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Fungal infections after bone marrow transplant
1University of Florida College of Medicine, Department of Medicine, Gainesville 32610-0277, USA.
Abstract:
With improved control of cytomegalovirus infection, invasive fungal infections have become the leading cause of infectious mortality after bone marrow transplantation (BMT). A number of changes in transplant practices have led to changes in patterns of fungal infections: neutropenic episodes have been shortened through the use of hematopoietic growth factors and peripheral blood as a source of stem cells. More potent immunosuppressive regimens, including T-cell depletion techniques, have encouraged the use of alternate donor sources with greater numbers of transplant recipients experiencing more prolonged and more profound immunodeficiency following engraftment. The advent of new antifungal agents has led to a decline in Candida infections, but has encouraged the emergence of other less susceptible fungal pathogens. The development of molecular techniques to distinguish different fungal strains has led to identification of nosocomial transmission as an unexpected means for the spread of fungal infections in BMT units. These shifts in fungal infection patterns emphasize the need for infection control monitoring. The development of more accurate diagnostic tools and the incorporation of new antifungal agents into practice are needed to further improve outcomes.
Insights
Invasive fungal infections are now the primary cause of death post-bone marrow transplantation (BMT), surpassing cytomegalovirus. Advances in BMT practices have altered infection patterns, necessitating improved diagnostics and antifungal strategies.
Area of Science:
- Hematology
- Infectious Diseases
- Transplantation Medicine
Background:
- Invasive fungal infections (IFIs) are the leading cause of mortality after bone marrow transplantation (BMT), especially with improved cytomegalovirus control.
- Changes in BMT practices, including shorter neutropenic periods and potent immunosuppression, alter IFIs patterns.
- Emergence of less susceptible fungal pathogens and nosocomial transmission are significant concerns in BMT units.
Purpose of the Study:
- To analyze the evolving landscape of fungal infections following bone marrow transplantation.
- To highlight the impact of modern BMT practices on infectious mortality.
- To underscore the need for enhanced infection control and diagnostic strategies.
Main Methods:
- Review of current literature and clinical practices in bone marrow transplantation.
- Analysis of shifts in fungal infection epidemiology and causative agents.
- Evaluation of the role of molecular techniques in identifying transmission routes.
Main Results:
- Invasive fungal infections have surpassed cytomegalovirus as the leading cause of infectious mortality post-BMT.
- Hematopoietic growth factors and peripheral blood stem cells have shortened neutropenic episodes.
- Potent immunosuppression and T-cell depletion increase the risk of prolonged immunodeficiency.
- Newer antifungal agents have reduced Candida infections but increased infections by less susceptible fungi.
- Molecular techniques have identified nosocomial transmission as a significant factor in BMT fungal infections.
Conclusions:
- Modern BMT practices have significantly altered the patterns and epidemiology of fungal infections.
- There is a critical need for enhanced infection control measures and surveillance in BMT units.
- Development of more accurate diagnostic tools and integration of novel antifungal agents are essential to improve patient outcomes.