Invasive fungal disease in allogeneic hematopoietic stem cell transplant recipients: an autopsy-driven survey

: Invasive mycoses are pre‐eminent causes of morbidity and mortality in the allogeneic stem cell transplant setting. In spite of novel diagnostic modalities, the timely and specific identification of invasive mycoses still remains challenging. We analyzed the case history of 97 consecutive patients...

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Bibliographic Details
Published in:Transplant infectious disease 2008-04, Vol.10 (2), p.106-109
Main Authors: Sinkó, J., Csomor, J., Nikolova, R., Lueff, S., Kriván, G., Reményi, P., Bátai, Á., Masszi, T.
Format: Article
Language:English
Subjects:
Administration, Oral
Adolescent
Adult
Antifungal Agents - administration & dosage
Antifungal Agents - therapeutic use
aspergillosis
Aspergillosis - diagnosis
Aspergillosis - drug therapy
Aspergillosis - mortality
Autopsy
candidiasis
Candidiasis - diagnosis
Candidiasis - drug therapy
Candidiasis - mortality
Child
Child, Preschool
Female
Hematopoietic Stem Cell Transplantation
Humans
Infant
Injections, Intravenous
invasive mycosis
Male
Middle Aged
mucormycosis
Mycoses - diagnosis
Mycoses - drug therapy
Mycoses - mortality
preemptive therapy
Transplantation, Homologous
Treatment Outcome
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Summary:: Invasive mycoses are pre‐eminent causes of morbidity and mortality in the allogeneic stem cell transplant setting. In spite of novel diagnostic modalities, the timely and specific identification of invasive mycoses still remains challenging. We analyzed the case history of 97 consecutive patients receiving 103 allogeneic stem cell transplants between January 2003 and October 2006 performed by a single team at 2 transplant centers in Budapest, Hungary. All patients with febrile neutropenia not responding to broad‐spectrum antibacterial therapy received amphotericin B deoxycholate empirically. In cases of proven or probable invasive aspergillosis, intravenous voriconazole was instituted. Patients who failed to improve on initial therapy were treated with an antifungal combination, while responders were switched to oral voriconazole. A total of 38 patients died following allografting. Both centers had an autopsy rate of 100% due to central health care regulations. An infectious cause of death could be identified in 15 cases, invasive fungal disease being the most prevalent and accounting for 10 fatalities. Six patients died of invasive aspergillosis, while invasive candidiasis and mucormycosis led to a fatal outcome in 2 cases each. Despite the regular use of galactomannan antigen detections and imaging, an ante mortem diagnosis of proven/probable invasive fungal disease could only be established in 4 of 10 autopsy‐verified cases (aspergillosis: 3, candidiasis: 1, mucormycosis: 0). In the remaining 6 patients, deep mycoses were missed clinically and were revealed only by postmortem histology. Present diagnostic and therapeutic strategies still seem to be suboptimal for the management of invasive fungal diseases in the high‐risk allogeneic stem cell transplant population.
ISSN:1398-2273
1399-3062
DOI:10.1111/j.1399-3062.2007.00264.x