A retrospective study was conducted to analyze the clinical features and pathogenic roles of bacteremia caused by Acinetobacter lwoffii during a 4-year period. Acinetobacter lwoffii (formerly Acinetobacter calcoaceticus var. lwoffii) is recognized as normal flora of the skin, oropharynx and perineum of healthy individuals. There are few reports of Acinetobacter lwoffii bacteremia associated with indwelling catheters in humans, particularly in immunocompromised hosts. The records of 18 patients with Acinetobacter lwoffii bacteremia whose underlying conditions included cancer (11 patients), systemic lupus erythematosus (n=1), chronic obstructive pulmonary disease (n = 2) and other diseases (n = 4), all but one of whom had indwelling catheters during the bacteremic episode, were examined. The clinical syndromes were classified as probable catheter-related bacteremia (n = 14), definite catheter-related bacteremia (n = 2), primary bacteremia (n = 1) or biliary tract infection (n = 1). The infections improved after removal of the catheter and/or appropriate antimicrobial therapy. One death was attributable to the bacteremic event. The results of this study show that indwelling catheter-related Acinetobacter lwoffii bacteremia in immunocompromised hosts appears to be associated with a low risk of mortality.

Summary:Pulmonary tuberculosis (TB) is an endemic infectious disease in Taiwan. A retrospective study was conducted to define clinical manifestations and outcomes of patients with pulmonary TB among hematopoietic stem cell transplantation (HSCT) recipients. We identified eight out of 350 HSCT recipients as having pulmonary TB over a 6-year period. The relative risk of having pulmonary TB after HSCT was 13.1-fold higher than in the general population. There was a trend toward increased risk of having pulmonary TB in allogeneic HSCT as compared to autologous HSCT (4.8 ± 1.8% vs 0, P = 0.067). All the eight patients with pulmonary TB received allogeneic HSCT and most (seven of eight patients) developed the infection during treatment for GVHD. Computed tomography of the chest was normal in one patient, with the rest showing either interstitial (two patients) or alveolar infiltrates (five patients) at the onset of pulmonary TB. The four fatal cases had an obviously shorter duration between HSCT and onset of infection. Our data suggest that pulmonary TB in HSCT recipients is not uncommon in this endemic area. Therefore, an effective strategy of prophylactic treatment for candidates and recipients of allogeneic HSCT, who may have latent pulmonary TB infection, must be developed. Bone Marrow Transplantation (2001) 27, 1293-1297. Keywords: pulmonary tuberculosis; graft-versus-host disease; hematopoietic stem cell transplantation; prophylactic anti-tuberculous treatment Hematopoietic stem cell transplantation (HSCT) recipients are prone to acquire several kinds of opportunistic infections during the early stages of engraftment post-BMT and while receiving immunosuppressive therapy for GVHD. 1,2 The incidence, clinical characteristics, and management of opportunistic infections caused by bacterial, fungal and viral agents have been well known for decades. However, few publications have described the incidence and outcome of tuberculosis (TB) in HSCT recipients. 1,3-10 Pulmonary TB in Taiwan is common: 30 cases/10 5 inhabitants/year for age Ͻ50 years and 221 cases/10 5 inhabitants/year for age у50 years, respectively. 11 In 1998, the prevalence of TB in the adult (age у20 years) general population was 0.65%. 11 In HSCT recipients, the disease may pose an even greater problem, since the impaired cellular immunity renders these patients susceptible to infection, as is the case in those with autoimmune disorders or compromised immunity. For example, in HIV-infected patients, the incidence of pulmonary TB is 17.3%, making it the second most common infection after Pneumocystis carinii pneumonia. 11,12 In this report, a retrospective study was conducted to define the characteristics and incidence of pulmonary TB in HSCT recipients during a 6-year period in a tertiary referral hospital. Demographic data, risk factors, clinical presentations and outcomes are described. Chest radiographs and computed tomography (CT) of patients with pulmonary TB were reviewed. Patients and methods PatientsThree hundred and fifty patients who underwe...

To evaluate postextubation swallowing dysfunction (PSD) 21 days after endotracheal extubation and to examine whether PSD is time-limited and whether age matters.For this prospective cohort study, we evaluated 151 adult critical care patients (≥20 years) who were intubated for at least 48 hours and had no pre-existing neuromuscular disease or swallowing dysfunction. Participants were assessed for time (days) to pass bedside swallow evaluations (swallow 50 mL of water without difficulty) and to resume total oral intake. Outcomes were compared between younger (20–64 years) and older participants (≥65 years).PSD, defined as inability to swallow 50 mL of water within 48 hours after extubation, affected 92 participants (61.7% of our sample). At 21 days postextubation, 17 participants (15.5%) still failed to resume total oral intake and were feeding-tube dependent. We found that older participants had higher PSD rates at 7, 14, and 21 days postextubation, and took significantly longer to pass the bedside swallow evaluations (5.0 vs 3.0 days; P = 0.006) and to resume total oral intake (5.0 vs 3.0 days; P = 0.003) than their younger counterparts. Older participants also had significantly higher rates of subsequent feeding-tube dependence than younger patients (24.1 vs 5.8%; P = 0.008).Excluding patients with pre-existing neuromuscular dysfunction, PSD is common and prolonged. Age matters in the time needed to recover. Swallowing and oral intake should be monitored and interventions made, if needed, in the first 7 to 14 days postextubation, particularly for older patients.

Cryptococcosis and TB co-infection, although rare, develops in both immunocompromised and healthy individuals. Early diagnosis and treatment may improve patient prognosis. There should be a high index of suspicion in order to achieve a timely diagnosis in a TB endemic area.

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