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Rhinocerebral aspergillosis in patients undergoing bone marrow transplantation
1Department of Otolaryngology-Head and Neck Surgery, Hadassah University Hospital, Jerusalem, Israel.
Abstract:
Rhinocerebral aspergillosis (RA) is becoming increasingly common in patients undergoing bone marrow transplantation (BMT). The disease can involve nearly all major head and neck structures, including the nose, paranasal sinuses, and orbits. Intracranial extension of the infection is of major concern, since this is usually a fatal complication. Our study population comprised 423 consecutive BMT patients at Hadassah University Hospital from January 1986 to August 1992. Eight patients (1.9%) developed RA, 5 of whom had underlying hematologic malignancies, and 3 of whom had severe aplastic anemia. Only 2 of the 8 patients responded completely to therapy, with a follow-up of 15 months. It appears that RA is a fatal complication in immunocompromised patients post-BMT. Early diagnosis followed by extensive surgical debridement of necrotic tissue and systemic, as well as topical, antifungal therapy with amphotericin B or its new formulations and the patient's recovery of bone marrow function may improve the outcome of this life-threatening complication.
Insights
Rhinocerebral aspergillosis (RA) is a serious complication for bone marrow transplant (BMT) patients. Early diagnosis and aggressive treatment, including surgery and antifungals, are crucial for improving outcomes in these immunocompromised individuals.
Area of Science:
- Infectious Diseases
- Hematology
- Oncology
Background:
- Rhinocerebral aspergillosis (RA) is an emerging invasive fungal infection in bone marrow transplant (BMT) recipients.
- RA can affect head and neck structures, with intracranial extension posing a significant mortality risk.
Purpose of the Study:
- To investigate the incidence and outcomes of RA in BMT patients.
- To identify factors influencing treatment response and survival.
Main Methods:
- Retrospective analysis of 423 BMT patients from January 1986 to August 1992.
- Identification of patients who developed RA and review of their clinical data and treatment regimens.
Main Results:
- Eight patients (1.9%) developed RA, primarily those with hematologic malignancies or aplastic anemia.
- Only 2 out of 8 patients achieved complete response to therapy, with a median follow-up of 15 months.
- RA was associated with high mortality in this immunocompromised cohort.
Conclusions:
- Rhinocerebral aspergillosis is a frequently fatal complication post-BMT.
- Optimal management likely involves early diagnosis, surgical debridement, aggressive antifungal therapy (e.g., amphotericin B), and restoration of bone marrow function.