Systemic nocardiosis following allogeneic bone marrow transplantation.
Five cases of systemic Nocardia infection were diagnosed among 301 allogeneic bone marrow transplant recipients. A sixth case included in this report received her transplant at another institution. The cumulative annual incidence rate of this infection was 1.75%. All patients had been treated previously for acute graft-versus-host disease (GVHD). At the time of diagnosis of systemic Nocardia infection, a median of 198 (range 148-1121) days after transplantation, all patients had extensive chronic GVHD and were taking 2 to 3 immunosuppressive medications. Prior to diagnosis of Nocardia infection patients had experienced multiple opportunistic infections, including infections with Mycobacterium avium-intracellulare, Pneumocystis carinii, and cytomegalovirus antigenemia. Treatment with trimethoprim-sulfamethoxazole (TMP-SMX), ceftriaxone, or carbapenem antibiotics resulted in a median survival of 219 days from the time of diagnosis and an actuarial 1-year survival of 40%. All patients who received more than 2 weeks of therapy were cured of their infections. Notably, 5/6 patients in this cohort were unable to take TMP-SMX because of myelosuppression. In comparison with randomly selected control patients, the use of pentamidine for prevention of P. carinii infection was associated with a marginal increase in the risk of Nocardia infection. We postulate that the use of TMP-SMX may be of benefit in the prophylaxis of infections other than P. carinii in patients with chronic GVHD.
Daly
A S
AS
Allogeneic Bone Marrow Transplant Service, Department of Medical Oncology and Hematology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada. andrew.daly@uhn.on.ca
McGeer
A
A
Lipton
J H
JH
D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D001927:Brain Diseases / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009615:Nocardia / Q000145:classification / Q000302:isolation & purification; D009617:Nocardia Infections / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D012874:Skin Diseases, Infectious / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D014184:Transplantation, Homologous / Q000009:adverse effects