Cytomegalovirus (CMV) transmission via stem cells or marrow in CMV donor seropositive/recipient seronegative (D+/R−) hematopoietic cell transplantation (HCT) is surprisingly inefficient, and factors associated with transmission in these high-risk HCT recipients are unknown. In a retrospective cohort of D+/R− HCT recipients, cumulative incidence curve estimates were used to determine posttransplantation rates of CMV and multivariable Cox proportional models to assess risk factors associated with transmission. A total of 447 patients from 1995 to 2007 were eligible for enrollment. Overall, 85 of 447 (19.0%) acquired CMV at a median of 49 days (IQR 41–60) posttransplantation. CMV disease before day 100 occurred in 6 of 447 (1.3%) patients and in 7 of 447 (1.6%) after day 100. The donor graft, specifically the total nucleated cell count (adjusted hazard ratio [HR] 2.7; 95% confidence interval [CI], 1.4–4.7, P = .0002), was the only factor associated with CMV transmission in multivariable analyses. Notably, the source stem cells (marrow versus peripheral blood stem cell [PBSC]), screening method, and graft-versus-host disease (GVHD) were not associated with transmission. Thus, a highly cellular graft was the only identifiable risk factor associated with CMV transmission, suggesting that viral genomic content of the donor graft determines transmission efficiency in D+/R− HCT recipients.

Aspergillus lentulus has been recognized within Aspergillus section Fumigati as a phenotypically similar but genetically distinct species, displaying reduced susceptibility to antifungal agents. It has been described as a cause of invasive aspergillosis in patients who underwent hematopoietic stem cell transplantation, solid organ transplant recipients, those on prolonged corticosteroid therapy, or in patients with structural lung disease including chronic obstructive pulmonary disease. We report a case of successful treatment of probable invasive pulmonary aspergillosis due to A. lentulus and polymicrobial infection with Pseudomonas aeruginosa in a patient with relapsing granulomatosis with polyangiitis and recent high-dose steroid therapy.

No abstract

Key Clinical MessageEndemic fungal infections can present atypically and should be considered in the differential diagnosis of any soft tissue infection not responding appropriately to antibiotic therapy. Diagnosis can be confirmed with a biopsy. Most fungal soft tissue infections require extended duration of treatment.