HERMES RYOITI HIGASHINO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
9 resultados
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- Impact of Discontinuing Levofloxacin Prophylaxis on Bloodstream Infections in Neutropenic Hematopoietic Stem Cell Transplantation Patients(2022) GUIMARAES, Thais; BORGES, Igor Carmo; SPADAO, Fernanda de Souza; MARIANO, Livia; NASCIMENTO, Marina de Mattos; HIGASHINO, Hermes; ROSSI, Flavia; ROCHA, Vanderson; COSTA, Silvia FigueiredoMultidrug-resistant pathogens have emerged worldwide. We have driven the hypothesis that the non-use of fluoroquinolone prophylaxis during neutropenia could reduce antibiotic resistance in Gram-negative bacteria that cause bloodstream infections (BSIs) in hematopoietic stem cell transplantation (HSCT) patients and that this change in resistance pattern could lead to an impact on BSI mortality. This is a quasi-experimental study comparing BSI incidence, resistance patterns of bacteria that cause BSI, and BSI mortality when levofloxacin prophylaxis was routine for neutropenic HSCT patients (2016-2018) to when fluoroquinolone prophylaxis was discontinued in our center (2019). Bivariate comparisons and multivariate logistic regression models were used for analyses. A total of 310 HSCTs (66 (21%) allogeneic and 244 (79%) autologous) were performed during the study period. Sixty (19%) patients had BSIs, 30 in each evaluated period. The discontinuation of levofloxacin prophylaxis was associated with an increase in BSI incidence and a decrease in the resistance rates of causative BSI bacteria and in BSI 30-day mortality. The increase in the rate of resistant bacteria causing BSI and in BSI mortality might outweigh the benefits of a decrease in BSI incidence caused by fluoroquinolone prophylaxis in neutropenic HSCT patients. We suggest that the routine use of fluoroquinolone in this context be revisited.
- Measles, mumps and rubella vaccine 12 months after hematopoietic stem cell transplantation(2023) RANDI, Bruno Azevedo; FERNANDES, Eder Gatti; HIGASHINO, Hermes Ryoiti; LOPES, Marta Heloisa; ROCHA, Vanderson Geraldo; COSTA, Silvia Figueiredo; SARTORI, Ana Marli ChristovamThe measles, mumps and rubella (MMR) vaccine is usually recommended from 24 months after a hematopoietic stem cell transplant (HSCT). Some authors have demonstrated that the MMR vaccination can be safe from 12 months post-HSCT in non-immunosuppressed patients, as recommended by the Brazilian National Immunization Program/Ministry of Health, since 2006. The objectives of this study were to evaluate when patients received MMR vaccine after an HSCT in our care service and if there were reports of any side effects. We retrospectively reviewed the records of HSCT recipients who received at least one MMR dose in our care service, a quaternary teaching hospital in Sao Paulo city, Brazil, from 2017 to 2021. We identified 82 patients: 75.6% (90.1% in the autologous group and 45.1% in the allogeneic group) were vaccinated before 23 months post-transplantation. None reported side effects following the vaccination. Our data support that the MMR vaccination is safe from 12 to 23 months after HSCT.
- Aplastic Anemia and Chagas Disease: T. cruzi Parasitemia Monitoring by Quantitative PCR and Preemptive Antiparasitic Therapy(2022) CARVALHO, Noemia Barbosa; FREITAS, Vera Teixeira de; BEZERRA, Rita Cristina; NAKANISHI, Erika Shimoda; VELLOSO, Elvira Pereira; HIGASHINO, Hermes Ryoiti; BATISTA, Marjorie Vieira; FONSECA, Guilherme Henrique; ROCHA, Vanderson; COSTA, Silvia Figueiredo; SHIKANAI-YASUDA, Maria AparecidaBackground: Aplastic anemia is a rare and life-threatening condition, seldomly witnessed concomitantly with Chagas disease. We aim to discuss the management of these patients under risk of chronic Chagas disease reactivation (CDR), a severe condition with a high morbimortality that occurs in chronic Chagas disease patients under immunosuppression. Case reports: Trypanosoma cruzi (T. cruzi) parasitemia was monitored in three patients for 4-58 months by conventional PCR (cPCR), quantitative PCR (qPCR), microhematocrit/buffy coat, blood culture, and/or xenodiagnosis. One patient received antiparasitic treatment (benznidazole) and the other received allopurinol. Although parasitemia was controlled during and after benznidazole treatment at 300 mg/d for 51 days, in one patient, hematologic parameters worsened continuously before, during, and after treatment. Allopurinol led only to the temporary suppression of T. cruzi parasitemia in the second patient, but after danazol and hematological improvement, parasitemia became undetectable until the end of monitoring. Discussion and Conclusion: Unexpected undetectable or low parasitemia by cPCR/qPCR was reported. We show that the monitoring of parasitemia by qPCR and the use of preemptive therapy when the parasitemia was positive proved to be beneficial to our patients. As a result of the toxicity of more effective antiparasitics, shorter regimens of benznidazole or less toxic drugs in preemptive therapy are options that deserve future studies.
