Bone marrow necrosis related to paracoccidioidomycosis: the first eight cases identified at autopsy

To report the first eight bone marrow necrosis (BMN) cases related to paracoccidioidomycosis (PCM) from patient autopsies with well-documented bone marrow (BM) histology and cytology.A retrospective evaluation was performed on BM specimens from eight autopsied patients from Botucatu University Hospital with PCM-related BMN. Relevant BMN literature was searched and analysed.All eight patients had acute PCM. Six had histological only (biopsies) and two cytological only (smears) specimens. Five biopsy specimens revealed severe and one mild coagulation patterned necrotic areas. Five had osteonecrosis. The cytological specimens also showed typical BMN patterns. Paracoccidioides brasiliensis yeast forms were visible within necrotic areas in all cases

Tratamento com posaconazol de casos de cromoblastomicose e micetoma maduromicótico resistentes a outros antifúngicos

Eumycetoma and chromoblastomycosis are chronic, disfiguring fungal infections of the subcutaneous tissue that rarely resolve spontaneously. Most patients do not achieve sustained long-term benefits from available treatments; therefore, new therapeutic options are needed. We evaluated the efficacy of posaconazole, a new extended-spectrum triazole antifungal agent, in 12 patients with eumycetoma or chromoblastomycosis refractory to existing antifungal therapies. Posaconazole 800 mg/d was given in divided doses for a maximum of 34 months. Complete or partial clinical response was considered a success; stable disease or failure was considered a nonsuccess. All 12 patients had proven infections refractory to standard therapy. Clinical success was reported for five of six patients with eumycetoma and five of six patients with chromoblastomycosis. Two patients were reported to have stable disease. As part of a treatment-use extension protocol, two patients with eumycetoma who initially had successful outcome were successfully retreated with posaconazole after a treatment hiatus of >; 10 months. Posaconazole was well tolerated during long-term administration (up to 1015 d). Posaconazole therapy resulted in successful outcome in most patients with eumycetoma or chromoblastomycosis refractory to standard therapies, suggesting that posaconazole may be an important treatment option for these diseases.Eumicetoma e cromoblastomicose são infecções fúngicas crônicas do tecido subcutâneo que evoluem com aspecto desfigurado, raramente involuindo espontaneamente. A maioria dos pacientes não apresenta melhora sustentada por longo tempo com os tratamentos disponíveis, sendo de grande importância as novas opções terapêuticas. A eficácia do posaconazol, um novo agente antifúngico de amplo espectro do grupo dos triazóis, foi estudada em 12 pacientes com eumicetoma ou cromoblastomicose refratária às terapêuticas antifúngicas disponíveis. Os pacientes receberam por no máximo 34 meses, doses divididas de 800 mg/dia de posaconazol. Resposta clínica parcial ou completa foi considerada como sucesso; doença estável ou falha terapêutica foi considerada como insucesso. Todos os 12 pacientes tinham infecções comprovadas ou prováveis, refratárias à terapêutica padrão preconizada. Sucesso clínico foi registrado em cinco de seis pacientes com eumicetoma e cinco de seis pacientes com cromoblastomicose. Em dois pacientes observou-se doença estável. Como parte do protocolo de extensão do tratamento, dois pacientes com eumicetoma que inicialmente tinham tido sucesso terapêutico e que após um intervalo maior de 10 meses apresentaram recidiva da micose, foram retratados com sucesso com posaconazol. Posaconazol foi bem tolerado durante o longo período de administração (até 1015 dias). A terapêutica com posaconazol foi seguida de sucesso na maioria dos pacientes com eumicetoma ou cromoblastomicose refratária à terapêutica padrão, sugerindo que tal droga possa ser uma importante opção no tratamento de tais doenças

Doença de Chagas crônica: do xenodiagnóstico e hemocultura à reação em cadeia da polimerase

