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Fusarium infections in patients with severe aplastic anemia: review and implications for management
C Girmenia1, A P Iori, F Boecklin
1Dipartimento di Biotecnologie Cellulari ed Ematologia, University La Sapienza, Rome, Italy.
Background And Objective:
The prognosis of severe fungal infections, such as fusarium infections, in patients with aplastic anemia is directly related to the recovery of bone marrow functions. In this study, in vitro anti-Fusarium activity of granulocytes was investigated, the case of disseminated infection in a child with very severe aplastic anemia is reported, and implications for management of such infective complications are discussed.
Design And Methods:
The in vitro efficiency of PMNL from three untreated, normal blood donors and from two G-CSF-treated WBC donors in contrasting the growth of the Fusarium sp strain isolated from the patient we present was measured by a 3H-glucose uptake inhibition assay and confirmed by microscopic examination.
Results:
Basic growth inhibitory activity of unstimulated PMNL on Fusarium cells was significantly enhanced in the presence of GM-CSF in all three blood donors tested. In one of the two G-CSF-treated donors, in vitro efficiency of PMNL in contrasting the growth of the fungus increased notably after G-CSF treatment. We report the case of a 3-year-old girl with very severe aplastic anemia unresponsive to conventional immunosuppressant therapy who developed a disseminated fusarium infection. The child initially responded to liposomal amphotericin B and granulocyte transfusions from G-CSF stimulated donors. Subsequently she was given a cord blood stem cell transplantation but died of disseminated infection.
Interpretation And Conclusions:
Including the present case, there are only ten reports of invasive infections caused by the genus Fusarium in aplastic anemia patients and only two of the patients survived. In vitro data seem to suggest that in vivo treatment with rh-G-CSF could have a stimulatory effect on the anti-Fusarium activity of neutrophils. Despite the efficacy of granulocyte transfusions by G-CSF-stimulated donors in the temporary control of fusarium infection, treatment of the underlying hematologic disease is required to cure the infection in patients with severe aplastic anemia. Granulocyte transfusions by G-CSF-stimulated donors while awaiting bone marrow recovery following the blood stem cell transplant should be considered.
Insights
Severe fungal infections in aplastic anemia patients depend on bone marrow recovery. Granulocyte transfusions from G-CSF stimulated donors may temporarily control Fusarium infections while awaiting recovery.
Area of Science:
- Hematology
- Mycology
- Infectious Diseases
Background:
- Prognosis of severe fungal infections in aplastic anemia (AA) is linked to bone marrow function recovery.
- Disseminated Fusarium infection poses a significant risk in patients with severe AA.
Observation:
- In vitro, granulocyte anti-Fusarium activity was enhanced by GM-CSF.
- G-CSF treatment notably increased PMNL efficiency against Fusarium in one donor.
- A child with severe AA developed disseminated Fusarium infection despite initial treatment.
Findings:
- PMNL (polymorphonuclear leukocytes) from healthy donors showed enhanced anti-Fusarium activity with GM-CSF.
- G-CSF treatment improved PMNL's ability to inhibit Fusarium growth in some cases.
- The child with AA responded temporarily to liposomal amphotericin B and granulocyte transfusions but ultimately succumbed to disseminated infection.
Implications:
- In vitro data suggest rh-G-CSF may stimulate neutrophil anti-Fusarium activity in vivo.
- Granulocyte transfusions from G-CSF-stimulated donors offer temporary control of Fusarium infections.
- Curing invasive Fusarium infections in severe AA necessitates treating the underlying hematologic disease; granulocyte transfusions are supportive during bone marrow recovery.