Invasive aspergillosis in hematopoietic stem cell transplant recipients: a retrospective analysis

Abstract

Invasive aspergillosis (IA) currently is an important cause of mortality in subjects undergoing hematopoietic stem cell transplants (HSCT) and is also an important cause of opportunistic respiratory and disseminated infections in other types of immunocompromised patients. We examined the medical records of 24 cases of proven and probable invasive aspergillosis (IA) at the Hospital de Clinicas of the Federal University of Parana, Brazil, from January 1996 to October 2006. During this period occurred a mean of 2.2 cases per year or 3.0 cases per 100 HSTC transplants. There was a significant relationship between structural changes in the bone marrow transplant (BMT) Unit and the occurrence of IA cases (p=0.034, relative risk (RR) = 2.47). Approximately 83% of the patients died due to invasive fungal infection within 60 days of follow up. Some factors tended to be associated with mortality, but these associations were not significant. These included corticosteroid use, neutropenia (<100 cells/mm 3 ) at diagnosis, patients that needed to change antifungal therapy because of toxicity of the initial first-line regimen and disseminated disease. These factors should be monitored in BMT units to help prevent IA. Physicians should be aware of the risk factors for developing invasive fungal infections and try to reduce or eliminate them. However, once this invasive disease begins, appropriate diagnostic and treatment measures must be implemented as soon as possible in order to prevent the high mortality rates associated with this condition.

Risk factors for fungal pulmonary infections in hematopoietic stem cell transplantation recipients: the role of iron overload

“…In addition, the spectrum of the fungal microorganisms was also similar with the previous reports that showed Aspergillus spp as the most common agent. 5,7,9,16 The major limitation of this study is the failure to detect a causative microorganism in 37.5% of the patients, which was attributable to the difficulties in performing bronchoscopy on some of the patients due to the several contraindications such as respiratory distress and severe thrombocytopenia rendering a significant number of our patients as possible cases of IFIs. However, several authors indicated that diagnostic yield of bronchoscopy for FPIs is low and does not have a survival benefit in HSCT recipients.…”

“…5,6 Pulmonary involvement is the most common localization of IFIs during the course of HSCT. 7 Unfortunately, both the diagnosis and the therapy are a clinical dilemma as the diagnostic tools used for early and reliable diagnosis are often inadequate. A variety of fungal microorganisms are responsible for several diseases in HSCT recipients.…”

Distribution of filamentous fungi causing invasive fungal disease at the haematological unit, Hospital de Clínicas de Porto Alegre, Brazil

“…In addition, aggressive medical interventions have allowed critically ill patients to survive longer, increasing their overall risk to acquire fungal infections. 5,12 In the present study, we showed the distribution of fi lamentous fungi causing invasive fungal diseases at the haematology unit of HCPA, a reference medical centre in Southern Brazil. Roughly, half of infections were caused by Aspergillus species, especially A. fumigatus and A. fl avus (the latter usually in association with invasive fungal rhinosinusitis).…”

“…The distribution of Aspergillus species causing IFD at Hospital de Clínicas da Universidade Federal do Paraná -another referral centre for allogeneic HSCT in Southern Brazil -was recently published. 12 A total of 24 cases of proven/probable IA were detected over a 10-year period in that investigation, including 11 proven IA cases. The reported incidence of 3% was probably underestimated, since galactomannan testing was not available at the time of the study.…”

Donor-Derived Solid Malignancies after Hematopoietic Stem Cell Transplantation

“…Afteralongprocessandlargeamountsofclinicalpractice,it is now considered a novel therapeutic strategy benefiting patientswithvarioushematologicalmalignancies [1][2][3],solid malignancies [4], or inherited stem cell disorders [5][6][7]. In recentyears,therehasbeenagrowingnumberoflong-term recipients as the technique and quality of allo-HSCT is improving;however,thiscohortstillsuffersfromahighriskof potential late allo-HSCT complications, including the developmentofsecondaryneoplasms [8],graftversushostdisease (GVHD) [9], and infections [10]. With the introduction of newgenerationsofdrugsintoclinicalpractice,GVHDandinfections can be effectively prevented, controlled, and even cured.ApartfromGVHDandvariousinfections,donorcell leukemia(DCL),ahematologicaldisorderfirstlyreportedin 1971 [11],hasbeenfoundtobeemergingatahighfrequency inclinic.Untilnow,DCLwasawell-recognizeddiseaseentity occurringafterallo-HSCTmainlyduetooncogenictransformationofnormaldonorhematopoieticcellsintherecipient.…”