Adenoviruses are increasingly recognized pathogens that affect blood and marrow transplant (BMT) recipients. Experiences with 2889 adult BMT recipients were reviewed to study the incidence, clinical spectrum, risk factors for dissemination, response to therapy, and outcome of adenovirus infections. Eight-five patients (3%) were diagnosed by means of culture (n=85) or culture and histopathological examination (n=6). Nine patients had asymptomatic viruria, and 76 had symptomatic infections, which included upper respiratory tract infection (n=20), enteritis (n=18), hemorrhagic cystitis (n=10), pneumonia (n=15), and disseminated disease (n=13). The overall mortality rate was 26%. A higher mortality rate was observed among patients with pneumonia (73%) and disseminated disease (61%). Risk factors for dissemination included receipt of an allogeneic transplant, presence of graft-versus-host disease (GVHD), and receipt of concurrent immunosuppressive therapy. Intravenous ribavirin was not associated with an appreciable benefit among 12 patients who received this treatment. In conclusion, adenovirus infections are an important cause of morbidity and mortality in adult BMT recipients, particularly allogeneic transplant recipients with GVHD who are receiving immunosuppressive therapy. The need for an effective, nontoxic antiviral therapy is apparent.

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Stenotrophomonas maltophilia colonization/infection in patients with cancer has significantly increased over the past 2 decades. Patients with prolonged neutropenia, exposure to broad-spectrum antibiotics, and those requiring mechanical ventilation have higher risk of infection. These micro-organisms are intrinsically resistant to carbapenems, and exposure to these agents has been linked to selection of S. maltophilia. Recently, these infections are being documented in patients without traditional risk factors. The spectrum of infection includes bacteremia, catheter-related infection, pneumonia, complicated biliary and urinary tract infection, and skin and skin-structure infection. Trimethoprim-sulfamethoxazole is the therapeutic agent of choice, but resistance is increasingly being reported. Susceptibility to alternative agents is unpredictable. Combination therapy and alternative routes of drug administration, such as aerosolized aminoglycoside, might be necessary. New insights into the mechanisms of drug resistance might lead to identification of new target sites. Agents that improve outer-membrane permeability and broad-spectrum beta-lactamase inhibitors may favorably impact difficult-to-treat (i.e., multidrug resistant) S. maltophilia infections.

The in vitro susceptibilities of 130 Xanthomonas maltophilia isolates to 12 antibiotics-trimethoprimsulfamethoxazole, minocycline, ticarcillin-clavulanate, ceftazidime, cefoperazone, cefoperazone-sulbactam, imipenem, ciprofloxacin, and the investigational quinolones PD 117558, PD 117596, PD 127391, and sparfloxacin-were determined by a microtiter broth dilution technique. Other than the investigational quinolones, the most active antibiotics were minocycline, trimethoprim-sulfamethoxazole, and ticarcillinclavulanate, in order. However, the first two were not bactericidal, while about half of the isolates exhibited intermediate susceptibility to ticarcillin-clavulanate. Patterns of susceptibility to trimethoprim-sulfamethoxazole and ciprofloxacin relative to the years of isolation of these strains reflected the development of resistance to the antibiotic prophylaxis practices in the hospital. We recommend that a combination of antibiotics, such as trimethoprim-sulfamethoxazole, minocycline, and ticarcillin-clavulanate, at or close to the maximum tolerated doses be used in the treatment of serious X. maltophilia infections.Xanthomonas maltophilia has emerged as a significant cause of morbidity and mortality in cancer patients (5,6,18). This organism is capable of causing life-threatening infections (5, 25) and is usually resistant to multiple antimicrobial agents, particularly to those of the beta-lactam class (25). The standard therapy for infections by this organism is trimethoprimsulfamethoxazole. The newly developed quinolones, which have broad antimicrobial activity, are now being used in both prophylaxis and therapy of infections in cancer patients. However, at The University of Texas M. D. Anderson Cancer Center, we have cared for patients with serious X maltophilia infections that developed during quinolone prophylaxis. Because of our concern for the emergence of resistance of X. maltophilia to quinolones and the limited therapeutic options available to treat this potentially life-threatening infection, we studied the in vitro activities of various antimicrobial agents, including quinolones, against 130 clinical isolates of X. maltophilia.The strains of X maltophilia used in this study were single patient isolates from the clinical microbiology laboratory at M. D. Anderson Cancer Center. Eighty-nine of the cultures were isolated from patients' bloodstreams, 24 were from urine, 12 were from sputum or the throat, and 5 were from miscellaneous sources. These isolates had been collected in the infectious disease laboratories since 1981 for their clinical significance. The bacteria were identified as X. maltophilia by various biochemical tests using the API 20C system (Analytab Products, Plainview, N.Y.). Organisms were stored in the laboratory at -70°C.All antimicrobial agents were obtained in the form of standard laboratory powders and were stored at -70°C before use. The drugs tested were trimethoprim-sulfamethoxazole (Hoffmann-La Roche, Montclair, N.J.); minocycline (Lederle, Pearl River, N.Y.); ciprofloxac...

Objectives: The aim of this study was to determine if there are significant relationships between lead concentrations in children's hair and height, sitting height, and estimated leg length. Methods: We analyzed three samples collected at different times: 1998, 2002, 2007. The total sample consisted of 825 children between 11 and 14 years of age living in different municipalities of Sardinia (Italy). Inductively coupled plasma atomic emission spectrometry (1998), inductively coupled plasma atomic absorption spectrometry (2002), and inductively coupled mass spectrometry (2007) were used to measure the lead concentration in hair (PbH). Some AAS measurements were also performed on the 1998 and 2007 samples to check the reliability of the data. Results: The mean PbH is much higher in 1998 (5.84 μg/g) than in 2002 (1.49 μg/g) and 2007 (0.78 μg/g). Multivariate regression analysis of the three samples, controlling for age and sex, indicates a subclinical impact of lead on growth that differs according to the mean lead concentration in the hair. In fact, for 1998, the relationships between all three anthropometric variables and logPbH are significantly negative. For 2002, there are significant negative associations between height and estimated leg length and logPbH but not between sitting height and logPbH. For 2007, there are not significant associations between logPbH and anthropometric variables. Conclusions: Our results support the use of hair lead levels as a biomarker to assess the impact of subclinical lead on the physical growth of children, especially when the study area presents medium and/or high levels of lead pollution. Am. J. Hum. Biol., 2011. © 2011 Wiley‐Liss, Inc.