AbstractGastrointestinal tract involvement in Langerhans cell histiocytosis (LCH) is extremely rare, with limited documentation of endoscopic manifestations. We report a 19‐month‐old girl who presented with repeated diarrhea and bloody stools, accompanied by recurrent pulmonary infections, anemia, hypoproteinemia, thrombocytopenia, coagulopathy, and hepatosplenomegaly with lymphadenopathy. Initial treatment with antibacterial agents, mesalazine, thalidomide, and prednisone led to temporary improvement; however, the symptoms repeatedly relapsed. She underwent three digestive endoscopies, but until the third endoscopy, a definitive diagnosis of Langerhans cell histiocytosis was established through biopsy. While upper gastrointestinal tract findings were not significant, notable changes were observed in the colorectal region. A colonoscopy revealed progression from erythema to diffuse hyperemia and edema, with erythema, erosion, and superficial ulcers extending into the distal ileal mucosa. Genetic analysis identified a BRAF‐V600E mutation. Following treatment with chemotherapy (vincristine and prednisone) and the BRAF inhibitor dabrafenib, the patient demonstrated significant clinical improvement within days. At the 1‐year follow‐up, the patient had normal bowel movements and a weight gain of 2.5 kg. Early gastrointestinal endoscopy with multiple biopsies in suspected children can facilitate early detection. Dabrafenib is a viable treatment option for Langerhans cell histiocytosis.

2024-11-01·animal

Review: Antimicrobial resistance of Klebsiella pneumoniae isolated from poultry, cattle and pigs

Review

作者: Witeska, M ; Kot, B ; Witeska, M. ; Kot, B.

Klebsiella pneumoniae, common pathogenic bacteria, cause dangerous infectious diseases in animals and humans. Klebsiella pneumoniae have numerous resistance mechanisms to antibacterials and the frequency of resistant K. pneumoniae isolates increases, making treatment of K. pneumoniae-induced infections difficult. Farm animals are a possible source of antibacterial resistant K. pneumoniae. The aim of this literature review (2018-2024) was to evaluate the antibacterial resistance of K. pneumoniae isolated from poultry, cattle and pigs in various countries. The analysis shows that farm animals are an important source of antibacterial-resistant and multidrug-resistant K. pneumoniae and that resistance patterns differ among antibacterial groups, animals and locations. In poultry, high resistance to penicillins (91%), III and IV generation cephalosporins (> 50%) occurred, and low to carbapenems (5%) and polymyxins (6%). In cattle, high resistance to sulphonamides (76%), IV generation cephalosporins, macrolides and lincosamides, and penicillins occurred (> 50%), and low to carbapenems (10%) and polymyxins (1%). Isolates from pigs showed high resistance to I and II-generation cephalosporins, I-generation fluoroquinolones, macrolides and lincosamides, tetracyclines (> 50%) and carbapenems (> 20%), and low to polymyxins (5%). The highest resistance rates to most antibacterial groups occurred in pigs, and in Africa and Asia, while the lowest in cattle, and in North and South America. Particularly, the relatively high resistance of K. pneumoniae to carbapenems and polymyxins in Africa poses a threat to animal and human health as these antibiotics are the last resort therapeutics used to treat severe infections. Different rates of K. pneumoniae resistance to antibacterials among isolates from farm animals probably result from differences in the treatment of each animal group with various antibacterial agents and different regimes of their use in various locations.

2024-10-01·Transplant Infectious Disease

Comment on ‘Stopping antibacterial prophylaxis in pediatric allogeneic hematopoietic cell transplantation: An internal audit’

Letter

作者: Mohring, Daniela ; Schaumburg, Frieder ; Burkhardt, Birgit ; Rossig, Claudia ; Wintjes, Nina ; Groll, Andreas H. ; Kolve, Hedwig ; Kraemer, Katja

Background : Antibacterial prophylaxis in children and adolescents undergoing allogeneic hematopoietic cell transplantation (HCT) is controversial and not recommended by international guidelines.We analyzed relevant posttransplant outcomes following discontinuation of antibacterial prophylaxis at a major European pediatric transplant center.Methods : The single-center retrospective audit included all pediatric allogeneic HCT patients (pts) transplanted between 2011 and 2020 before (≤2014) and after (≥2015) stopping routine antibacterial prophylaxis with penicillin, metronidazole, and ciprofloxacin upon start of the conditioning regimen.The primary endpoint was overall survival until the first hospital discharge.Secondary endpoints included the occurrence of fever; bacterial infections; and cumulative days with antibacterial agents until discharge.Results : A total of 257 HCT procedures were performed in 249 pts (median age: 10 years, range, 0.2-22.5) for leukemia/lymphoma (n = 150) and nonmalignant disorders (n = 107).Of these, 104 procedures were performed before (cohort 1) and 153 after (cohort 2) stopping prophylaxis.Overall survival until discharge was 90.4% in cohort 1 and 96.1% in cohort 2 (p = .06).No differences were observed in the occurrence of fever (92.3 vs. 94.1%; p = .57) and bacterial infections (34.6 vs. 25.5%; p = .11).The median number of days on antibacterial agents was significantly lower in cohort 2 (39 vs. 34; p = .002).Detection rates of resistant organisms were overall low.Conclusion : In this single-center audit, the stop of routine antibacterial prophylaxis had no effect on the occurrence of fever, bacterial infections, resistant organisms, and GVHD.Overall antibiotic use was significantly reduced, and survival was noninferior to the historical control cohort.

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适应症	最高研发状态	国家/地区	公司	日期
假单胞菌感染	临床1期	-	The Ohio State University	-
假单胞菌感染	临床前	-	The University of Montana	-
葡萄球菌感染	临床前	-	The University of Montana	-
葡萄球菌感染	临床前	-	Sorrento Therapeutics, Inc.	-
葡萄球菌感染	临床前	-	The Ohio State University	-
假单胞菌感染	药物发现	-	Sorrento Therapeutics, Inc.	-