Hereditární teleangiektazie je vrozené onemocnění, při kterém se u pacientů na kůži a sliznicích objevuje charakteristické rozšíření drobných kapilár nazývané jako teleangiektázie. Teleangiektázie se stoupajícím věkem často praskají a způsobují krvácení. Pokud se krvácení opakuje příliš často, ať už ve formě epistaxí, hemoptýz, nebo krvácení do trávicího traktu, rozvíjí se u pacientů anémie, často vedoucí k významnému defi citu železa. Daleko závažnější je výskyt arteriovenózních malformací v parenchymatozních orgánech. Malformace postupně rostou se zvyšujícím se věkem pacienta. Nejčastěji jsou postiženy plíce, žaludek, játra a mozek. Krvácení z malformací v těchto lokacích může být smrtelné, a proto je jejich včasná identifi kace důležitá. Screening arteriovenózních malformací ve výše zmíněných rizikových lokacích je doporučován nejen u samotného pacienta, ale i u jeho rodiny. Aktuálně se nabízí také možnost průkazu kauzálních mutací. Léčba by vždy měla být posouzena individuálně. Někdy postačí pouze lokální terapie, hemostyptika nebo substituce železa, jindy je potřeba nasadit systémovou léčbu.
Hereditary telangiectasia is a congenital disease in which patients develop a characteristic enlargement of small capillaries on the skin and mucous membranes, called telangiectasia. With increasing age, telangiectasias often rupture and cause bleeding. If bleeding recurs too frequently, whether in the form of epistaxis, haemoptysis or gastrointestinal bleeding, patients develop anaemia, often leading to significant iron deficiency. Far more serious is the occurrence of arteriovenous malformations in parenchymatous organs, progressively increasing with increasing patient age. The lungs, stomach, liver and brain are most commonly affected. Bleeding from malformations in these localizations can be fatal and therefore early identification is important. Screening for arteriovenous malformations in the above-mentioned high-risk localizations is recommended not only for the patient himself but also for his family. Currently, the possibility of detecting causative mutations is also offered. Treatment should always be assessed on an individual basis. Sometimes only local therapy, haemostatic therapy or iron substitution is sufficient, other times systemic therapy is needed.
- MeSH
- hereditární hemoragická teleangiektazie * diagnóza patofyziologie terapie MeSH
- lidé MeSH
- prevalence MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Infectious complications during induction chemotherapy of acute myeloid leukaemia are very common. Prophylactic use of antibiotics however is an ongoing challenge in this situation due to bacterial multi-drug resistance. The aim of this study was to provide a comprehensive overview of the incidence of infectious complications in patients with AML undergoing induction therapy using the "7+3" protocol without routine antibiotic prophylaxis at one clinical site providing specialised haematological care in the Czech Republic, over a period of 15 years. The study also evaluates the aetiological spectrum of causative agents and the development of antibiotic resistance in the context of the use of the various classes of antibiotics. The analysis includes evaluation of the importance of risk factors for infectious complications and their impact on treatment of the underlying disease. The data are compared with published figures for similar cohorts of patients. PATIENTS AND METHODS: This study presents a retrospective analysis of infectious complications in 242 patients with acute myeloid leukaemia undergoing the first cycle of induction therapy without routine antibiotic prophylaxis in one clinical site in Czech Republic during years 2006-2020. RESULTS: A total of 363 febrile episodes (FE) were recorded. At least 1 FE during the induction was detected in 229 (94.6%) patients. Clinically defined infection was the cause in 96 (26.4%) FEs and blood stream infection in 69 (19.0%) FEs. Both complications occurred simultaneously in 29 (8.0%) FEs. 169 (46.6%) FEs were evaluated as fever of unknown origin (FUO). The achievement of complete remission had a significant effect on the duration of the FE (6 vs. 9 days, P=0.0005) and on the overall survival duration (79.3 vs. 6.5 months, P<0.0001). Patients diagnosed with infection or FUO at diagnosis were significantly more likely to suffer from colonisation by multi-drug resistant bacterial strains at discharge (29.2% vs. 16.3%, P=0.022). This group of patients used antibiotic therapy for a significantly longer time (35 vs. 23 days, P<0.0001). Infection was a contributing cause of death in 18 (7.4%) patients. Mortality was significantly related to the failure to achieve complete remission (P<0.0001). CONCLUSION: Infectious mortality during induction treatment without routine antibiotic prophylaxis was comparable to the published cohorts with prophylaxis. Regular microbiology surveillance with adequate initial antibiotic treatment can compensate routine antibiotic prophylaxis with slower development of antibiotic resistance.
- MeSH
- akutní myeloidní leukemie * komplikace farmakoterapie MeSH
- antibakteriální látky terapeutické užití MeSH
- antibiotická profylaxe metody MeSH
- lidé MeSH
- přehledová literatura jako téma MeSH
- retrospektivní studie MeSH
- sepse * farmakoterapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
