IntroductionPatients submitted to hematopoietic stem cell transplantation have an increased risk of Clostridium difficile infection and multiple risk factors have been identified. Published reports have indicated an incidence from 9% to 30% of transplant patients however to date there is no information about infection in these patients in Chile.MethodsA retrospective analysis was performed of patients who developed C. difficile infection after hematopoietic stem cell transplantations from 2000 to 2013. Statistical analysis used the Statistical Package for the Social Sciences software.ResultsTwo hundred and fifty patients were studied (mean age: 39 years; range: 17–69), with 147 (59%) receiving allogeneic transplants and 103 (41%) receiving autologous transplants. One hundred and ninety-two (77%) patients had diarrhea, with 25 (10%) cases of C. difficile infection being confirmed. Twenty infected patients had undergone allogeneic transplants, of which ten had acute lymphoblastic leukemia, three had acute myeloid leukemia and seven had other diseases (myelodysplastic syndrome, chronic myeloid leukemia, severe aplastic anemia). In the autologous transplant group, five patients had C. difficile infection; two had multiple myeloma, one had amyloidosis, one had acute myeloid leukemia and one had germinal carcinoma. The overall incidence of C. difficile infection was 4% within the first week, 6.4% in the first month and 10% in one year, with no difference in overall survival between infected and non-infected groups (72.0% vs. 67.6%, respectively; p-value = 0.56). Patients infected after allogeneic transplants had a slower time to neutrophil engraftment compared to non-infected patients (17.5 vs. 14.9 days, respectively; p-value = 0.008). In the autologous transplant group there was no significant difference in the neutrophil engraftment time between infected and non-infected patients (12.5 days vs. 11.8 days, respectively; p-value = 0.71). In the allogeneic transplant group, the median time to acute graft-versus-host disease was similar between the two groups (p-value = 0.08), as was the incidence of grades 1–4 acute graft-versus-host disease (40% vs. 48%; p-value >0.05).ConclusionThe incidence of C. difficile infection after hematopoietic stem cell transplantation was low, with a significant number of cases occurring shortly after transplantation. Allogeneic transplants had a three-time higher risk of infection compared to autologous transplants, but this was not associated with increased mortality, decreased overall survival or higher risk of acute graft-versus-host disease.

IntroductionWe present the case of a patient with acquired hemophagocytic syndrome secondary to parainfluenza virus infection, a complication that has not, to the best of our knowledge, been previously reported.Case presentationA 33-year-old Chilean man with fever secondary to parainfluenza 2 virus infection developed progressive cholestasis, hepatosplenomegaly, cytopenia and an increased ferritin level (>2000IU/L). A bone marrow analysis showed hemophagocytosis. Our patient received HLH-94 chemotherapy, and he achieved complete and sustained remission after a two-year follow-up, without the need for hematopoietic stem cell transplantation.ConclusionHemophagocytic syndrome is a severe disease with high mortality. A high index of suspicion is essential to improve survival. A viral etiology is frequent and although Epstein-Barr virus is the most frequently associated, other viruses like parainfluenza can cause this disease.

Aldrich (2), neuroblastoma (2) and 1 osteopetrosis and 1 medulloblastoma. Norovirus was detected by RNA RT-PCR test of stool performed by Focus Diagnostics, Cypress, Ca. The dose of Nitazoxanide was 100 mg po BID for ages 1 to 4 years, 200 mg po BID for age 4 to 11 years, and 500 mg po BID for greater than 11 years. 1 pt, 33 months post allo HSCT with normal immune studies was not treated as symptoms resolved prior to test result. All other pts clinically responded with improvements in diarrhea, nausea, and abdominal pain in 2-4 days (median 2 days). 3 pts were pre-HSCT on chemo/immunotherapy and 11 were 17 days to 34 months after HSCT. All the treated pts were on immune suppression or chemotherapy. 9 allo HSCT pts were on immunosuppression and 5 of these had GVHD at onset of symptoms. Immune suppression included tacrolimus/solumedrol (3), cellcept/solumedrol (2) plus infliximab (1), tacrolimus (1), cyclosporine (1), tacrolimus/cellcept (1). 3 pts were receiving immunotherapy (1), or chemotherapy for solid tumors (2) prior to planned HSCT. 1 pt was 10 months post auto HSCT. Clearance of stool virus was variable. 2/3 pts treated prior to HSCT became negative on stool study within 5-14 days of treatment (1 unknown duration). Among pts treated after HSCT 4/9 had persistent viral shedding, 2 received drug until death (1 adenovirus, 1 CHF) both were treated greater than 2 months, 3 with GVHD still shed virus after 6 months of treatment, and 4 are off therapy and remain negative for norovirus RNA. 1 auto HSCT pt stopped viral shedding 2 months post starting Nitazoxanide. 2 HSCT pts with clinical resolution but persistent viral shedding stopped treatment and had clinical symptoms return. These pts responded to restarting therapy within 2 days but continue to shed virus. UGI endoscopy/colonoscopy were performed in 5 pts at the time of infection, all showed inflammation/edema but no GVHD was seen on histology. Peripheral blood CD4 counts among those with persistent viral shedding ranged from <50-445/ul and for those that cleared virus 143-1222/ul. Nitazoxanide is effective therapy for norovirus gastroenteritis in immune compromised patients. Therapy needs to be continued until stool RNA studies become negative.

