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  1. Article: How I Treat Febrile Neutropenia.

    Nucci, Marcio

    Mediterranean journal of hematology and infectious diseases

    2021  Volume 13, Issue 1, Page(s) e2021025

    Abstract: The management of febrile neutropenia is a backbone of treating patients with hematologic malignancies and has evolved over the past decades. This article reviews my approach to the evaluation and treatment of febrile neutropenic patients. Key topics ... ...

    Abstract The management of febrile neutropenia is a backbone of treating patients with hematologic malignancies and has evolved over the past decades. This article reviews my approach to the evaluation and treatment of febrile neutropenic patients. Key topics discussed include antibacterial and antifungal prophylaxis, the initial workup for fever, the choice of the empiric antibiotic regimen and its modifications, and criteria for discontinuation. For each of these questions, I review the literature and present my perspective.
    Language English
    Publishing date 2021-03-01
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 2674750-9
    ISSN 2035-3006
    ISSN 2035-3006
    DOI 10.4084/MJHID.2021.025
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Infections in patients with chronic lymphocytic leukemia.

    Guarana, Mariana / Nucci, Marcio

    Hematology, transfusion and cell therapy

    2023  Volume 45, Issue 3, Page(s) 387–393

    Abstract: Introduction: Infection is a major complication in patients with chronic lymphocytic leukemia (CLL). Newly diagnosed patients are at high risk of developing infection caused by encapsulated bacteria, such as Streptococcus pneumoniae and Haemophylus ... ...

    Abstract Introduction: Infection is a major complication in patients with chronic lymphocytic leukemia (CLL). Newly diagnosed patients are at high risk of developing infection caused by encapsulated bacteria, such as Streptococcus pneumoniae and Haemophylus influenzae.
    Method and results: However, once treatment is initiated, the spectrum of pathogens causing infection broadens, depending on the treatment regimens. With disease progression, cumulative immunosuppression occurs as a consequence of multiple treatment lines and the risk of infection further increases. On the other hand, the use of targeted therapies in the treatment of CLL have brought new risks of infection, with an increased incidence of invasive fungal diseases, particularly aspergillosis, in patients receiving Bruton kinase inhibitors.
    Conclusion: In this article, we review the epidemiology of infection in patients with CLL, taking into account the treatment regimen, and briefly discuss the management of infection.
    Language English
    Publishing date 2023-07-01
    Publishing country Brazil
    Document type Journal Article ; Review
    ISSN 2531-1387
    ISSN (online) 2531-1387
    DOI 10.1016/j.htct.2023.05.006
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  3. Article ; Online: Invasive fusariosis.

    Nucci, Marcio / Anaissie, Elias

    Clinical microbiology reviews

    2023  Volume 36, Issue 4, Page(s) e0015922

    Abstract: Invasive fusariosis is a serious invasive fungal disease, affecting immunocompetent and, more frequently, immunocompromised patients. Localized disease is the typical clinical form in immunocompetent patients. Immunocompromised hosts at elevated risk of ... ...

    Abstract Invasive fusariosis is a serious invasive fungal disease, affecting immunocompetent and, more frequently, immunocompromised patients. Localized disease is the typical clinical form in immunocompetent patients. Immunocompromised hosts at elevated risk of developing invasive fusariosis are patients with acute leukemia receiving chemotherapeutic regimens for remission induction, and those undergoing allogeneic hematopoietic cell transplant. In this setting, the infection is usually disseminated with positive blood cultures, multiple painful metastatic skin lesions, and lung involvement. Currently available antifungal agents have poor
    MeSH term(s) Humans ; Fusariosis/drug therapy ; Fusariosis/microbiology ; Hematopoietic Stem Cell Transplantation ; Antifungal Agents/therapeutic use ; Fusarium ; Immunocompromised Host
    Chemical Substances Antifungal Agents
    Language English
    Publishing date 2023-11-08
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 645015-5
    ISSN 1098-6618 ; 0893-8512
    ISSN (online) 1098-6618
    ISSN 0893-8512
    DOI 10.1128/cmr.00159-22
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    Zs.A 2409: Show issues Location:
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  4. Article ; Online: Practical issues related to non-Aspergillus invasive mold infections.

