Table 1 Patient information.
Patient | 1 | 2 | 3 | 4 | 5 |
|---|---|---|---|---|---|
Sex | M | M | M | F | F |
Age (years) | 4 | 3 | 7 | 16 | 13 |
Primary diagnosis | Beta thalassaemia major | Beta thalassaemia major | Fanconi | Sickle cell | Sickle cell |
Reason for transplant | Regular blood transfusion from age 6 m, then chelation therapy. Liver biopsy: mild fibrous expansion of portal tracts and mild lymphocytic infiltrate | Regular blood transfusion from age 5 m, then chelation therapy. Liver biopsy: mild generalised fibrous expansions of portal tracts with mild portal and lobular inflammation | No complications yet | Frequent vaso-occlusive crisis requiring hospital admissions despite hydroxycarbamide and blood transfusions, avascular necrosis hip | Frequent vaso-occlusive crisis, acute ischaemic stroke resulting in left sided hemiparesis, |
Conditioning | Busulfan 14 mg/kg, Cyclophosphamide 200 mg/kg, alemtuzumab 0.3 mg/kg | Treosulfan 42 g/m2, Cyclophosphamide 200 mg/kg, alemtuzumab 0.3 mg/kg, | Fludarabine 150 mg/m2, Cyclophosphamide 40 mg/kg, anti-thymocyte globulin 11.25 mg/kg | Busulfan 14 mg/kg, Cyclophosphamide 200 mg/kg, Alemtuzumab 0.3 mg/kg | Busulfan 14 mg/kg, Cyclophosphamide 200 mg/kg, Alemtuzumab 0.3 mg/kg |
GvHD prophylaxis | Ciclosporin 1.5 mg/kg bd, Methotrexate 10 mg/m2 Day +4 and +7 | Ciclosporin 1.5 mg/kg bd, mycophenolate mofetil 600 mg/m2 bd | Ciclosporin 1.5 mg/kg bd | Ciclosporin 1.5 mg/kg bd, Methotrexate 10 mg/m2 Day +4 and +7 | Ciclosporin 1.5 mg/kg bd, Methotrexate 10 mg/m2 Day +4 and +7 |
Transplant type | Sibling | Maternal HLA matched BMT | Sibling | Sibling | Sibling |
Day post BMT with NTM bacteraemia | −5 | 115 | 89 | 77 | 117 |
Days post line insertion with NTM bacteraemia | 9 | 167 | 101 | 91 | 159 |
Presentation | Fever | Fever | Fever, rigors | Weight loss, nausea, vomiting and rigors | Fever |
Neutrophil count | Normal | Neutropenia | Normal | Normal | Neutropenia |
GVHD | No | No | No | No | Unknown |
Isolate species | Mycobacterium mucogenicum | Mycobacterium chelonae | Mycobacterium fortuitum | Mycobacterium chelonae | Mycobacterium spp- undefined |
Initial antibiotic therapy | Azithromycin, Amikacin, rifabutin | Clarithromycin, Amikacin and Meropenem | Clarithromycin, amikacin and meropenem | Clarithromycin, Amikacin, Meropenem, Rifabutin | Exact regime unknown—included clarithromyin |
Change in antibiotic and reason | Rifabutin was stopped due to pancytopenia, 2 m later ceftriaxone added for consolidation | Meropenem stopped as resistant, clarithromycin stopped late in therapy due to high LFT | Rifabutin added. | Meropenem stopped, ciprofloxacin added, amikacin stopped due to nausea and vomiting, replaced with ethambutol | Clarithromycin stopped due high LFT |
Duration (months) | 3 | 6 | 3 | 3 | Unknown |
Co-infection | None | CoNS in BC and from line tip | None | Enterobacter cloacae (urine) | CoNS in BC |
Hospital/community acquired | Hospital | Community | Community | Community | Community |
