Infectious Complications of Human Bone Marrow Transplantation

Winston, Drew J.; Gale, Robert Peter; Meyer, Dorothy V.; Young, Lowell S.

doi:10.1097/00005792-197901000-00001

Cited by 411 publications

(108 citation statements)

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“…Recent advances in the diagnosis of pulmonary complications in immunocompromised patients with underlying hematological malignancy or recipients of HSCT, coupled with improved prophylaxis and therapy of several infections, such as CMV and PCP, may have changed the spectrum of diseases in these patients [15,18,19]. Furthermore, improved operative techniques and postoperative supportive care may make SLB a safer and better tolerated procedure in this patient population than previously reported.…”

Section: Discussionmentioning

confidence: 99%

Surgical lung biopsy in patients with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: Improved Outcome with specific diagnosis

et al. 2005

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Using a retrospective review of medical records, we sought the findings of surgical lung biopsy (SLB) in patients with hematological malignancy or hematopoietic stem cell transplantation (HSCT) and unexplained pulmonary infiltrates and to determine the impact of this procedure on management and outcome of these patients. Sixty-two patients who underwent SLB were evaluated; 31 patients had underlying hematological malignancy and 31 patients were HSCT recipients; 58% of whom underwent allogeneic HSCT. Thirty-three patients (53%) had focal infiltrates on chest CT scan while 29 (47%) had diffuse infiltrates. Thirteen patients were mechanically ventilated prior to SLB, and 27 (43%) were neutropenic. There were 66 diagnoses in the 62 patients, 44 (67%) were specific and 22 (33%) were nonspecific. The most common specific diagnoses were infection (29%), malignancy (27%), and inflammatory conditions (11%). Aspergillosis was the most common diagnosis of all biopsies (21%). SLB led to a change in therapy in 40% of patients and was associated with complications in 7 patients (11%). Specific diagnosis was more likely to lead to a change in therapy (48% vs. 27%, P = 0.06) and was associated with a lower mortality when compared to a nonspecific finding (30% vs. 59%, P = 0.02). Nonspecific diagnosis, on the other hand, was seen more in patients on mechanical ventilation prior to SLB compared to those off mechanical ventilation (69% vs. 27%, P = 0.02). SLB provides a specific diagnosis in the majority of patients with hematologic malignancy or HSCT recipients and unexplained pulmonary infiltrates. Specific diagnosis is more likely to lead to a change in therapy and is associated with a better outcome. Am. J. Hematol. 78:94-99, 2005. ª 2005 Wiley-Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

Surgical lung biopsy in patients with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: Improved Outcome with specific diagnosis

et al. 2005

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“…6,7 CNS infections occurred mostly in patients who had undergone allogeneic BMT and are reported to occur in 3-8% of patients after allogeneic, syngeneic or autologous BMT. [1][2][3][4] CMV encephalitis and cerebral aspergillosis are the most common CNS infections, whereas cerebral toxoplasmosis seems to be a rare condition.…”

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Opportunistic CNS infection after bone marrow transplantation

Maschke

Dietrich

Prumbaum³

et al. 1999

Bone Marrow Transplant

131

100

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Summary:We retrospectively identified opportunistic CNS infections in 655 patients who had undergone allogeneic, syngeneic or autologous BMT or PBSCT between 1990 and 1997. Twenty-seven patients (4%) developed CNS infections. All CNS infections occurred in allogeneic BMT or PBSCT patients. The most common CNS infections were toxoplasma encephalitis (74%) and cerebral aspergillosis (18%). Furthermore, we identified one patient with candida encephalitis and one patient with viral encephalitis. Overall mortality of patients with opportunistic CNS infection was 67%. There were two different groups of toxoplasma encephalitis with a different appearance on MR imaging. The first group showed edema, but no gadolinium enhancement, whereas the second group exhibited typical MRI appearances with the exception of frequent hemorrhagic transformation. The first group had a significant shorter latency between BMT and onset of CNS infection (mean 45 days vs 180 days, P = 0.02), a significant higher daily dose of corticosteroids as treatment for graft-versus-host disease (GVHD) (P = 0.01), more severe GVHD and a higher mortality (71% vs 36%). This study shows that the most common CNS infections in our patient population are toxoplasma encephalitis and cerebral aspergillosis, that there are two distinct subgroups of toxoplasma encephalitis and that CNS infections occur after allogeneic BMT only. Keywords: CNS infection; cerebral toxoplasmosis; cerebral aspergillosis Both allogeneic and autologous BMT are associated with several neurologic complications secondary to the underlying disease and prolonged myelosuppression. [1][2][3][4] The use of immunosuppressive drugs such as corticosteroids and cyclosporine in order to avoid rejection of the allograft and to control graft-versus-host disease (GVHD) is another major risk factor for neurologic complications especially CNS infections. In previous studies the most common complications were cerebral hemorrhage, metabolic encephalopathy and CNS infection. 1-5 Neurologic complications were more frequent in patients when AML was the underlying disease than in other leukemia patients. 4

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“…13 Currently, it is thought that the first step in the development of systemic candidiasis is colonization of the gastrointestinal tract or oropharynx by Candida spp. Candidal infection may then disseminate by one of three major routes: 1) direct vascular invasion via an intravascular catheter 1 3 ' 9 1 4 ; 2) vascular invasion following disruption of the mucosal surface of the colonized oropharyngeal or gastrointestinal tract 2 1 4 1 8 ; or 3) persorption of organisms through the intact gastrointestinal mucosa and into the bloodstream due to sheer numbers of colonizing organisms.…”

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“…1 0 2 1 ' 2 2 The clinical signs and symptoms associated with both local and systemic candidiasis are well known but are nonspecific and generally not helpful in distinguishing bacterial infection from candidal infection. 13 The laboratory diagnosis is also both insensitive and nonspecific. 1 3 , 9 1 0 Although histologic examination of tissue obtained by biopsy remains extremely useful in establishing the diagnosis of invasive disease, it is frequently not practical in patients at high risk for candidal infection, due to severe thrombocytopenia or impaired coagulation in these patients.…”

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“…1 3 , 9 1 0 Although histologic examination of tissue obtained by biopsy remains extremely useful in establishing the diagnosis of invasive disease, it is frequently not practical in patients at high risk for candidal infection, due to severe thrombocytopenia or impaired coagulation in these patients. 13 In addition to the diagnostic problems noted above, problems exist in interpreting cultures obtained from a variety of other body sites due to the propensity for Candida spp, particularly C albicans, to colonize these sites without causing infection. 2,14,21,22 Studies by Sandford et al 22 document the fact that despite colonization by C albicans in the respiratory, genitourinary, and gastrointestinal tract of the majority of patients with hematologic malignancies or bone marrow transplantation, only a small percentage ever develop invasive disease due to this organism.…”

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