    Nucci, Marcio / Nouér, Simone A

    Molecular aspects of medicine

    2023  Volume 94, Page(s) 101230

    Abstract: Infection by non-Aspergillus molds has been increasingly reported. The management of such infections is challenging both for diagnosis and treatment, including the need of well-trained mycologists to properly identify rare fungi, difficulties in ... ...

    Abstract Infection by non-Aspergillus molds has been increasingly reported. The management of such infections is challenging both for diagnosis and treatment, including the need of well-trained mycologists to properly identify rare fungi, difficulties in distinguishing between contamination, colonization and infection, the lack of randomized studies comparing different drugs or regimens, poor activity of available antifungal agents, lack of correlation between in vitro antifungal susceptibility tests and clinical outcome, and poor prognosis. Mucormycosis and fusariosis are the most frequent non-Aspergillus mold infections. Mucormycosis occurs more frequently in four major groups of patients: solid organ transplant recipients, patients with hematologic malignancies receiving chemotherapy or hematopoietic cell transplantation, diabetic patients, and immunocompetent individuals who suffer various types of skin and soft tissue trauma. Invasive fusariosis occurs almost exclusively in patients with hematologic malignancies. In this review we discuss practical issues related to the management of these and other non-Aspergillus mold infections.
    MeSH term(s) Humans ; Mucormycosis/diagnosis ; Mucormycosis/drug therapy ; Mucormycosis/etiology ; Fungi ; Antifungal Agents/therapeutic use ; Fusariosis/drug therapy ; Hematologic Neoplasms/drug therapy
    Chemical Substances Antifungal Agents
    Language English
    Publishing date 2023-11-26
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 197640-0
    ISSN 1872-9452 ; 0098-2997
    ISSN (online) 1872-9452
    ISSN 0098-2997
    DOI 10.1016/j.mam.2023.101230
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    Zs.A 1189: Show issues Location:
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  5. Article ; Online: Evaluation of the knowledge of hematologists about the management of infectious complications in hematologic patients.

    Guarana, Mariana / Nucci, Marcio

    Hematology, transfusion and cell therapy

    2023  

    Abstract: Introduction: Infection is a serious complication among patients with hematologic malignancies (HMs) and in hematopoietic cell transplant (HCT) recipients. In most centers, the management of these complications is provided by the hematologist in person, ...

    Abstract Introduction: Infection is a serious complication among patients with hematologic malignancies (HMs) and in hematopoietic cell transplant (HCT) recipients. In most centers, the management of these complications is provided by the hematologist in person, thus demanding a knowledge of basic aspects of infection.
    Methods: To evaluate the knowledge of the hematologist on infections, we invited clinicians to answer two questionnaires with 20 multiple-choice questions covering epidemiology, prophylaxis, diagnosis and treatment of infection in patients with HMs and HCT.
    Results: We obtained 289 answers: 223 in survey 1 (febrile neutropenia) and 66 in survey 2 (infection in HCT). The median score was 5.0 in both surveys (range 0.5 - 9.0). In survey 1, the questions with the lowest number of correct answers were Q3 (8%), concerning the cefepime dose, and Q1 (9%), which asked about the epidemiologic link between the use of high dose cytarabine and viridans streptococcal bacteremia. In survey 2, two questions about cytomegalovirus (CMV) infection had the lowest percentage of correct answers (Q4, 12% and Q11, 18%). Clinicians attending to HCT recipients had higher scores, compared to clinicians attending to patients with HM only (median score of 5.0 and 4.5, p = 0.03, in survey 1 and 6.0 and 4.5, p = 0.001, in survey 2). In both surveys staff clinicians, residents and professors had similar scores.
    Conclusion: This is the first study in Brazil assessing the knowledge of hematologists on infectious complications. The low median score overall indicates an urgent need for continuous education. Such initiatives will eventually result in better patient care.
    Language English
    Publishing date 2023-02-09
    Publishing country Brazil
    Document type Journal Article
    ISSN 2531-1387
    ISSN (online) 2531-1387
    DOI 10.1016/j.htct.2023.01.003
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  6. Article ; Online: Should patients with acute myeloid leukemia treated with venetoclax-based regimens receive antifungal prophylaxis?

