Glenn Keith, Lindholm David A, Meis Gregory, Watts Luisa, Conger Nicholas
Wright-Patterson Medical Center, Wright-Patterson Air Force Base, Ohio.
Am J Trop Med Hyg. 2017 Nov;97(5):1619-1622. doi: 10.4269/ajtmh.17-0112.
chronic infection is frequently subclinical and thus under-recognized, although its increasing prevalence in nonendemic regions has implications for immunocompromised hosts. We present a 75-year-old male with stage II multiple myeloma who presented with relapse of infection after initial treatment, negative surveillance testing, and subsequent resumption of chemotherapy for his multiple myeloma. The optimal regimen for secondary prophylaxis against recurrent infections is unknown. Secondary prophylaxis should be considered for patients who recur and/or remain at high risk of recurrence because of ongoing immunosuppression. We implemented a prophylactic regimen of ivermectin 200 mcg/kg once monthly. In addition, improved laboratory assays for strongyloidiasis are needed to aid with diagnosis, monitoring of treatment response, and early detection of relapse.
慢性感染通常是亚临床的,因此未得到充分认识,尽管其在非流行地区的患病率不断上升对免疫功能低下的宿主有影响。我们报告一名75岁男性,患有II期多发性骨髓瘤,在初始治疗、监测检测结果为阴性以及随后恢复多发性骨髓瘤化疗后出现感染复发。预防复发性感染的最佳方案尚不清楚。对于复发和/或因持续免疫抑制而仍处于高复发风险的患者,应考虑进行二级预防。我们实施了每月一次、剂量为200 mcg/kg的伊维菌素预防方案。此外,需要改进类圆线虫病的实验室检测方法,以辅助诊断、监测治疗反应和早期发现复发。