No abstract

During the 10-yr study period, 16 patients were diagnosed with childhood-onset SLE. Five of them (31%) had pulmonary involvement including acute lupus pneumonitis, invasive pulmonary aspergillosis, cytomegalovirus pneumonia and pulmonary haemorrhage (in two patients). These 5 patients with lupus lung disease are presented in more detail.

Summary:We report a unique case of brucellosis transmitted by BMT. An 8-year-old boy with the diagnosis of Fanconi's anemia received an allogeneic BMT from his HLAidentical sibling. Routine culture from the infused marrow suspension grew Brucella abortus on day +4 post BMT. Spiking fevers occurred on days +2 and +16. The first febrile episode responded to broad-spectrum antibiotic therapy. However, the second episode did not. B. abortus was isolated from blood cultures taken during the second febrile episode. The Brucella agglutination titer was negative. Antibiotic therapy with oral doxycycline and i.v. gentamycin was successful with no recurrence of infection during 13 months of follow-up. The donor's blood culture was also positive for B. abortus and Brucella antibodies were detectable at 1:320 titer when he presented with fever and hepatosplenomegaly on day +32. We emphasize the need to consider brucellosis in patients undergoing BMT. We suggest that donor and recipient be evaluated for brucellosis especially in countries where the incidence of this infection is relatively high. Bone Marrow Transplantation (2000) 26, 225-226. Keywords: brucellosis; bone marrow transplantation; infection Brucellosis continues to be an important health problem worldwide, mainly in the Mediterranean area and in developing countries. It is primarily a zoonotic infection which can be transmitted to humans through direct contact with infected animals and through consumption of unpasteurized milk or milk products. Human to human transmission of brucellosis is extremely rare. Transmission of Brucella by blood transfusion has been described, 1,2 however, there are no reports in the literature concerning brucellosis occurring in a recipient of bone marrow transplantation. A patient who received bone marrow cells containing Brucella melitensis has been reported, although brucellosis in this recipient could not be demonstrated. 3 We report the case of a patient with bacteriologically documented brucellosis transmitted by BMT. Case reportAn 8-year-old boy with Fanconi's anemia received an allogeneic BMT from his HLA-identical brother. Conditioning consisted of oral busulphan 6 mg/kg/total dose for 4 days and intravenous cyclophosphamide 40 mg/kg/total dose for 4 days. Since there was a bidirectional ABO incompatibility, bone marrow was infused after RBC and plasma depletion. The nucleated cell dose of marrow was 2 × 10 8 /kg. A routine culture was sent from the bone marrow suspension. Selective gut decontamination with ciprofloxacin and fluconazole was administered during neutropenia. Graft-versus-host disease (GVHD) prophylaxis was cyclosporin A 3 mg/kg/day i.v. and methotrexate 5 mg/kg i.v. for three doses after transplant. An absolute neutrophil count (ANC) of over 500/mm 3 occurred on day +11, and a platelet count of over 20 000/mm 3 on day +28. Grade I acute GVHD occurred on day +28.The early post-transplant course was complicated by fever that developed on day +2. Broad-spectrum antibiotic therapy with meropenem was started and th...

This study in a small cohort of patients suggests that the use of colistin in severe nosocomial infections caused by multidrug-resistant Gram-negative bacteria is well-tolerated and efficacious.

In order to determine the role of levels of acute phase proteins (APPs) for the development of amyloidosis in familial Mediterranean fever (FMF) patients, the levels of serum amyloid A (SAA), C reactive protein (CRP), fibrinogen and erythrocyte sedimentation rate were measured in paired sera of 36 FMF patients during and in between acute attacks, 39 of their healthy parents (obligate heterozgotes), and 15 patients with FMF associated amyloidosis. To compare the levels of APPs, 39 patients with chronic infections or inflammatory diseases who may develop secondary amyloidosis, 20 patients with acute infections who are known to have elevated acute phase response but will never develop amyloidosis and 19 healthy controls were included. The median levels of all APPs are increased in the patients with FMF during attacks and a significant decrease was observed after the attack was over. The level of SAA was above reference range in all FMF patients during the attack free period and the level of at least one other APP was also above normal in 64% of the patients. Both CRP and SAA levels were found to be higher in obligate heterozygotes compared to controls. The levels of SAA in patients with FMF during the attack-free period, obligate heterozygotes and patients with FMF-amyloidosis were found to be similar. The levels in each group were found to be higher than SAA levels found in healthy controls yet lower than the levels measured in the patients with acute infections and patients with chronic inflammation or chronic infections. In conclusion, our results show that SAA level reflects subclinical inflammation with high sensitivity but its value for the prediction of amyloid formation process seems to be low.