    Guarana, Mariana / Nucci, Marcio

    Leukemia research

    2023  Volume 131, Page(s) 107341

    Abstract: Invasive fungal disease (IFD) is a major complication in patients with acute myeloid leukemia (AML) receiving intensive induction chemotherapy, and the use of anti-mold prophylaxis is considered standard of care. On the other hand, the use of anti-mold ... ...

    Abstract Invasive fungal disease (IFD) is a major complication in patients with acute myeloid leukemia (AML) receiving intensive induction chemotherapy, and the use of anti-mold prophylaxis is considered standard of care. On the other hand, the use of anti-mold prophylaxis in AML patients receiving less-intensive venetoclax-based regimens is not well established, basically because the incidence of IFD may not be high enough to justify primary antifungal prophylaxis. Furthermore, dose adjustments in venetoclax are needed because of drug interactions with azoles. Finally, the use of azoles is associated with toxicity, including liver, gastrointestinal and cardiac (QT prolongation) toxicity. In a setting of low incidence of invasive fungal disease, the number needed to harm would be higher than the number needed to treat. In this paper we review the risk factors for IFD in AML patients receiving intensive chemotherapeutic regimens, the incidence and risk factors for IFD in patients receiving hypomethylating agents alone, and in patients receiving less-intensive venetoclax-based regimens. We also discuss potential problems with the concomitant use of azoles, and present our perspective on how to manage AML patients receiving venetoclax-based regimens without primary antifungal prophylaxis.
    MeSH term(s) Humans ; Antifungal Agents/adverse effects ; Triazoles/therapeutic use ; Retrospective Studies ; Bridged Bicyclo Compounds, Heterocyclic/adverse effects ; Leukemia, Myeloid, Acute/complications ; Leukemia, Myeloid, Acute/drug therapy ; Invasive Fungal Infections/drug therapy ; Invasive Fungal Infections/epidemiology ; Invasive Fungal Infections/prevention & control ; Azoles
    Chemical Substances Antifungal Agents ; venetoclax (N54AIC43PW) ; Triazoles ; Bridged Bicyclo Compounds, Heterocyclic ; Azoles
    Language English
    Publishing date 2023-06-14
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 752396-8
    ISSN 1873-5835 ; 0145-2126
    ISSN (online) 1873-5835
    ISSN 0145-2126
    DOI 10.1016/j.leukres.2023.107341
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    Zs.A 1321: Show issues Location:
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  7. Article ; Online: Is Early Invasive Pulmonary Aspergillosis Coming of Age?

    Nucci, Marcio

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2019  Volume 70, Issue 2, Page(s) 347

    MeSH term(s) Aspergillosis ; Early Diagnosis ; Humans ; Invasive Pulmonary Aspergillosis ; Prospective Studies ; Tomography, X-Ray Computed
    Language English
    Publishing date 2019-05-10
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciz381
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    Zs.A 1505: Show issues Location:
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    Zs.MO 480: Show issues

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  8. Article ; Online: Toxicity and outcome of adults with acute myeloid leukemia receiving consolidation with high-dose cytarabine.

    Lopes, Lais Moreira / Nucci, Marcio / Portugal, Rodrigo Doyle

    Hematology, transfusion and cell therapy

    2023  

    Abstract: Introduction: High-dose cytarabine is considered standard of care as consolidation chemotherapy in adults with acute myeloid leukemia (AML) who are not eligible for allogeneic hematopoietic cell transplantation, but may be associated with significant ... ...

