Epidemiology and Outcome of Mould Infections in Hematopoietic Stem Cell Transplant Recipients

Abstract

Reports have focused on the emergence of moulds as pathogens in recipients of hematopoietic stem cell transplants. To review the incidence of and risks for mould infections, we examined the records of 5589 patients who underwent hematopoietic stem cell transplantation at the Fred Hutchinson Cancer Research Center (Seattle) from 1985 through 1999. After 1992, the incidence of invasive aspergillosis increased in allograft recipients and remained high through the 1990s. Infections with non-fumigatus Aspergillus species, Fusarium species, and Zygomycetes increased during the late 1990s, especially in patients who received multiple transplants. Although infection caused by Scedosporium species was common in patients who had neutropenia, infection caused by Zygomycetes typically occurred later after transplantation, when patients had graft-versus-host disease. The overall 1-year survival rate was equally poor (similar20%) for all patients with mould infections. The results of the present study demonstrate the changing epidemiology of mould infections, emphasizing the increasing importance of amphotericin B--resistant organisms and the differences in risks and outcome of infection with different filamentous fungi.

Fungal Infections in Transplant and Oncology Patients

“…Pneumocystosis, endemic fungal infections, and cryptococcosis were rarely encountered in the HSCT population. Consistent with prior reports [4][5][6][7], mortality was high and one-year survival was low for HSCT patients with IFI. Fusarium infections and IA were associated with the lowest one year survival (6% and 25%, respectively); however, survival among patients with zygomycosis (28%) and IC (34%) was not substantially better.…”

“…While cryptococcosis has been most commonly encountered in the HIV infected population [52], a multicenter study reporting 306 cases of cryptococcosis in non-HIV-infected patients found 0.7% of total cases occurred in HSCT recipients, 18% in SOT recipients, 9% in patients with hematologic malignancies, and 9% in patients with other malignancies [53]. Other U.S. studies have found similarly low rates of cryptococcal infection in the HSCT population [1,5,54], most likely owing to use of routine fluconazole prophylaxis following HSCT. The overall mortality for cryptococcosis in the non-HIV population was 30%, attributable mortality 12%, and hematologic malignancy as an underlying diagnosis was associated with decreased survival [53].…”

“…Unfortunately, the incidence of zygomycosis appears to be increasing in oncology centers and in HSCT populations specifically, possibly related to the use of voriconazole prophylaxis [35][36][37][38][39]. [1,5,54], most likely owing to use of routine fluconazole prophylaxis following HSCT. The overall mortality for cryptococcosis in the non-HIV population was 30%, attributable mortality 12%, and hematologic malignancy as an underlying diagnosis was associated with decreased survival [53].…”

Aspergillus ustusInfections among Transplant Recipients

“…For example, at the Fred Hutchinson Cancer Research Center in Seattle, the proportion of infections caused by non- fumigatus Aspergillus species increased during the latter 1990s. Most of these infections were caused by A. flavus , A. nidulans , A. terreus , and A. niger ( 3 ). …”

Hard palate perforation in acute lymphoblastic leukemia due to mucormycosis — a case report

“…Rhinocerebral mucormycosis is the most common form of mucormycosis that occurs in patients having diabetic ketoacidosis, haemotological malignancies and haemopoietic stem cell transplant. Patient having haemotological malignancies develop mucormycosis due to prolonged corticosteroid therapy which causes immunosuppression, chemotherapy induced neutropenia and repeated blood transfusion leading to iron overload which was also observed in the reported patient [14,15]. Patients of rhinocerebral mucormycosis clinically present with facial pain, numbness, nasal congestion and conjunctival suffusion.…”