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Fungal infections in marrow transplant recipients under antifungal prophylaxis with fluconazole

J S R Oliveira1, F R Kerbauy, A L Colombo

  • 1Disciplina de Hematologia e Hemoterapia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil. salvador@hemato.epm.br

Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas
|July 20, 2002
PubMed

Insights

Invasive mold infections pose a significant threat to bone marrow transplant (BMT) recipients. Fluconazole prophylaxis is insufficient against emerging fungal pathogens in these immunocompromised patients.

Area of Science:

  • Mycology
  • Hematology
  • Transplant Medicine

Background:

  • Fungal infections are a leading cause of morbidity and mortality in bone marrow transplant (BMT) recipients.
  • Factors contributing to increased incidence include prolonged granulocytopenia, broad-spectrum antibiotics, conditioning regimens, and immunosuppression for graft-versus-host disease (GvHD).

Observation:

  • This series reports five cases of invasive mold infections in 64 BMT recipients receiving fluconazole prophylaxis.
  • Infections documented include Scedosporium prolificans, Aspergillus fumigatus, Rhizopus arrhizus (zygomycosis), Aspergillus spp., and Fusarium sp.

Findings:

  • Invasive mold infections occurred despite fluconazole prophylaxis.
  • Documented cases involved various fungal species and affected different sites, including skin, lungs, ribs, and brain.
  • Specific cases highlight infections in patients with chronic myeloid leukemia, severe aplastic anemia, GvHD, and acute lymphocytic leukemia.

Implications:

  • Opportunistic fungal infections beyond Candida are a growing concern in BMT patients on fluconazole.
  • Current antifungal prophylaxis strategies may require re-evaluation for BMT recipients.
  • Further research is needed to optimize antifungal management in this vulnerable population.

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