title: Late onset of invasive aspergillus infection in bone marrow transplant patients at a university hospital.
abstract: Despite new antifungal treatment strategies, invasive aspergillosis (IA) remains a principal cause of infectious mortality after bone marrow transplantation (BMT). 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 > or = 21 days of corticosteroid therapy of >or= 1mg/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 post-transplant 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.
authors.affiliation: University of Florida College of Medicine, Shands Hospital, Gainesville, FL 32610-0277, USA.
authors.forename: W B
authors.initials: WB
authors.lastname: Grow
authors.forename: J S
authors.initials: JS
authors.lastname: Moreb
authors.forename: D
authors.initials: D
authors.lastname: Roque
authors.forename: K
authors.initials: K
authors.lastname: Manion
authors.forename: H
authors.initials: H
authors.lastname: Leather
authors.forename: V
authors.initials: V
authors.lastname: Reddy
authors.forename: S A
authors.initials: SA
authors.lastname: Khan
authors.forename: K J
authors.initials: KJ
authors.lastname: Finiewicz
authors.forename: H
authors.initials: H
authors.lastname: Nguyen
authors.forename: C J
authors.initials: CJ
authors.lastname: Clancy
authors.forename: P S
authors.initials: PS
authors.lastname: Mehta
authors.forename: J R
authors.initials: JR
authors.lastname: Wingard
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D001230:Aspergillus / Q000145:classification / Q000302:isolation & purification; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000150:complications; D005260:Female; D005431:Florida / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007223:Infant; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014182:Transplantation, Autologous / Q000009:adverse effects / Q000401:mortality; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000401:mortality
chemical_list: D000305:Adrenal Cortex Hormones