thus suggested that the clinical picture of P. aeruginosa bacteremia complicating hematologic disorders is influenced by the predisposing conditions associated with the underlying diseases and their treatment.

Acute Disease↗
PubMed1989

[Pseudomonas aeruginosa bacteremia associated with hematologic disorders [II]. Blood culture isolates and surveillance cultures].

We experienced 57 episodes of Pseudomonas aeruginosa bacteremia in 55 patients with hematologic disorders such as acute leukemia over a 16-year period. All the patients were treated on the same hospital ward. A total of 57 blood culture isolates of P. aeruginosa were divided into nine serogroups. Seventy-four percent of the isolates belonged to four serogroups, which became preponderant one after the other. Surveillance throat and/or stool cultures grew the organisms identical to the isolates from the blood at or prior to the onset of bacteremia in 75% of the episodes. Only 11% of the patients had had P. aeruginosa cultured at admission. The acquisition of the organism was closely associated with antibiotic therapy for other presumed or proved infection. On the other hand, 60% of the episodes occurred during the administration of at least one in vitro effective antibiotic. In five episodes, the patients had received an antipseudomonal penicillin and an aminoglycoside in combination, both of which proved effective in vitro against the infecting organism, when bacteremia occurred. In managing P. aeruginosa bacteremia complicating hematologic disorders, it was thus suggested that surveillance cultures should be regularly carried out, and that attention should be drawn to the occurrence of "breakthrough" bacteremia.

Acute Disease↗
PubMed1989

[Pseudomonas aeruginosa bacteremia associated with hematologic disorders [III]. Prognostic factors].

We reviewed 57 episodes of Pseudomonas aeruginosa bacteremia in 55 patients with hematologic disorders such as acute leukemia during a 16-year period, focusing especially on the prognosis. Survival at one week after onset was observed in only 39% of the episodes. Prognosis was significantly better in patients with unimicrobial bacteremia than in those with polymicrobial bacteremia (21/42 vs 1/15, p less than 0.01), in patients without shock than in those with shock (13/21 vs 9/36, p less than 0.02), in patients with granulocyte count at onset of at least 100/mm3 than in those with more marked granulocytopenia (10/13 vs 12/44, p less than 0.01), in patients with an increase in granulocyte count by at least 100/mm3 during their infection than in those without any subsequent increase (18/18 vs 4/13, p less than 0.001), and in patients with total serum protein level at onset of at least 6.0 g/dl than in those with hypoproteinemia (18/32 vs 4/25, p less than 0.01). Patients with bacteremia secondary to urogenital infection tended to have a higher one-week survival rate than those with pneumonia followed by bacteremia (4/8, 50% vs 2/9, 22%). With regard to the antibiotic treatment of unimicrobial bacteremia, 14 (70%) of 20 patients receiving therapy with one or two anti-pseudomonal beta-lactam antibiotics and an aminoglycoside in combination that were effective in vitro against the infecting organism survived, and so did only seven (32%) of 22 patients receiving therapy with either one in vitro effective beta-lactam or aminoglycoside or inadequate drugs (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1988

Bacillus cereus bacteremia in an adult with acute leukemia.

Bacillus cereus, which used to be considered non-pathogenic, was isolated from the blood of a patient with acute leukemia who was receiving intensive chemotherapy. Fatal bacteremia developed with a clinical syndrome of acute gastroenteritis, followed by both meningoencephalitis with subarachnoid hemorrhage and multiple liver abscesses probably caused by infective vasculitis. Surveillance stool cultures revealed colonization with the organism prior to the onset of diarrhea, and repetitive blood cultures were found to be positive. Thus, this case suggested some new important clinicopathologic features of true B. cereus bacteremia complicating acute leukemia.

Acute Disease↗
PubMed1988

Edwardsiella tarda septicemia complicating acute leukemia.

We describe here an unusual case of Edwardsiella tarda septicemia preceded by acute gastroenteritis in a patient with acute leukemia in complete remission receiving maintenance chemotherapy. She also had ulcerated rectal cancer with bleeding, which was thought to serve as the portal of entry into the blood stream. She was successfully treated with cefmetazole and gentamicin in combination. However, the concomitant resolution of chemotherapy-induced granulocytopenia may have had a favorable effect as well.

Acute Disease↗
PubMed1988

A clinical index for the timing of blood cultures in febrile patients with acute leukemia.

In an attempt to define a clinical index for the timing of blood cultures in febrile patients with acute leukemia, subjective symptoms at onset of bacteremia were investigated in a total of 109 consecutive episodes. General malaise, chills, and nausea and vomiting were most frequently observed (66%, 59%, and 50%, respectively). The gastrointestinal (GI) symptoms including nausea and vomiting, abdominal discomfort and fullness, abdominal pain, and diarrhea were encountered in 72% of all the episodes, forming the second largest group next to those closely associated with high fever. These GI symptoms were usually mild and of brief durations, and their occurrence had no relation to sites of infections or etiology of bacteremia. In some cases, nausea and vomiting were aggravated by intensive antileukemic chemotherapy or massive GI bleeding. It was thus suggested that GI symptoms, particularly nausea and vomiting, concomitant with a remarkable, sometimes abrupt rise in temperature during granulocytopenia may serve as a useful index for the timing for blood collection for culture to improve the probability of detection of bacteremia.

Acute Disease↗