Access restricted to higher education institution's students and staff
master's thesis
Infekcije kod djece s malignim bolestima

Igor Vlatković (2016)
Metadata
TitleInfekcije kod djece s malignim bolestima
AuthorIgor Vlatković
Mentor(s)Jelena Roganović (thesis advisor)
Abstract
Maligna bolest djeluje supresivno na brojne komponente nespecifičnog i specifičnog imunološkog sustava. Apsolutni broj neutrofila (ABN) manji od 500 neutrofila/mL krvi najvažnija je odrednica pojavnosti i težine bakterijske i gljivične infekcije. Febrilna neutropenija (FN) je onkološka hitnoća. Početna evaluacija pacijenta uključuje detaljan fizikalni pregled, laboratorijske pretrage i mikrobiološko uzorkovanje. Odmah treba započeti empirijsku antibiotsku terapiju. Zbog heterogenosti pacijenata s FN i terapijskog pristupa, nužno je odrediti čimbenike rizika za stratifikaciju u nisko- i visokorizičnu skupinu. Zbog geografskih razlika, u kliničkoj potvrdi ispravnosti određenih modela valjalo bi odrediti kompatibilnost korištenja jednog od modela stratifikacije za svaku regiju. Bakterije su najčešći uzročnici infekcija u djece s malignim bolestima, s češćim gram-pozitivnim infekcijama. Monoterapija je u većine pacijenata učinkovita, a najčešće se koriste: cefepim, ceftazidim, piperacilin-tazobaktam, imipenem i meropenem. Kod perzistentne FN treba posumnjati na gljivičnu infekciju. Najčešći su gljivični uzročnici Candida i Aspergillus. Djelotvorni su antimikotici: amfotericin B deoksikola, lipidna preparacija amfotericina B i ehikokandidi. Terapija FN prekida se nakon što su: hemokulture negativne 48 sati, pacijent afebrilan 24 sata i ako je uslijedio oporavak koštane srži. Izvanbolničko liječenje i oralna antimikrobna terapija su mogući izbori liječenja za FN niskog rizika. Ciprofloksacin je terapija prvog izbora. Granulocitni čimbenik rasta je važna komponenta liječenja, a smanjuje broj epizoda FN i duljinu hospitalizacije.
Committee MembersSrđan Banac (committee chairperson)
Igor Prpić (committee member)
Maja Abram (committee member)
GranterSveučilište u Rijeci
Medicinski fakultet
Lower level organizational unitsKatedra za pedijatriju
PlaceRijeka
StateCroatia
Scientific field, discipline, subdisciplineBIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Pediatrics
Scientific field, discipline, subdisciplineBIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Oncology
Study programme typeuniversity
Study levelintegrated undergraduate and graduate
Study programmeMedicine
Academic title abbreviationdr. med.
Genremaster's thesis
Language Croatian
Defense date2016-09-23
Parallel abstract (English)
Malignant disease acts suppressively on both the innate and the adaptive immune system. Absolute neutrophil count (ANC) less than 500 neutrophils/mL of blood is the main determinate of susceptibility to bacterial and fungal infection. Febrile neutropenia (FN) is an oncologic emergency. Initial evaluation of a patient includes a thorough physical examination, laboratory investigations and microbiological cultures. Empirical antibiotic therapy has to be started immediately. Due to heterogeneity of patients with FN and therapeutic approach, risk factors for stratification into low- and high-risk group have to be implemented. There seems to be a geographical difference in validation of various clinical decision rules and each region has to validate a specific risk model. Bacteria are the most common cause of infection in paediatric oncology patients with prevalent gram-positive infections. Monotherapy with: cefepime, ceftazidime, piperacillin-tazobactam, imipenem and meropenem has been shown to be effective in majority of patients. In persistent FN fungal infection should be suspected, most common fungi being Candida and Aspergillus. Effective antifungals are: amphotericin B deoxycholate, lipid formulations of amphotericin B and echinocandins. The therapy of high risk FN can be ceased when: blood cultures have been negative for 48 hours, patients have been afebrile for 24 hours and there has been a bone marrow recovery. Outpatient management and oral antibiotics are appropriate therapeutic approach for low-risk FN. Ciprofloxacin is the first line therapy. Granulocyte-colony stimulating factor is a valuable addition to the therapy regimen which reduces the number of FN episodes and the length of hospitalization
Parallel keywords (Croatian)maligne bolesti infekcije djeca
Resource typetext
Access conditionAccess restricted to higher education institution's students and staff
Terms of usehttp://rightsstatements.org/vocab/InC/1.0/
URN:NBNhttps://urn.nsk.hr/urn:nbn:hr:184:301322
CommitterBosa Licul