Booklet for Hemato-Oncologists
Case 3 (A, B) - Tachypnea and bilateral peri-hilar interstitial haziness during the induction phase, while in severe aplasia
Child, 1 year old, male, affected by cALL. During induction therapy, at day +63, in severe aplasia (ANC (=absolute neutrophil count) < 500/mm³, duration 7 days), he presented with tachypnea (> 50/min), a dry cough, and fever (38.7°C). Further evaluation revealed decreased O
saturation. Auscultation was not pathologic, but a chest X-ray showed bilateral perihilar interstitial haziness. As supportive therapy, he received non-absorbable antibiotics and topical antifungals, but no other antimicrobial compounds. One week earlier, a central line had been inserted.
A - What combination of anti-infective therapy do you administer immediately?
1. Aminoglycoside + cephalosporine (anti-pseudomonal 3 rd/4th generation)
2. Aminoglycoside + anti-pseudomonal cephalosporine + antifungal agents
3. Aminoglycoside + anti-pseudomonal cephalosporine + macrolide
4. Cotrimoxazole + macrolide + antifungal agents
5. Aminoglycoside + anti-pseudomonal cephalosporine + Cotrimoxazole + macrolide
B - When should you start the administration of Co-Trimoxazole as prophylaxis for Pneumocystis jiroveci (formerly: carinii)?
1. At diagnosis of the underlying malignancy
2. At the end of induction therapy
3. When the first respiratory symptoms occur
4. During maintenance therapy
5. In most patients, no PcP prophylaxis is necessary
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