Although there has been an improvement in the diagnosis of chronic Chagas' disease, the low sensitivity of indirect parasitological tests is a drawback to its application in diagnosis and post-therapeutic control. Polymerase chain reaction (PCR) has limited use in routine diagnosis due to the need of specific laboratory facilities, common DNA cross-contamination, and high costs. At the same time, the high variability of PCR results found in different regions of Brazil raises some questions concerning its applicability for diagnosis. PCR's high specificity is indicative that it can be used as a confirmation method in inconclusive serology diagnosis as well as an auxiliary method in pos-therapeutic control of chronic Chagas' disease when comparing to serology and parasitological techniques. It is discussed here the applicability of molecular and indirect parasitological methods in the diagnosis and post-therapeutic control of chronic Chagas' disease based on the literature published from 1954 to 2001.Embora tenham ocorrido aprimoramentos no diagnóstico parasitológico da doença de Chagas crônica, a baixa sensibilidade dos exames indiretos é uma limitação para sua aplicação ao diagnóstico e controle pós-terapêutico. A reação em cadeia da polimerase (PCR) tem seu emprego restrito na rotina diagnóstica pela necessidade de infra-estrutura adequada, facilidade de contaminação e custo elevado. Paralelamente, a variabilidade de resultados pela PCR observados em diferentes regiões do Brasil suscita questões relativas à sua aplicação ao diagnóstico. Sua alta especificidade aponta para sua aplicação como método confirmatório no diagnóstico de pacientes com provas sorológicas duvidosas e como método auxiliar no controle pós-terapêutico da doença crônica em comparação às técnicas sorológicas e parasitológicas. O objetivo do trabalho foi discutir e comparar a aplicação dos métodos moleculares e parasitológicos indiretos no diagnóstico e controle pós-terapêutico da doença de Chagas crônica, com base na literatura publicada no período de 1954-2001

Co-infection Trypanosoma Cruzi/hiv: Systematic Review (1980 - 2010) [coinfecção Trypanosoma Cruzi/hiv: Revisão Sistemática (1980 - 2010)]