Azacitidine can prolong survival but with significant adverse effects. Untreated patients had a high early mortality.

Introduction: Patients undergoing hematopoietic cell transplantation (HCT) have an increased risk of Clostridium difficile infection (CD) and multiple risk factors have been found. Literature reports CD infection in nearly 20% of transplanted patients. No information about this infection in HCT patients has been reported in Chile. Patients and Methods: We performed a retrospective analysis of 250 patients undergoing HCT at the Catholic University Hospital in Santiago, Chile, between 2000 and the first semester of 2013, including allogeneic (allo) HCT and autologous (auto) HCT patients. Statistical analysis of the data was conducted using SPSS Statistics v21. Results: Of the 250 transplanted patients studied, 59% (n=147) were allo-HCT and 41% (n=103) were auto-HCT. The mean age was 39 years old (range: 15-69), with a male predominance (151 patients; 60%). The main indication for HCT was acute leukemia (n=104; 42%) followed by multiple myeloma (n=36; 14%) and lymphoma (n=49; 20%). 93% of patients received myeloablative (MA) conditioning regimen, and all of them received proton pump inhibitors and prophylactic antibiotics during the previous months of the HCT. Of the 250 patients studied, 192 (77%) had at least one episode of diarrhea that required study, among them 13% (n=25) were documented as positive for CD (toxin assay or PCR test), the mean age of this group was 36 years old (range: 18-62), also with a male predominance (15 patients; 60%). All of the infected patients had mild to moderate diseases and there were no deaths attributed to it. 80% (n=20) of the infected patients underwent allo-HCT and 20% (n=5) auto-HCT. In the allo-HCT group, 53% had acute lymphoblastic leukemia (ALL), 6% acute myeloid leukemia (AML), 24% chronic myeloid leukemia (CML) and 12% other causes. In the auto-HCT group, 40% were transplanted due to multiple myeloma, 20% amyloidosis, 20% germinal cancer and 20% acute myeloid leukemia. No patient required total central parenteral nutrition previous to the infection. During the 3 months before HCT, 84% (n=21) of the infected patients used antibiotics including cephalosporins, carbapenem, aminoglicosides and vamcomycin. The overall incidence of CD infection in the first week, month and year after transplant, was 4.0%, 6.4% and 10%, respectively, with a median time frame from transplantation to infection diagnosis of 20 days. In auto-HCT, 7 days, 30 days and 1 year CD incidence was 1.9, 2.9 and 4.9%, respectively. In allo-HCT, 7 days, 30 days and 1 year CD incidence was 5.4, 8.8 and 13.6%, respectively. There was no significant statistical difference in overall survival (OS) between the infected and non-infected patients one year after the transplant (OS 67.6% for CD negative vs. 72.0% for CD positive, p=0.61). Conclusions: In our institution CD infection in patients undergoing HCT had a similar incidence to other reports. Most of cases occur before the first week after HCT (40% of the cases), and the incidence of the infection remained stable during the first year after the procedure. We identified the type of transplant (allo-HCT 3 times higher risk than auto-HCT) and disease (ALL 3 times higher risk than AML) as risk factors for CD infection. Disclosures No relevant conflicts of interest to declare.