Disseminated aspergillosis caused by Aspergillus ustus in a patient following allogeneic peripheral stem cell transplantation (original) (raw)
Related papers
Invasive aspergillosis in hematopoietic stem cell transplant recipients: a retrospective analysis
Brazilian Journal of Infectious Diseases, 2008
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.
Survival rate after organ transplantation has increased in number as a result of advances in surgical techniques however in subjects undergoing hematopoietic stem cell transplants (HSCT), Invasive aspergillosis (IA) remains an important cause of high. Various species of Aspergillus is ubiquitous in the environment, and its spores are easily transported in the air. It became a serious opportunistic infection in immunocompromised individuals. Delayed diagnosis is has become an area of concern because the Systemic inflammatory response syndrome (SIRS) is decreased by supressed immunity. A high degree of awareness and efforts for an early diagnosis may partake to improve the poor prognosis. Often it is too late till the time diagnosis is confirmed. In these types of high risk subject's expeditious application of antifungal therapy are essential for survival. The high risk of mortality caused by Invasive aspergillosis in hematopoietic stem cell transplants patients occur due to many factors i.e. heavy environmental exposure, receipt of corticosteroids, granulocytopenia, post engraftment timing ,mucosal barrier disruption by cytotoxic chemotherapy and radio therapy, usage of broad spectrum antimicrobial drugs and delay immunologic reconstitution but it found that from the past many years neutropenia has been the predominant risk factor for Invasive aspergillosis. Currently management of invasive aspergillosis continues to be area of concern; despite the use of newer antifungal agents the mortality rate among hematopoietic stem cell transplants subjects remains unacceptably high.
Bone Marrow Transplantation, 2002
We reviewed the medical records of 93 allogeneic and 149 autologous transplant recipients during a 20 month period, with attention to cases of proven or probable IA. No autologous transplant recipient developed IA, whereas IA was seen in 15.1% of allogeneic recipients (including two of five patients with a prior history of IA despite prophylaxis), for an overall incidence of 5.8%. The median time to occurrence was 92 days post transplant, with no de novo cases developing prior to engraftment. Survival 100 days from diagnosis was 29%. Risk factors for the development of IA included у21 days of corticosteroid therapy of у1 mg/kg/day and post-transplant cytomegalovirus (CMV) infection. These two risk factors were statistically linked. Our data illustrate a shift toward a later occurrence of posttransplant IA, suggesting a need for close, prolonged surveillance in the outpatient environment. The contributory role of protracted corticosteroid use is also highlighted. These data have important implications in an era of alternate donor transplants and more intense immunosuppression. Established strategies implementing newer, less toxic antifungal agents as prophylaxis in high-risk patients are needed.
Clinical Infectious Diseases, 1993
Over 13 years, we have seen 16 cases of proven invasive aspergillosis in 446 bone marrow transplant recipients, an incidence of 3.6%. The incidence of infection is low in patients with uncomplicated allogeneic or autologous bone-marrow transplants (<2% and 0, respectively). Of the 16 episodes following transplantation, 10 occurred in patients with late transplant complications who were no longer in protective isolation. In patients who had focal pulmonary lesions (as diagnosed by computed tomographic scanning), culture of bronchoalveolar lavage (BAL) fluid was not an effective diagnostic procedure. In diffuse pulmonary disease due to Aspergillus, culture of BAL fluid had a sensitivity of 100%. Aspergillus species were isolated from an additional six patients who had no evidence of invasive aspergillosis. Graft rejection was a significant predisposing factor for the development of invasive aspergillosis (P < .001, log-rank test), and in our hospital, these patients now receive intravenous amphotericin B as prophylaxis. None of the six patients whose chest roentgenograms showed abnormalities before transplantation and who underwent surgical resection as part of the treatment for invasive aspergillosis developed recurrent infection.
An Outbreak of Invasive Aspergillosis Among Allogeneic Bone Marrow Transplants: A Case-Control Study
Infection Control, 1985
Between April 1982 and March 1983,10 of 26 (38.4%) allogeneic bone marrow transplant recipients housed on a newly opened bone marrow transplant unit developed invasive aspergillosis. By contrast, between September 1977 and March 1982, only 3 of 46 (6%) transplant recipients developed invasive aspergillosis. A case-control study to identify host factors related toAspergillusinfection found that aspergillosis was more common in patients with chronic myelogenous leukemia and aplastic anemia, older patients, patients having cytomegalovirus disease, patients who experienced prolonged granulocytopenia, patients conditioned with ara-C (100-200 mg/day), and patients who received longer duration of antimicrobial therapy. A series of logistic regression analyses revealed that underlying disease was the single best predictor ofAspergillusinfection. This study demonstrates that underlying disease is an important risk factor for aspergillosis and that special measures may be warranted when trans...
Invasive Pulmonary Aspergillosis in Solid Organ and Bone Marrow Transplant Recipients
Transplantation Proceedings, 2005
Background. Invasive pulmonary aspergillosis (IPA) remains a major cause of mortality in transplant recipients. New strategies in therapy are needed. Methods. We prospectively followed all solid organ and bone marrow transplant recipients from January 1998 to January 2003 who showed pulmonary infiltrates. We retrospectively analyzed all of the patients diagnosed as having IPA. Clinical and epidemiological data were collected. Influence of new treatment strategies on survival was also analyzed.
Infections are one of the major causes of morbidity and mortality after stem cell transplantation (SCT). Opportunistic infections of varying severity with bacterial fungal and viral organisms occur in > 90% of patients after allogeneic SCT. Fatal opportunistic infections have been reported in 4-15% of related transplant recipients and 12-28% of unrelated transplant recipients. More than half of the transplant patients affected by invasive aspergillosis die despite treatment. Cutaneous aspergillosis has been rarely reported in transplant patients.
Journal of Antimicrobial Chemotherapy, 2007
Background: The onset of invasive aspergillosis (IA) after allogeneic haematopoietic stem cell transplantation (HSCT) is bimodal. However, IA early after HSCT has become less frequent due to the shortened neutropenic period, and the clinical significance of empirical treatment for aspergillosis based on persistent febrile neutropenia (FN) became less clear. Therefore, we started a presumptive treatment strategy, in which anti-Aspergillus agents were started when patients developed positive serum test and/or infiltrates or nodules on X-ray or CT-scan associated with persistent FN, in 2002.