Related Experiment Videos
Pulmonary resection for fungal infection in children undergoing bone marrow transplantation
F M Lupinetti1, D M Behrendt, R H Giller
1Department of Surgery, University of Iowa School of Medicine, Iowa City.
Abstract:
Recipients of bone marrow transplants for hematologic malignancies are at risk for a variety of infectious complications. We have reviewed our experience with six patients 2 to 15 years of age who developed significant fungal infections of the lungs before or after bone marrow transplant. No patient was known to have active fungal or bacterial infection at the time bone marrow transplant was performed. In two patients fungal infections were diagnosed before bone marrow transplant, and operations were performed to permit bone marrow transplant under optimal conditions. Four patients had pulmonary mycoses discovered after bone marrow transplant, and underwent operation 12 to 24 days following transplant. Operations consisted of lobectomy (three), multiple unilateral wedge resections (one), staged segmentectomy and contralateral wedge resection (one), and staged bilateral wedge resection (one). Survival following bone marrow transplant was achieved for 6 months and 11 months in patients undergoing lung resection before transplant, and for 24, 30, 39, and 60 days in patients undergoing lung resections after transplant. Bone marrow transplant recipients are at high risk of pulmonary mycoses, and a vigorous search for occult fungal infections should be carried out before transplant. Aggressive operative treatment of fungal infections of the lungs combined with antifungal chemotherapy before transplant may offer the best hope of extended survival.
Insights
Bone marrow transplant recipients face high risks of fungal lung infections. Early surgical intervention and antifungal therapy before transplant may improve survival rates for these patients.
Area of Science:
- Medicine
- Oncology
- Infectious Diseases
Background:
- Bone marrow transplant (BMT) recipients are susceptible to severe infectious complications.
- Hematologic malignancies necessitate BMT, increasing infection risk.
- Pulmonary mycoses pose a significant threat to BMT patients.
Purpose of the Study:
- To review the experience with fungal lung infections in pediatric BMT recipients.
- To evaluate the outcomes of surgical intervention for pulmonary mycoses in this population.
- To determine the impact of treatment timing on patient survival.
Main Methods:
- Retrospective review of six pediatric patients (2-15 years) with fungal lung infections.
- Analysis of surgical procedures (lobectomy, wedge resection, segmentectomy) performed before or after BMT.
- Evaluation of survival data in relation to treatment timing and surgical approach.
Main Results:
- Two patients had pre-transplant fungal infections requiring surgery for optimal transplant conditions.
- Four patients developed post-transplant pulmonary mycoses, undergoing surgery 12-24 days post-BMT.
- Survival varied: 6-11 months for pre-transplant surgery, 24-60 days for post-transplant surgery.
Conclusions:
- Pulmonary mycoses are a critical concern for BMT recipients.
- Proactive screening for occult fungal infections before BMT is crucial.
- Aggressive surgical treatment combined with antifungal chemotherapy before BMT offers the best survival prognosis.