Infectious diarrhea in autologous stem cell transplantation: high prevalence of coccidia in a South American center

Abstract

BackgroundDiarrhea is frequently seen in autologous stem cell transplantation. Although toxicity related to conditioning is the most common cause, infectious pathogens can play a distinctive role particularly in certain regions and environments.MethodsThe role of enteropathogens was investigated in 47 patients submitted to autologous stem cell transplantation at a Brazilian center between May 2011 and May 2013. All patients who presented with diarrhea consented to stool sample analysis to identify the etiological agents including coccidia, Strongyloides sp., Clostridium difficile and other pathogenic bacteria.ResultsThirty-nine patients (83%) had diarrhea, among whom seven (17.5%) presented with coccidia, three (7.5%) with Candida sp., one (2.5%) with C. difficile, and one (2.5%) with Giardia lamblia. There was a tendency toward a higher incidence of diarrhea in older patients (p-value = 0.09) and those who received conditioning with lomustine, etoposide, cytarabine, and melphalan (p-value = 0.083). Furthermore, the number of days of neutropenia was higher in patients with diarrhea (p-value = 0.06).ConclusionsThe high frequency of diarrhea caused by coccidia shows the importance of investigating and correctly identifying etiological agents and highlights the possible varieties of intestinal infections in patients who undergo autologous stem cell transplantation.

Myeloma and Cystoisospora belli

“…In developing countries without good hygienic foundations, parasitic infections are common but there is usually no routine screening of MM patients. In a recent report from Brazil, de Castro et al [ 2 ] studied infectious diarrhea in autologous stem cell transplantation cases, including myeloma patients, and found that there were many parasitic infections including C. belli infections. In conclusion, we suggest a new recommendation for screening for parasitic infection in any patients with MM and other hematological malignancies.…”

Diarrhea after autologous stem cell transplantation in low-middle income countries: is Clostridium difficile the most prevalent infectious etiology?

“…In this issue of Hematology, Transfusion and Cell Therapy, Castro et al investigated the role of enteric pathogens in 47 recipients of ASCT between May 2011 and May 2013. 7 Thirty-nine recipients (83%) met the criteria for the diagnosis of diarrhea. Among them, conditioning regime toxicity was the most prevalent cause (35%).…”