1. Late onset of invasive aspergillus infection in bone marrow transplant patients at a university hospital.
- Author
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Grow WB, Moreb JS, Roque D, Manion K, Leather H, Reddy V, Khan SA, Finiewicz KJ, Nguyen H, Clancy CJ, Mehta PS, and Wingard JR
- Subjects
- Adolescent, Adrenal Cortex Hormones adverse effects, Adrenal Cortex Hormones therapeutic use, Adult, Aged, Aspergillosis complications, Aspergillosis microbiology, Aspergillus classification, Aspergillus isolation & purification, Bone Marrow Transplantation mortality, Child, Child, Preschool, Cytomegalovirus Infections complications, Female, Florida epidemiology, Hospitals, University, Humans, Immunosuppression Therapy adverse effects, Infant, Male, Middle Aged, Opportunistic Infections complications, Opportunistic Infections epidemiology, Opportunistic Infections microbiology, Retrospective Studies, Risk Factors, Survival Rate, Time Factors, Transplantation, Autologous adverse effects, Transplantation, Autologous mortality, Transplantation, Homologous adverse effects, Transplantation, Homologous mortality, Aspergillosis epidemiology, Bone Marrow Transplantation adverse effects
- Abstract
Despite new antifungal treatment strategies, invasive aspergillosis (IA) remains a principal cause of infectious mortality after bone marrow transplantation (BMT). We reviewed the medical records of 93 allogeneic and 149 autologous transplant recipients during a 20 month period, with attention to cases of proven or probable IA. No autologous transplant recipient developed IA, whereas IA was seen in 15.1% of allogeneic recipients (including two of five patients with a prior history of IA despite prophylaxis), for an overall incidence of 5.8%. The median time to occurrence was 92 days post transplant, with no de novo cases developing prior to engraftment. Survival 100 days from diagnosis was 29%. Risk factors for the development of IA included > or = 21 days of corticosteroid therapy of >or= 1mg/kg/day and post-transplant cytomegalovirus (CMV) infection. These two risk factors were statistically linked. Our data illustrate a shift toward a later occurrence of post-transplant IA, suggesting a need for close, prolonged surveillance in the outpatient environment. The contributory role of protracted corticosteroid use is also highlighted. These data have important implications in an era of alternate donor transplants and more intense immunosuppression. Established strategies implementing newer, less toxic antifungal agents as prophylaxis in high-risk patients are needed.
- Published
- 2002
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