Introduction: The co-infection Trypanosoma cruzi/HIV has been described as a clinical event of great relevance. The objective of this study was to describe clinical and epidemiological aspects published in literature. Methods: It is a systematic review of a descriptive nature from the databases Medline, Lilacs, SciELO, Scopus, from 1980 to 2010. Results: There were 83 articles (2.8 articles/year) with a total of 291 cases. The co-infection was described in 1980 and this situation has become the defining AIDS clinical event in Brazil. This is the country with the highest number of publication (51.8%) followed by Argentina (27.7%). The majority of cases are amongst adult men (65.3%) native or from endemic regions with serological diagnosis in the chronic stage (97.9%) and indeterminate form (50.8%). Both diseases follow the normal course, but in 41% the reactivation of the Chagas disease occurs. The most severe form is the meningoencephalitis, with 100% of mortality without specific and early treatment of the T. cruzi. The medication of choice was the benznidazole on doses and duration normally used for the acute phase. The high parasitemia detected by direct or indirect quantitative methods indicated reactivation and its elevation is the most important predictive factor. The lower survival rate was related to the reactivation of the Chagas disease and the natural complications of both diseases. The role of the antiretroviral treatment on the co-infection cannot yet be defined by the knowledge currently existent. Conclusions: Despite the relevance of this clinical event there are still gaps to be filled.446762770Dias, J.C.P., Globalização, iniqüidade e doença de Chagas (2007) Cad Saude Publica, 23, pp. S513-S522Akhavan, D., (2000) Analise de custo-efetividade do programa de controle da doença de Chagas no Brasil, , Relatório final. 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Relato de dos casos, revision de la bibliografia y propuesta de un algoritmo (1998) Medicina (Buenos Aires), 58, pp. 504-506Sartori, A.M.C., Lopes, M.H., Benvenuti, L.A., Caramelli, B., di Pietro, A.O., Nunes, E.V., Reactivation of Chagas' disease in a human immunodeficenc virus-infected patient leading to severe heart disease with a late positive direct microscopic examination of the blood (1998) Am J Trop Med Hyg, 59, pp. 784-786Manigot, D.A., SIDA y Chagas: La dificultad de globalizar los protocolos (1998) Medicina (Buenos Aires), 58, pp. 522-524Pacheco, R.S., Ferreira, M.S., Machado, M.I., Brito, C.M.M., Pires, M.Q., da-Cruz, A.M., Chagas' disease and HIV co-infection: Genotypic characterization of the Tripanosoma cruzi strain (1998) Mem Inst Oswaldo Cruz, 93, pp. 165-169Lazo, J.E., Meneses, A.C.O., Rocha, A., Frenkel, J.K., Marquez, J.O., Lopes, E.R., Meningoencefalites toxoplásmica e chagásica em pacientes com infecção pelo vírus da imunodeficiência humana: Diagnóstico diferencial anatomopatológico e tomográfico (1998) Rev Soc Bras Med Trop, 31, pp. 163-171Lazo, J., Meneses, A.C.O., Rocha, A., Ferreira, M.S., Marquez, J.O., Lopes, E.R., Chagasic meningoencephalitis in the immunodeficient (1998) Arq Neuropsiquiat, 56, pp. 93-97Cohen, J.H., Tsai, E.C., Ginsberg, H.J., Godes, J., Pseudotumoral chagasic meningoencephalitis as the first manifestation of Acquired Immunodeficiency syndrome (1998) Surg Neurol, 49, pp. 324-327Iliovich, E., Lopez, R., Kum, M., Uzandizaga, G., Peritonitis espontanea chagasica en un enfermo de SIDA (1998) Medicina (Buenos Aires), 58, pp. 507-508Bisugo, M.C., Araújo, M.F.L., Nunes, E.V., Cunha, E.A., Oliveira Jr., O.C., Guilherme, C.S., Isolamento de Trypanosoma cruzi por xenocultura após aplicação de xenodiagnóstico in vivo e/ou in vitro em pacientes na fase crônica da doença de Chagas e na co-infecção pelo HIV (1998) Rev Inst Adolfo Lutz, 57, pp. 89-96Sartori, A.M.C., Shikanai-Yasuda, M.A., Amato Neto, V., Lopes, M.H., Follow-up of 18 patients with Human Immunodeficiency Vírus infection and chronic Chagas' disease, with reactivation of Chagas' disease causing cardiac disease in three patients (1998) Clin Infect Dis, 26, pp. 177-179Aguiar, J.I., Aguiar, E.S., Serologic testing for Chagas' disease and HIV in counseling programs and blood banks in midwest Brazil (1999) Braz J Infect Dis, 3, pp. 176-179Perez-Ramirez, L., Barnabé, C., Sartori, A.M.C., Ferreira, M.S., Tolezano, J.E., Nunes, E.V., Clinical analysis and parasite genetic diversity in Human Immunodeficiency Vírus/Chagas' disease coinfections in Brazil (1999) Am J Trop Med Hyg, 64, pp. 198-206Galhardo, M.C.G., Martins, I.A., Hasslocher-Moreno, A., Xavier, S.S., Coelho, J.M.C., Vasconcelos, A.C.V., Reativação da infecção por Trypanosoma cruzi em paciente com Síndrome de Imunodeficiência Adquirida (1999) Rev Soc Bras Med Trop, 32, pp. 291-294Pagano, M.A., Segura, M.J., di Lorenzo, G.A., Garau, M.L., Molina, H.A., Cahb, P., Cerebral tumor-like american trypanosomiasis in Acquired Immunodeficiency Syndrome (1999) Ann Neurol, 45, pp. 403-406Santos, S.S., Almeida, G.M.D., Monteiro, M.L.R., Gemignani, P., Duarte, M.I.S., Toscano, C.M., Ocular myositis and diffuse meningoencephalitis from Trypanosoma cruzi in an AIDS patient (1999) Trans R Soc Trop Med Hyg, 93, pp. 535-536Sartori, A.M.C., Sotto, M.N., Braz, L.M.A., Oliveira Jr., O.C., Patzina, R.A., Shikanai-Yassuda, M.A., Reactivation of Chagas' disease manifested by skin lesions in a patient with AIDS (1999) Trans R Soc Trop Med Hyg, 93, pp. 631-632Silva, N., O'Bryan, L., Medeiros, E., Holand, H., Suleiman, J., Mendonça, J.S., Trypanosoma cruzi meningoencephalitis in HIV-Infected patients (1999) Journal of Acquir Immune Defic Syndr & Hum Pathol, 20, pp. 342-349Morgado, M.G., Barcellos, C., Pina, M.F., Bastos, F.I., Human Immunodeficiency Vírus/Acquired Immunodeficiency Syndrome and tropical diseases: A Brazilian perspective (2000) Mem Inst Oswaldo Cruz, 95 (SUPPL. I), pp. 145-151Oeleman, W., Velásquez, J.N., Carnevale, S., Besasso, H., Teixeira, G.M., Peralta, J.M., Intestinal Chagas' disease in patients with AIDS (2000) AIDS, 14, pp. 1072-1073Corti, M., AIDS and Chagas' disease. Review (2000) AIDS patients care STDs, 14, pp. 581-588Corti, M., Trione, N., Corbera, K., Vivas, C., Enfermedad de Chagas: Otra causa de masa cerebral ocupante en pacientes com syndrome de immunodeficiencia adquirida (2000) Enfermedades Infecciosas y Microbiologia Clínica, 18, pp. 194-199Cahn, P., Belloso, W.H., Murillo, J., Prada-Trujillo, AIDS in Latin America (2000) Infec Dis Clin North Ame, 14, pp. 185-209Concetti, H., Retegui, M., Pérez, G., Pérez, H., Chagas' disease of the cervix uteri in a patient with Acquired Immunodeficiency Syndrome (2000) Hum Pathol, 31, pp. 120-122Jesus-Pedro, R., Doença de Chagas e Síndrome da Imunodeficiência Adquirida: Quantos estariam co-infectados no Brasil? (2001) JBA São Paulo, 2, pp. 5-6Antunes, A.C.M., Cecchini, F.M.L., von Bock Bolli, F., Oliveira, P.P., Rebouças, R.G., Monte, T.L., Cerebral trypanosomiasis and AIDS (2002) Arq Neuropsiquiat, 60, pp. 730-733Harms, G., Feldmeier, H., Review: HIV infection and tropical parasitic diseases-deleterious interactions in both directions? 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Access and right to health for Bolivian migrants in a Brazilian metropolis

