THE ROLE OF CORTICOSTEROIDS IN ADULT RESPIRATORY DISTRESS SYNDROME CAUSED BY VIRIDANS GROUP STREPTOCOCCI BACTEREMIA IN NEUTROPENIC PATIENTS

Main Article Content

Abraham Tareq Yacoub
Lysenia Mojica
Lily Jones
Andrea Knab
Sally Alrabaa
John Norman Greene *
(*) Corresponding Author:
John Norman Greene | john.greene@moffitt.org

Abstract

Introduction

During the last decades, gram-positive bacteremia has increased dramatically. Gram-positive cocci are the most frequent cause of nosocomial bloodstream infections. Among Gram-positive cocci, Viridans streptococci are a common cause of bacteremia in cancer patients with neutropenia, causing serious complications such as pneumonia, septic shock, and ARDS [1-6]. We present a series of cases of VGS bacteremia complicated with ARDS; early initiation of corticosteroids resulted in complete recovery.

Materials and Methods
A retrospective chart review of patients with hematologic malignancy diagnosed with VGS bacteremia admitted to the Moffitt Cancer Center in Tampa, Florida between 1/1/2001 and 4/1/2012 was completed. Data was collected about respiratory symptoms, diagnosis of adult respiratory syndrome, results of blood cultures, medications received and outcome.

Results

In this study, 70 cases of VGS bacteremia in neutropenic patients were reviewed.  The most common adverse event of VGS bacteremia in this group of patients is the development of serious pulmonary complications such as ARDS. In our study, 7 patients developed ARDS. The most common identifies streptococcal species was Streptococcus mitis, isolated in 4 of 7 patients. All 7 patients received corticosteroids early with the onset of respiratory failure. The most commonly prescribed regimen was methylprednisolone 60 mg intravenously every 12 hour for an average of 3 days.  All patients received comparable supportive care, appropriate antibiotics, ventilation and hemodynamic support. All patients (100 %) recovered from respiratory failure after receiving corticosteroids. There were no significant adverse events attributable to steroids use.

Conclusion

Streptococcus mitis is the species most frequently isolated from the patients who have developed ARDS from Streptococcus viridans bacteremia. Our data suggest that the early administration of corticosteroids to neutropenic patients who develop early signs of respiratory failure with VGS bacteremia can prevent the progression of ARDS and improve mortality.  Moderate doses of steroids with short duration of administration were not associated with significant adverse events in our case series. While the use of corticosteroids in this setting has been described in the literature since the early 1990s, there remains a scarcity of data and our study help shed some light on this area. Moreover there is little recognition among clinicians of the association between ARDS and VGS bacteremia (particularly mitis species in neutropenic cancer patients) and thus this treatment modality is used late in the course of illness which may reduce benefit.  Further studies are warranted to validate these findings and to further examine the utility of preemptive use of corticosteroids in cancer patients who develop VGS bacteremia, in regards to ARDS incidence reduction.


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Article Details

Author Biography

John Norman Greene, Section Chief, Division of Infectious Diseases and Tropical Medicine - Moffitt Cancer Center, Tampa FL Professor of Medicine

BIOGRAPHICAL SKETCH

Provide the following information for the Senior/key personnel and other significant contributors in the order listed on Form Page 2.
Follow this format for each person. DO NOT EXCEED FOUR PAGES.

 

NAME

John N. Greene MD FACP

POSITION TITLE

 

Professor, Division of Infectious Disease & International Medicine

 

eRA COMMONS USER NAME (credential, e.g., agency login)

 

EDUCATION/TRAINING  (Begin with baccalaureate or other initial professional education, such as nursing, include postdoctoral training and residency training if applicable.)

INSTITUTION AND LOCATION

DEGREE

(if applicable)

MM/YY

FIELD OF STUDY

College of William and Mary, Williamsburg, Virginia

BS

1982

Biology and Psychology

University of South Florida College of Medicine,

Tampa, Florida

MD

1986

Medicine

University of South Florida College of Medicine, Tampa, Florida

Residency

1986-1989

Internal Medicine

University of South Florida College of Medicine, Tampa, Florida

Fellowship

1989-1991

Infectious Disease

     

A.        Personal Statement

Dr. John N. Greene received his medical degree from the University of South Florida College of Medicine, Tampa, Florida.  He is a Professor of Medicine and currently the Section Chief, Division of Infectious Diseases and Tropical Medicine and Senior Member of the Blood & Marrow Transplant department at Moffitt Cancer Center, Tampa, FL.  He is affiliated with numerous committees, community outreach projects, associations, and boards.  He is an accomplished speaker and writer, having published over 166 manuscripts in peer reviewed journals and has been a speaker for over 160 invited presentations.  He has written and published one book, and written over 30 chapters in other books.  Dr. Greene has been a mentor to hundreds of medical students throughout his career and has taken many students with him on his yearly medical mission trips to third world countries

 

B.        Positions and Honors

 

1994-present               “Moffitt Angel” Award (Patients’ Family Request).

1996-present               Citation, “The Best Doctors in America: Southeast Region.”