- Monkeypox Virus Transmission to Healthcare Worker through Needlestick Injury, Brazil(2022) CARVALHO, Laina Bubach; CASADIO, Luciana V. B.; POLLY, Matheus; NASTRI, Ana Catharina; TURDO, Anna Claudia; ELIODORO, Raissa H. De Araujo; SABINO, Ester Cerdeira; LEVIN, Anna Sara; PROENCA, Adriana Coracini Tonacio de; HIGASHINO, Hermes RyoitiWe describe monkeypox virus (MPXV) transmission from a patient to a healthcare worker through needlestick injury. A lesion appeared at the inoculation site 5 days after inju-ry. Blood tested MPXV-positive by PCR before symptoms worsened; blood remained MPXV-positive at discharge 19 days after symptom onset. Postexposure prophylaxis could prevent potential MPXV bloodborne transmission.
- Rhodococcus hoagii bloodstream infection in an allogeneic hematopoietic stem cell transplantation patient: Case report and review of literature(2020) CAMPANA, Pedro da Silva; MARTINHO, Lorena Zaine Matos; BATISTA, Marjorie Vieira; HIGASHINO, Hermes; RIZEK, Camila; ROSSI, Flavia; OLIVEIRA, Fernando Nivaldo; ROCHA, Vanderson; COSTA, Silvia FigueiredoWe report a case of bloodstream infection caused by R. hoagii in a woman with acute myeloid leukemia, 37-years-old, who received an allogeneic hematopoietic stem cell transplant. She developed cutaneous and gastrointestinal tract graft versus host disease, respectively on day 29 and day 69. On day 157 she developed to acute severe respiratory failure. Rhodococcus sp was identified by MALDI-TOF and 16S rRNA sequencing from blood culture as Rhodococcus hoagii. The patient was a nurse that lived in urban areas, and stated no recent trips to countryside areas neither contacted with animals. Despite of the treatment with antibiotics with action against R. hoagii such as linezolid and meropenem the patient evolved to multiorgan dysfunction and death. Our case-report emphasizes the importance of early diagnosis and the use of 16S rRNA sequencing to confirmed the identification of species of Rhodococcus infection. (c) 2020 The Authors.
- COVID-19 in hematopoietic stem-cell transplant recipients: A systematic review and meta-analysis of clinical characteristics and outcomes(2023) RANDI, Bruno Azevedo; HIGASHINO, Hermes Ryoiti; SILVA, Vinicius Ponzio da; XAVIER, Erick Menezes; ROCHA, Vanderson; COSTA, Silvia FigueiredoPatients who undergo hematopoietic stem-cell transplantation (HSCT) are more susceptible to developing severe forms of COVID-19 with an increased risk of mortality. The aim of this study was to analyze, by performing a systematic review and meta-analysis, all studies that evaluated COVID-19 in HSCT adult recipients and present clinical characteristics and outcomes. Studies were eligible for inclusion if they: (I) described the clinical characteristics of COVID-19 in adult (aged 18 years old or above) HSCT recipients; (II) described outcomes of COVID-19 in this population, mainly lethality; (III) were full-text articles. We searched MedLine, Embase, SCOPUS, LILACS and Web of Science for full-text studies that evaluated COVID-19 in adult HSCT patients until 26 Apr 2023. Two independent reviewers screened the articles and extracted the data. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Studies Reporting Prevalence Data was used to assess quality of the included studies. Meta-analysis was performed and the pooled prevalence of severe/critical disease and of death with a 95% CI was calculated with the random-effects model. Sixteen studies were included; seven (43.7%) were multicenter. Most of the studies were from Europe (37.5%). All of them had a low risk of bias using the JBI Checklist. A total of 1186 patients were included. Allogeneic HSCT patients were the majority in most studies, with a total of 861 patients (72.5%). The symptomatic rate was 79.4%. The pooled prevalence of severe/critical COVID-19 was 24.0% (95% CI 0.13-0.36; I2 = 94%; n = 334/990). The pooled prevalence of death for the entire population was 17% (95% CI 0.13-0.22; I2 = 76%; n = 221/1117), 17% (95% CI 0.12-0.23; I2 = 67%; n = 152/822) for allogeneic-HSCT and 14% (95% CI 0.08-0.22; I4 = 65%; n = 48/293) for autologous-HSCT. In conclusion, frequently the infection of SARS-CoV-2 in HSCT was symptomatic and lethality is higher than in general population. Thus, it is essential to focus on the implementation of measures to mitigate the risk of SARS-CoV-2 infection in this population, as well as to carefully assess HSCT recipients who develop COVID-19.