This paper analyzes the health care accessibility conditions afforded Bolivian immigrants to the Brazilian health system and their perception of the right to health. A cross-sectional, quantitative and qualitative study was carried out from 2013 to 2015. Data were collected by a questionnaire with closed questions answered by 633 Bolivian individuals; questions regarding access to health were answered by 472 immigrants over 18 years old. Semi-structured interviews conducted with 55 subjects (Bolivians, health professionals, representatives of Health Departments, Consulate of Bolivia, Public Defender’s Office, Federal Public Prosecutor’s Office and Non-Governmental Organizations) underwent content analysis. Most Bolivian immigrants know the Unified Health System (SUS) and often use Primary Health Care; however, they described structural and systemic barriers to health accessibility, such as lack of documentation, working conditions, medium and high complexity procedures, language barriers, among others. The national health card (CNS) is an important gateway to access health care, playing a role of social integration. Interviewees recognize Health as a Social Right, pointing it out as a human and solidary value. Ensuring this recognition, when not based on the consolidation of social policies aimed at strengthening universal social protection, is threatened.Este artigo analisa as condições de acesso do imigrante boliviano ao sistema de saúde brasileiro e a percepção do direito à saúde. É um estudo transversal de metodologia quantitativa e qualitativa, realizado de 2013 a 2015. Foi elaborado um questionário com perguntas fechadas respondidas por 633 bolivianos, e em relação ao acesso à saúde por 472 indivíduos bolivianos maiores de 18 anos. A abordagem qualitativa foi feita por meio da análise de conteúdo de entrevistas semiestruturadas com 55 sujeitos (bolivianos, profissionais de saúde, representantes de Secretarias de Saúde, Consulado da Bolívia, Defensoria Pública da União, Ministério Público Federal e Organizações Não Governamentais). Os bolivianos conhecem o Sistema Único de Saúde (SUS) e utilizam com frequência a Atenção Primária à Saúde (APS). Todavia, barreiras de acesso são descritas, como falta de documentação, condições de trabalho, procedimentos de média e/ou alta complexidades, dificuldades para entenderem o que é dito assim como para serem compreendidos, entre outras. Sobressai-se a obtenção do Cartão Nacional de Saúde (CNS) como porta de entrada para o acesso à saúde, desempenhando papel de integração social. O reconhecimento da Saúde como direito social destaca-se entre os entrevistados, apontado como valor humano e solidário. A garantia desse reconhecimento fica ameaçada quando não se apoia na consolidação de políticas sociais que visem o fortalecimento da proteção social universal

Salmonelose associada à esquistossomose mansônica hépato-esplênica: ação do praziquantel