1997                                        Physician of the Year, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL

1998                                        “Doctor of the Day”, Florida Senate, Tallahassee, FL

2003                                        Nomination for “Outstanding Sophomore Instructor” by the graduating class, University                                                                                of South Florida College of Medicine, Tampa, FL

2003                                        “The Leonard Tow 2003 Humanism in Medicine” Award, “In Recognition of Exemplary                                                                              Compassion, Competence and Respect in the Delivery of Care,” The Arnold P. Gold

Foundation.

2005                      Election to the Gold Humanism Honor Society in Recognition of Exemplary Service to Others

2006                      USF Department of Internal Medicine Faculty Award for H. Lee Moffitt Resident Teaching Award.

2007-2008             Selected by peers “Best Doctors in America® 2007-2008”

2008-2009                               Biographical candidate representing industry in the Who’s Who Among Executives and                                                                              Professionals “Honors Edition”

2009-2010                               Selected by peers “Best Doctors in America® 2009-2010”

2010-2011       Who’s Who of Executives Professionals and Entrepreneurs 2010-2011

C.        Selected Peer-reviewed Publications

Marela Velez, Beata Casanas, John N. Greene*, Jose Morey, Dominick Mastroianni, Richard Oehler – Pasteurella multocida Infections in Cancer Patients - Asian Biomedicine Vol. 4 No. 3 June 2010; 449-455

 

Pham T, Greene JN*, Sandin RL, Vincent AL, Messina J. – A Chronic Nodular Hand and Forearm Lesion  - Infectious Diseases in Clinical Practices “Images in ID – What’s Your Diagnosis? – Vol. 18, No. 4, July 2010; 261-263

 

Knapp CF, Tucci VT, Keeler JA, Sandin RL, Greene JN*, - Primary Cutaneous Acremonium Infection in a Neutropenic Patient After Trauma – Infectious Diseases in Clinical Practices  – Vol. 18, No. 4, July 2010; 277-278

 

Choudhry A, Tucci V, Greene JN*, - Disseminated Bipolaris Infection – Review Article:  Infectious Diseases in Clinical Practices Vol. 18, No. 5, September 2010; 296-298

 

Li, Y, Greene JN, Sandin RL, - “Recurrent Soft Tissue Infection Seventy Years After Initial Trauma”.  – Images in ID – What’s the Diagnosis?  Infectious Diseases in Clinical Practice, November 2010:18:389-391

 

Greene JN – Prevention of Infections in Patients with Hematologic Malignancies – The spectrum of infections is changing as microbes take advantage of neutropenia – National Comprehensive Cancer Network (NCCN) 5th Annual Congress:  Hematologic Malignancies 2010, pages 30-33

 

Rivera, RJ, Alrabaa, SF, List, A, Greene, JN*.,  “Successful Treatment of Refractory Disseminated Mycobacterium Abscessus infection using Gamma Interferon” – Case Report - Infections Diseases in Clinical Practices –  Vol. 19, Issue 2,  March 2011;142-145

 

Prince MD, Suber JS, Aya-ay ML, Cone Jr. JD, Greene JN, Smith Jr. DJ, Smith PD, - “Prosthesis Salvage in Breast Reconstruction Patients with Periprosthetic Infection and Exposure” Plas. Reconstr. Surg. 129: 42, June 2012

 

Lortholary O, Obenga G, Biswa P, Cailott D, Chachaty E, Bienvenu AL, Cornet M, Greene JN, Herbert R, Lacroix C, Grenouillet F, Raad I, Sitbon K, Troke P; the French Mycoses Study Group – An International, Retrospective Analysis of 73 Cases of Invasive Fusariosis Treated  with Voriconazole – Antimicrobial Agents Chemotherapy, Vol. 54, No. 10, Oct. 2011, p. 4446-4450

 

Stein, M, Palumbo, B., Letson, DG, Bui, MM, Sandin, RL, Greene, JN – Case Report – “A Case of Coccidioides Synovitis of the Knee Presents Clinically as Pigmented Villonodular Synovitis” Infectious Diseases in Clinical Practice.  (1)6:439-441, November 2011

 

Osterndorf B., Oehler RL, Greene JN – Case Report “Human Staphylococcus intermedius Infection in a Patient with Post-radiation Changes – Infectious Diseases in Clinical Practices 19(6);426-427, November 2011

 

Prince MD, Suber JS, Aya-Ay ML, Cone JD Jr, Greene JN, Smith DJ Jr, Smith PD. Prosthesis salvage in breast reconstruction patients with periprosthetic infection and exposure. Plast Reconstr Surg. 2012 Jan;129(1):42-8. PubMed PMID: 22186499.

Manry, Matthew; Cox, Jennifer; Casanas, Beata; Quilitz, Rod; Greene, John N.  Rituximab-Associated Occurrence of Disseminated Miliary Tuberculosis Infectious Diseases in Clinical Practice. 20(1):82-84, January 2012.

 

Givins P, Velez AP, Sandin RL, Quilitz RE, Greene JN* – Development of Enteroviral Meningoencephalitis Following Rituximab Treatment for Non-Hodgkin’s Lymphoma - Infectious Diseases in Clinical Practice  - July 2012;20(4):291-293

 

Casanas BC, Kass J, Pathak A, Tucci V, Payor A, Vincent AL, Greene JN*, Sandin RL, - 1 Non-gastrointestinal Aeromonas Hydrophilia Infections in Cancer Patients –  Infectious Diseases in Clinical Practice – July 2012;20(4):268-271

D.        Research Support

None

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