Infections among allogeneic bone marrow transplant recipients in India

Abstract

Summary:Infections are a major cause of morbidity and mortality in patients undergoing high-dose therapy and allogeneic bone marrow transplantation (BMT) despite prophylaxis, use of growth factors and newer antimicrobial drugs. We report the clinical profile of infections among 297 patients who underwent 304 allogeneic transplants between 1986 and December 2001. All patients developed febrile neutropenia. There were 415 documented infections among 304 transplants. This included bacterial (34.9%), viral (42.9%), fungal (15.9%) and other infections (6.3%) including tuberculosis. Bacterial pathogens were mainly Gram-negative bacteria (80%) as compared to Grampositive (20%) bacteria. The common Gram-negative bacteria were nonfermenting Gram-negative bacteria (NFGNB) (24.9%), Pseudomonas (17.9%), Escherichia coli (17.9%) and Klebsiella (9.7%). The major source of positive cultures was blood (53.7%) followed by urine (25.5%) and sputum (8.9%). In all, 133/304 (43.7%) transplants had 178 documented viral infections. The common viral infections were due to cytomegalovirus, herpes group of viruses and transfusion-related hepatitis; and 60/304 (19.7%) transplants had 66 documented fungal infections. Common fungi included Aspergillus species (69.7%), Candida (22.2%) and Zygomycetes (8.1%). Tuberculosis was documented in 2.3% of the transplants. Catheter infections were suspected or documented in 7.8% of the transplants (24/304). The incidence of infections in this series from developing countries is not significantly different from reports from the West.

Eicosanoid regulation of pulmonary innate immunity post-hematopoietic stem cell transplantation

“…During the first month post-HSCT, immune reconstitution is not complete and patients are extremely susceptible to bacterial, viral, and fungal infections [24,51]. One study indicated that over 80% of patients had either clinical or microbiologically significant bacterial, fungal, or viral infections during the neutropenic stage post-HSCT [40]. Aspergillosis is an especially dangerous threat to both allogeneic and autologous HSCT recipients during the pre-engraftment period [51].…”

Active tuberculosis limited to foreign-born patients after allogeneic hematopoietic stem cell transplant

“…Among these patients, the prevalence of TB after allo-SCT was B10%, a rate similar to or higher than that reported from centers in TB endemic regions. 6,10 Overall, 20% (4/20) of foreign-born patients with positive mycobacterial cultures had TB compared to 0% (0/34) of US-born patients (Po0.05).…”

Multi-organ failure due to Mycobacterium tuberculosis and Aspergillus flavus infection after allogeneic bone marrow transplantation

“…A recent report from India described Tuberculosis was seen in 1.7% of pediatrics transplant patients [2]. Another report from India Tuberculosis was documented in 2.3% of the transplant patients [3]. They can presents with fatal sepsis as reported by Kindler, T et al [4].…”

“…Fungal infection with aspergillus is common in BMT recipient. The incidence of fungal infection was 15.9% and commonly due to (69.7%) aspergillus species [3].…”