Cinco pacientes portadores de esquistossomose mansônica hépato-esplênica, associada à salmonelose, foram tratados com dose única de praziquantel (60 mg/kg peso), havendo desaparecimento da hipertermia do 1.° ao 3.° dia após a terapêutica e cura clínica subseqüente da salmonelose e da esquistossomose. O estudo da sensibilidade "in vitro" das bactérias isoladas: Salmonella minnesota, Salmonella dublin, Salmonella panama e Salmonella typhi (2 pacientes) não mostrou ação direta do praziquantel sobre tais enterobactérias. Os soros coletados antes e 24 horas após o tratamento não foram capazes de inibir o crescimento das bactérias isoladas dos respectivos pacientes.Five schistosomiasis patients (hepatesplenic stage) with chronic Salmonella bacteremia were given praziquantel by oral route, single dosis treatment (60 mg/kg). Fever decreased one to three days after the treatment and the patients recovered both from salmonellosis and schistosomiasis. "In vitro" sensitivity test employing Salmonella minnesota, Salmonella dublin, Salmonella panama and Salmonella typhi isolated from patients did not show any activity of praziquantel against these Salmonella species. Patients' sera collected before and 24 hours after treatment were not able to prevent bacterial growth

Coinfecção Trypanosoma cruzi/HIV: revisão sistemática (1980 - 2010)

INTRODUCTION: The co-infection Trypanosoma cruzi/HIV has been described as a clinical event of great relevance. The objective of this study wasto describe clinical and epidemiological aspects published in literature. METHODS: It is a systematic review of a descriptive nature from the databases Medline, Lilacs, SciELO, Scopus, from 1980 to 2010. RESULTS: There were 83 articles (2.8 articles/year) with a total of 291 cases. The co-infection was described in 1980 and this situation has become the defining AIDS clinical event in Brazil. This is the country with the highest number of publication (51.8%) followed by Argentina (27.7%). The majority of cases are amongst adult men (65.3%) native or from endemic regions with serological diagnosis in the chronic stage (97.9%) and indeterminate form (50.8%). Both diseases follow the normal course, but in 41% the reactivation of the Chagas disease occurs. The most severe form is the meningoencephalitis, with 100% of mortality without specific and early treatment of the T. cruzi. The medication of choice was the benznidazole on doses and duration normally used for the acute phase. The high parasitemia detected by direct or indirect quantitative methods indicated reactivation and its elevation is the most important predictive factor. The lower survival rate was related to the reactivation of the Chagas disease and the natural complications of both diseases. The role of the antiretroviral treatment on the co-infection cannot yet be defined by the knowledge currently existent. CONCLUSIONS: Despite the relevance of this clinical event there are still gaps to be filled.INTRODUÇÃO: A coinfecção Trypanosoma cruzi/HIV vem sendo sistematicamente descrita como um evento clínico de grande relevância. O objetivo deste estudo foi descrever aspectos clínicos e epidemiológicos publicados na literatura científica. MÉTODOS: Trata-se de revisão sistemática, de natureza descritiva, a partir da busca nas bases Medline, Lilacs, SciELO, Scopus, de 1980 a 2010. RESULTADOS: Identificou-se 83 artigos (2,8 artigos/ano), com um total de 291 casos registrados. A coinfecção foi descrita em 1980 e, no Brasil, tornou-se evento clínico definidor de AIDS. Este é o país com maior número de publicações (51,8%), seguido pela Argentina (27,7%). A maioria dos casos é de homens adultos (65,3%), naturais ou procedentes de regiões endêmicas, com diagnóstico sorológico, na fase crônica (97,9%) e na forma indeterminada (50,8%). As duas doenças evoluem naturalmente, mas em 41% dos casos ocorreu reativação da doença de Chagas. A forma mais grave é a meningoencefalite, com 100% de letalidade nos casos sem tratamento específico e precoce do T. cruzi. O medicamento indicado foi benznidazole, nas doses e duração utilizadas na fase aguda em imunocompetentes. O diagnóstico da reativação foi comprovado por alta parasitemia, detectada por métodos diretos ou indiretos quantitativos, sendo a sua elevação considerada fator preditivo para reativação. A menor sobrevida nacoinfecção esteve relacionada à reativação da doença de Chagas e às complicações naturais de ambas as doenças. O papel do tratamento antirretroviral sobre a evolução da coinfecção ainda não pode ser definido pelo conhecimento existente. CONCLUSÕES: Apesar da relevância deste evento clínico, ainda persistem lacunas a serem preenchidas.76277

Awareness of Chagas disease and socioeconomic characteristics of Bolivian immigrants living in Sao Paulo, Brazil

