Objectives: Microbiological cultures and posttransplantation course were analyzed in order to investigate the incidence and clinical significance of bacterial contamination of autologous bone marrow (BM) grafts. Methods: Cultures were obtained from BM after collection, BM concentrate after processing, contaminated/cryopreserved BM at thawing, and from peripheral blood (PB) following autologous BM transplantation (ABMT). The posttransplantation course of patients grafted with culture-positive BM was recorded and compared with patients who underwent ABMT with noncontaminated BM grafts. Results: In 239 BM grafts processed, the incidence of microbiological contamination was 26.4% (n = 63). Fifty marrow grafts were contaminated by bacteria from the skin flora: coagulase-negative Staphylococcus (CNSC), Propionibacterium, and Corynebacterium species (79%). Thirty-eight patients underwent ABMT (day 0) with cryopreserved culture-positive BM, and 32 patients were evaluable for microbiological cultures at thawing: in 10 of 32 BM grafts CNSC was found prior to reinfusion. Following ABMT, PB cultures revealed CNSC in 5 of 38 patients between days +4 and +12. However, the late occurrence of positive PB cultures after BM reinfusion made a relationship between BM CNSC and PB CNSC unlikely. In 33 of 38 patients, no graft-contaminating bacteria were detected in PB. Comparison of the posttransplantation course of patients who received contaminated BM with that of patients grafted with noncontaminated BM showed no significant differences concerning time to engraftment, febrile days, and days on antibiotics. Conclusion: (1) Collection and/or ex vivo processing can result in microbiological contamination of BM grafts predominantly with bacteria from the skin flora, and (2) only CNSC can be cultured at thawing from previously contaminated/cryopreserved BM. Since patients undergoing ABMT usually receive oral antibiotics from beginning of the conditioning regimen which are active against CNSC, no further administration of antibiotics is recommended for the reinfusion of bacterially contaminated BM grafts.
The pharmacokinetics and applicability of aerosol amphotericin B administrations were studied in 40 neutropenic patients and 4 healthy volunteers. Particle size was measured and pulmonary deposition was demonstrated by radioisotope studies. Inhalations were easy to administer and were well tolerated, with minimal systemic absorption of the drug.Invasive pulmonary aspergillosis (IPA) is a serious fungal infection in immunocompromised or neutropenic patients (3). The incidence of and mortality from IPA vary depending on the degree and duration of immunosuppression or neutropenia. After bone marrow transplantation (BMT), mortality can be as high as 95% (3, 12). Various strategies for systemic or topical prophylaxis of IPA have been developed (4,6,8,13,14,16,17), but they are still unsatisfactory (1,5,18). The use of aerosol amphotericin B (aeroAmB) is a promising approach. In a rat model, aeroAmB was effective as prophylaxis for IPA (15), and high concentrations of amphotericin B (AmB) were achieved in the lung tissues of these animals (10). Prophylactic aeroAinB has been used successfully in neutropenic patients, but little is known about the distribution and pharmacokinetics of aeroAmB in humans (2, 9). The goals of the present study were to determine the particle size, organ distribution, and pharmacokinetics of aeroAmB and to evaluate its clinical applicability. At first, the particle size of aeroAmB was determined by using a Phase-Doppler-Particle-Analyser (Aerometrics, Mountain View, Calif.), which allowed noninterfering optical measurements of individual particles at a size range of 0.53 to 18.5 ,um. For the measurements 10 mg of the AmB preparation for intravenous administration (Squibb, Munich, Federal Republic of Germany) were diluted with sterile water to a total volume of 5 ml and were placed into a RespirGard II nebulizer (Marquest, Englewood, Colo.). An air pressure of 1.8 x 105 Pa was used to drive the nebulizer, and particle sizes were measured at the mouthpiece of the device. A narrow particle size distribution was demonstrated, with a mean diameter of 2.6 ,um; 10% of the particles had a diameter of less than 0.9 ,um and 90% had a diameter of less than 4.2 ,um. The mass median diameter was 4.8 pum (Fig. 1)
(1) Collection and/or ex vivo processing can result in microbiological contamination of BM grafts predominantly with bacteria from the skin flora, and (2) only CNSC can be cultured at thawing from previously contaminated/cryopreserved BM. Since patients undergoing ABMT usually receive oral antibiotics from beginning of the conditioning regimen which are active against CNSC, no further administration of antibiotics is recommended for the reinfusion of bacterially contaminated BM grafts.
The detection in stool specimens of Cryptosporidium parvum and microsporidia, the most frequent parasitic pathogens causing diarrhea in AIDS patients, until now has depended on two different staining methods. However, since double infections occur and minimization of laboratory costs is mandatory, development of a method for simultaneous detection of these parasites appeared desirable. We report on a new, inexpensive, and easy-to-perform staining procedure to demonstrate both acid-fast oocysts of C. parvum and other coccidia, as well as microsporidial spores. This acid-fast trichrome stain yields results comparable to those obtained by the Kinyoun and modified trichrome methods and considerably reduces the time necessary for microscopic examination.
This study investigated the seroprevalence of antibodies against Anaplasma phagocytophilum in Berlin/Brandenburg, north-eastern Germany. During 1994-2001, 422 sera from patients with proven tick-exposure (specimens with antibodies against Borrelia burgdorferi) were compared with 249 control sera. Using indirect fluorescent antibody testing, significantly more positive samples were detected among Borrelia antibody-positive specimens (4.5%, 95% CI 2.5-6.5%) than among controls (1.2%, 95% CI 0.5-1.9%; p < 0.05). While six (2.2%, 95% CI 1.3-3.1%) samples were positive among Borrelia antibody-positive sera between 1994 and 1997, 13 (8.7%, 95% CI 6.9-10.5%) were positive between 1998 and 2001 (p < 0.01), indicating an uneven annual seroprevalence.
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