Nosocomial Invasive Aspergillosis in Lymphoma Patients Treated with Bone Marrow or Peripheral Stem Cell Transplants
| Autor: | Elizabeth C. Reed, Philip J. Bierman, Anne Kessinger, Barbara A. Winfield, Julie M. Vose, Mark A. Arneson, Peter C. Iwen, James O. Armitage, Gail L. Woods |
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| Rok vydání: | 1993 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty Pathology Epidemiology medicine.medical_treatment 030106 microbiology Neutropenia Aspergillosis Hospitals University 03 medical and health sciences 0302 clinical medicine Amphotericin B Internal medicine medicine Humans 030212 general & internal medicine Bone Marrow Transplantation Retrospective Studies Cross Infection Chemotherapy Hematology business.industry Aspergillus fumigatus Lymphoma Non-Hodgkin Nebraska Total body irradiation medicine.disease Combined Modality Therapy Hodgkin Disease Surgery Lymphoma medicine.anatomical_structure Infectious Diseases Bone marrow business Aspergillus flavus Stem Cell Transplantation medicine.drug |
| Zdroj: | Infection Control and Hospital Epidemiology. 14:131-139 |
| ISSN: | 1559-6834 0899-823X 0195-9417 |
| DOI: | 10.2307/30148476 |
| Popis: | Objectives:To determine the prevalence of aspergillosis in lymphoma patients housed in a protective environment while undergoing a bone marrow transplant or peripheral stem cell transplant and its relation to lymphoma type, type of transplant, period of neutropenia, method of diagnosis, species of Aspergillus, and the use of empiric amphotericin B.Design:Clinical, autopsy, and microbiology records were reviewed retrospectively to determine the presence or absence of invasive aspergillosis. All positive specimens underwent further review to determine parameters outlined above.Setting:The review took place at the University of Nebraska Medical Center with lymphoma patients housed in the oncology/hematology special care unit, which consists of 30 single-patient rooms under positive pressure with high-efficiency particulate air filtration.Patients:4 17 lymphoma patients admitted to the oncology/hematology special care unit who underwent 427 courses of high-dose chemotherapy with or without total body irradiation followed by a stem cell rescue.Results:Twenty-two cases (5.2%) of nosocomial invasive aspergillosis (14 caused by Aspergillus flavus, 2 by Aspergillus terreus, 2 by Aspergillus fumigatus, and 4 by characteristic histology) were diagnosed. The prevalence of disease according to transplant was 8.7% for allogeneic bone marrow transplant (2/23 treatments), 5.6% for autologous peripheral stem cell transplant (9/161), and 4.5% for autologous bone marrow transplant (11/243). Fifteen patients were presumptively diagnosed prior to death (68.2%) most commonly by histologic examination of skin biopsies. All 22 patients received amphotericin B therapy, 17 prior to aspergillosis diagnosis, and 7 (31.8%) survived. No patient with disseminated disease survived.Conclusions:Even when housing lymphoma patients undergoing myeloablative therapy in a protective environment containing high-efficiency particulate air filtration, there was a risk of developing aspergillosis. These data also showed that antemortem diagnosis with aggressive amphotericin B therapy was most effective in the management of infected lymphoma patients when engraftment occurred and the disease did not become disseminated. |
| Databáze: | OpenAIRE |
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