    Abstract Introduction: High-dose cytarabine is considered standard of care as consolidation chemotherapy in adults with acute myeloid leukemia (AML) who are not eligible for allogeneic hematopoietic cell transplantation, but may be associated with significant toxicity. We evaluated the toxicity associated with high-dose cytarabine given as consolidation in AML patients treated at a Brazilian public hospital.
    Methods: We retrospectively reviewed the charts of all patients with AML treated between 2008 and 2020 who obtained complete remission (CR) after one cycle of induction chemotherapy and received consolidation with at least one cycle of high-dose cytarabine (defined as 3 g/m
    Results: Among 61 patients who received induction remission, 32 obtained CR and 28 received at least one cycle of high-dose cytarabine, for a total of 67 cycles (median 2 cycles per patient, range 1 - 4). In 45 cycles (67.2%) the patient was discharged after the end of chemotherapy, with a median of 6 days at home (range 3 - 8). Readmission occurred in 31 of the 45 cycles (68.9%). The most frequent toxicities were febrile neutropenia (56.7%), nausea and vomiting (23.9%), oral mucositis (14.9%) and diarrhea (11.9%). Bacteremia was documented in 13 cycles (34.2%). There were three cases of typhlitis and two of invasive fungal disease (aspergillosis and candidemia). Four patients died (14.3%), with two deaths considered treatment-related (candidemia and typhlitis).
    Conclusion: In the setting of a Brazilian public hospital, high-dose cytarabine as consolidation therapy is feasible, with manageable toxicity profile.
    Language English
    Publishing date 2023-08-28
    Publishing country Brazil
    Document type Journal Article
    ISSN 2531-1387
    ISSN (online) 2531-1387
    DOI 10.1016/j.htct.2023.07.007
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  9. Article ; Online: Ecthyma gangrenosum in neutropenic patients and the importance of an early skin biopsy for direct examination.

    Gonzaga, Yung / Jeunon, Thiago / Machado, Jorge / Nucci, Marcio

    Anais brasileiros de dermatologia

    2022  Volume 97, Issue 4, Page(s) 534–536

    MeSH term(s) Biopsy ; Ecthyma/pathology ; Humans ; Pseudomonas Infections/pathology ; Pseudomonas aeruginosa ; Skin/pathology
    Language English
    Publishing date 2022-05-30
    Publishing country Spain
    Document type Journal Article
    ZDB-ID 433655-0
    ISSN 1806-4841 ; 0365-0596
    ISSN (online) 1806-4841
    ISSN 0365-0596
    DOI 10.1016/j.abd.2020.11.018
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    Zs.A 359: Show issues Location:
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    Zs.MO 344: Show issues

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  10. Article ; Online: Complex considerations - Fever and pancytopenia after solid organ transplantation.

    Francí, Elena Valdés / Adekunle, Ruth O / Nucci, Marcio / Pouch, Stephanie M

    Transplant infectious disease : an official journal of the Transplantation Society

    2023  Volume 25, Issue 4, Page(s) e14079

    Abstract: This case describes a 42-year-old man who underwent kidney transplantation and developed fevers, pancytopenia, and elevated liver function tests starting on post-operative day 9. An extensive microbiologic and molecular workup was performed, ultimately ... ...

    Abstract This case describes a 42-year-old man who underwent kidney transplantation and developed fevers, pancytopenia, and elevated liver function tests starting on post-operative day 9. An extensive microbiologic and molecular workup was performed, ultimately leading to a diagnosis of donor-derived toxoplasmosis with associated hemophagocytic lymphohistiocytosis in the recipient. This case highlights the potential for post-transplant toxoplasmosis in high-risk mismatch (D+/R-) recipients, as well as the role of Toxoplasma-targeted prophylaxis in such patients.
    MeSH term(s) Male ; Humans ; Adult ; Pancytopenia/etiology ; Organ Transplantation ; Kidney Transplantation/adverse effects ; Tissue Donors ; Fever/etiology
    Language English
    Publishing date 2023-06-06
    Publishing country Denmark
    Document type Case Reports ; Journal Article
    ZDB-ID 1476094-0
    ISSN 1399-3062 ; 1398-2273
    ISSN (online) 1399-3062
    ISSN 1398-2273
    DOI 10.1111/tid.14079
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    Zs.A 5100: Show issues Location:
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