Invasive filamentous fungal infections in allogeneic hematopoietic stem cell transplant recipients after recovery from neutropenia: clinical, radiologic, and pathologic characteristics.
Invasive filamentous fungal infection (IFFI) is an important cause of mortality in allogeneic hematopoietic stem cell transplant (HSCT) recipients. We reviewed 22 consecutive cases of IFFI in allogeneic HSCT recipients at Roswell Park Cancer Institute. IFFI was diagnosed after neutrophil recovery in 21 patients (95%). All had received corticosteroids within 1 month prior to IFFI diagnosis. Fourteen (64%) presented with dyspnea, and only 7 (32%) were febrile. Aspergillus species were isolated in 18 (82%) cases. Thirty day mortality after IFFI diagnosis was associated with a higher mean daily dose of corticosteroids (P=0.02) and receiving OKT3 (P=0.01) within 1 month prior to IFFI diagnosis and serum creatinine>2 mg/dl at the time of diagnosis (P=0.004). Histopathologic material from biopsy or autopsy was available in 15 patients (68%). In 8 (53%), the predominant lung histopathology was an acellular coagulative necrosis and hyphal angioinvasion was observed in some of these cases. These findings have generally been observed in neutropenic patients but not in non-neutropenic HSCT recipients. The predominance of coagulative necrosis in our series may reflect the high doses of corticosteroids used to treat graft-versus-host disease (GVHD), which may have disabled leukocyte trafficking and hyphal killing.
Shaukat
Aasma
A
Department of Medicine, School of Medicine and Biochemical Sciences, SUNY at Buffalo, Buffalo 14263, NY, USA.
Bakri
Faris
F
Young
Paul
P
Hahn
Theresa
T
Ball
Donna
D
Baer
Maria R
MR
Wetzler
Meir
M
Slack
James L
JL
Loud
Peter
P
Czuczman
Myron
M
McCarthy
Philip L
PL
Walsh
Thomas J
TJ
Segal
Brahm H
BH
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D001230:Aspergillus / Q000254:growth & development* / Q000302:isolation & purification; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy; D006651:Histocytochemistry; D006801:Humans; D008297:Male; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000627:therapeutic use; D009503:Neutropenia / Q000188:drug therapy; D011859:Radiography; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D016019:Survival Analysis; D014184:Transplantation, Homologous / Q000009:adverse effects
D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D016853:Muromonab-CD3