In this study which is part of a research project on Chagas disease (CD) among Bolivian immigrants in Sao Paulo, we describe socioeconomic characteristics, knowledge of CD and implications for acess to health care. We applied a structured questionnaire to a sample of 472 Bolivian adults (> 18 years) living in Sao Paulo and enrolled at the Barra Funda School Health Center. Participants’ median age was 28.5 years, 75.0% were from the Bolivian department of La Paz, and >90% worked in the garment industry. Respondents had lived in Sao Paulo for a median of 5.8 years. Only 169 (35.8%) were familiar with CD, while roughly half (50.4%) had lived in natural materials houses in Bolivia, 225 (47.7%) indicated familiarity with the vector, 23.9% had seen the vector in their homes in Bolivia, and 6.4% reported having been bitten by a triatomine bug. Factors associated with awareness of CD were analyzed by chi square tests, and those with p values <0.25 were included in a multivariable logistic regression model. In the multivariable logistic regression analysis, having a relative with CD (OR=4.3, 95% CI=1.5-12.0), having lived in a house with mud or wood walls (OR=0.4, 95% CI=0.2-0.8), and having heard of the triatomine bug, or vinchuca, (OR=10.0, 95% CI=5.1-19.5) were significantly associated with awareness of CD. This study shows a low familiarity with CD among Bolivian migrants living in Sao Paulo, Brazil. Raising awareness of the disease through specific communication strategies should be an essential component of public health programs to reduce the burden of CD in this and other vulnerable populations

Diarreia por Clostridium difficile em pacientes hematológicos e transplantados de células tronco hematopoiéticas: fatores de risco da forma grave e morte

Descrevemos a taxa de incidência de diarreia associada a Clostridium difficile (CDAD) em pacientes hematológicos e submetidos a transplante de células-tronco hematopoiéticas (TCTH) internados no HC-FMUSP no período de janeiro de 2007 a junho de 2011 usando dois denominadores 1.000 paciente e 1.000 dias de neutropenia e os fatores de risco associados à forma grave da doença e morte. O método de ELISA (Ridascreen-Biopharm, Germany) de detecção de toxinas A/B foi utilizado para o diagnóstico de C. difficile. Análise multivariada usando regressão logística múltipla foi conduzida para avaliar os potenciais fatores de risco associados com forma grave de CDAD e morte em até 14 dias do diagnóstico. Sessenta e seis episódios foram identificados em 64 pacientes entre 439 pacientes que apresentaram diarreia durante o período do estudo. A taxa de incidência de CDAD variou de 0,78 a 5,45 por 1.000 dias de neutropenia e de 0,65 para 5,45 por 1.000 pacientes-dias. A doença de base mais comum foi leucemia mielóide aguda 30/64(44%), 32/64 (46%) pacientes estavam neutropênicos, 31/64 (45%) foram submetidos à TCTH alogênico, 61/64 (88%) usaram antibióticos previamente e 9/64 (13%) apresentaram forma grave da doença. A maioria dos pacientes (89%) utilizou metronidazol oral no tratamento da CDAD e 19/64 (26%) evoluiram para óbito. Os fatores de risco independentes associados à morte foram forma grave da doença e uso de linezolida.We describe the rate of incidence of Clostridium difficile-associated diarrhea (CDAD) in hematologic and patients undergone stem cell transplant (HSCT) at HC-FMUSP, from January 2007 to June 2011, using two denominators 1,000 patient and 1,000 days of neutropenia and the risk factors associated with the severe form of the disease and death. The ELISA method (Ridascreen-Biopharm, Germany) for the detections of toxins A/B was used to identify C. difficile. A multivariate analysis was performed to evaluate potential factors associated with severe CDAD and death within 14 days after the diagnosis of CDAD, using multiple logistic regression. Sixty-six episodes were identified in 64 patients among 439 patients with diarrhea during the study period. CDA rate of incidence varied from 0.78 to 5.45 per 1,000 days of neutropenia and from 0.65 to 5.45 per 1,000 patient-days. The most common underlying disease was acute myeloid leukemia 30/64 (44%), 32/64 (46%) patients were neutropenic, 31/64 (45%) undergone allogeneic HSCT, 61/64 (88%) had previously used antibiotics and 9/64 (13%) have severe CDAD. Most of the patients (89%) received treatment with oral metronidazole and 19/64 (26%) died. The independent risk factors associated with death were the severe form of CDAD, and use of linezolid