The presented four patients with hematologic malignant disease developed severe fungal breakthrough infections
with rare causative agents.
Most patients with breakthrough infections
had underlying leukemia (33/37, 89%), compared with 9/31 patients (29%) who had no breakthrough infections
(p < 0.001), and neutropenia (31/37, 84%), compared with 13/31 (42%) who had no breakthrough infections
(p < 0.001).
The overall rate of breakthrough infection
, defined by positivity for antibodies against the hepatitis B core protein after 24 months of age, was 5.52%, but it also varied significantly based on the mothers' hepatitis B e-antigen stares.
(%) 3 (13.6) Predisposing factors (%) Prematurity 100 Catheter 100 TPN 100 Previous broad spectrum antibiotic 100 administration Diagnosis at admission (%) Prematurity 13.6 Prematurity + respiratory distress 72.7 syndrome (RDS) Prematurity + RDS + digestive disorders 4.5 Other (chylothorax, hydrops fetalis, etc.) 9.1 Clinical findings at the time of diagnosis (%) Fever 4.5 Abdominal distension 68.2 Apnea 45 Neutropenia 63.6 Thrombocytopenia 100 Breakthrough infection
(%) 63.6 Table 2--In vitro susceptibility profile of 34 Achromobacter xylosoxidans isolates to antimicrobial agents.
The sequence data suggested that the detectable serotype 4 and 7 strains apparently responsible for breakthrough infection
were the same as those circulating in unvaccinated military and civilian populations (16).
The initial description of an HBsAg mutant was made in the breakthrough infection
of a child born to a HBV-positive mother (16).
Adefovir should be given to those who develop breakthrough infection
while on lamivudine.
"If the kids are never getting their antibiotic, an infection is not a breakthrough infection
, which is the trigger for us to move ahead with more aggressive treatments such as surgery.
long-term protection against breakthrough infection
While this year's vaccine seems less protective than we hoped, we should still feel good recommending a vaccine that can prevent 40% of overall influenza cases and that provides an additional benefit of lessening severity in many breakthrough infections
. That said, we still need a better and universal influenza vaccine.
Of note, 4 were breakthrough infections
in patients receiving prophylactic itraconazole or posaconazole.
[3,26] Breakthrough infections
can occur, mainly in HIVexposed/infected babies.
, due to S-gene mutants of HBV, have occasionally been reported among children born to HBsAg-positive mothers, but at the present time, such mutants do not pose a public health threat.