- Colonization by Extended-Spectrum β-Lactamase-Producing Enterobacterales and Bacteremia in Hematopoietic Stem Cell Transplant Recipients(2024) GONCALVES, Luiza Arcas; ANJOS, Beatriz Barbosa; TAVARES, Bruno Melo; MARCHI, Ana Paula; CORTES, Marina Farrel; HIGASHINO, Hermes Ryoiti; MORAES, Bruna del Guerra de Carvalho; BAMPI, Jose Victor Bortolotto; PINHEIRO, Liliane Dantas; SPADAO, Fernanda de Souza; ROCHA, Vanderson; GUIMARAES, Thais; COSTA, Silvia FigueiredoBackground: Assessing the risk of multidrug-resistant colonization and infections is pivotal for optimizing empirical therapy in hematopoietic stem cell transplants (HSCTs). Limited data exist on extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) colonization in this population. This study aimed to assess whether ESBL-E colonization constitutes a risk factor for ESBL-E bloodstream infection (BSI) and to evaluate ESBL-E colonization in HSCT recipients. Methods: A retrospective analysis of ESBL-E colonization and BSI in HSCT patients was conducted from August 2019 to June 2022. Weekly swabs were collected and cultured on chromogenic selective media, with PCR identifying the beta-lactamase genes. Pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) assessed the colonizing strains' similarities. Results: Of 222 evaluated HSCT patients, 59.45% were colonized by ESBL-E, with 48.4% at admission. The predominant beta-lactamase genes were blaTEM (52%) and blaSHV (20%). PFGE analysis did not reveal predominant clusters in 26 E. coli and 15 K. pneumoniae strains. WGS identified ST16 and ST11 as the predominant sequence types among K. pneumoniae. Thirty-three patients developed thirty-five Enterobacterales-BSIs, with nine being third-generation cephalosporin-resistant. No association was found between ESBL-E colonization and ESBL-BSI (p = 0.087). Conclusions: Although the patients presented a high colonization rate of ESBL-E upon admission, no association between colonization and infection were found. Thus, it seems that ESBL screening is not a useful strategy to assess risk factors and guide therapy for ESBL-BSI in HSCT-patients.
- COVID-19 surveillance in a bone marrow transplantation unit: experience from a Brazilian tertiary-care teaching hospital(2024) RANDI, Bruno A.; GUIMARAES, Thais; SPADAO, Fernanda de S.; HIGASHINO, Hermes R.; LAZARI, Carolina dos S.; XAVIER, Erick M.; ROCHA, Vanderson; COSTA, Silvia F.PurposeIn this work, we aimed to describe the strategy of the weekly SARS-CoV-2 RT-PCR surveillance program that was implemented in our bone marrow transplantation (BMT) unit.MethodsOur unit performed SARS-CoV-2 RT-PCR before admission and then weekly during hospitalization even if the patient was asymptomatic. From May 2021 to May 2022, we collected data from all patients that were admitted in the BMT unit to perform transplantation. The total of SARS-CoV-2 RT-PCR performed and the positive rate were described.ResultsDuring the study period, 65 patients were admitted for HSCT. A total of 414 SARS-CoV-2 RT-PCR were performed. Two cases were detected (positivity rate, 0.48%). After the positive test, both patients were isolated outside the BMT unit.ConclusionWe postulate that diagnosing these patients and isolating them outside the transplantation unit may have prevented secondary symptomatic cases.
- COVID-19 in hematopoietic stem cell transplant recipients during three years of the pandemic: a multicenter study in Brazil(2024) RANDI, Bruno Azevedo; HIGASHINO, Hermes Ryoiti; SILVA, Vinicius Ponzio da; SALOMAO, Matias Chiarastelli; PIGNATARI, Antonio Carlos Campos; ABDALA, Edson; VASQUES, Fabiana; SILVA, Celso Arrais Rodrigues da; SILVA, Roberto Luiz da; LAZARI, Carolina dos Santos; LEVI, Jose Eduardo; XAVIER, Erick Menezes; CORTES, Marina Farrel; LUNA-MUSCHI, Alessandra; ROCHA, Vanderson; COSTA, Silvia FigueiredoHematopoietic stem cell transplant (HSCT) recipients are at -increased risk for severe COVID-19. The aim of this study was to evaluate the burden of COVID-19 in a cohort of HSCT recipients. This retrospective study evaluated a cohort of adult hospitalized HSCT recipients diagnosed with COVID-19 in two large hospitals in Sao Paulo, Brazil postHSCT, from January 2020 to June 2022. The primary outcome was all-cause mortality. Of 49 cases, 63.2% were male with a median age of 47 years. Allogeneic-HSCT (51.2%) and autologous-HSCT (48.9%) patients were included. The median time from HSCT to COVID-19 diagnosis was 398 days (IQR: 1211-134), with 22 (44.8%) cases occurring within 12 months of transplantation. Most cases occurred during the first year of the pandemic, in non-vaccinated patients (n=35; 71.4%). Most patients developed severe (24.4%) or critical (40.8%) disease; 67.3% received some medication for COVID-19, primarily corticosteroids (53.0%). The probable invasive aspergillosis prevalence was 10.2%. All-cause mortality was 40.8%, 51.4% in non-vaccinated patients and 14.2% in patients who received at least one dose of the vaccine. In the multiple regression analyses, the variables mechanical ventilation (OR: 101.01; 95% CI: 8.205 - 1,242.93; p = 0.003) and chest CT involvement at diagnosis >= 50% (OR: 26.61; 95% CI: 1.06 - 664.26; p = 0.04) remained associated with all-cause mortality. Thus, HSCT recipients with COVID-19 experienced high mortality, highlighting the need for full vaccination and infection prevention measures.