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

J. Sinkó, J. Csomor, R. Nikolova, S. Lueff, G. Kriván, P. Reményi, Á Bátai, T. Masszi

Research output: Article

44 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)106-109
Number of pages4
JournalTransplant Infectious Disease
Volume10
Issue number2
DOIs
Publication statusPublished - ápr. 2008

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Mycoses
Hematopoietic Stem Cells
Autopsy
Transplants
Aspergillosis
Mucormycosis
Stem Cells
Invasive Candidiasis
Febrile Neutropenia
Fatal Outcome
Hungary
Candidiasis
Homologous Transplantation
Transplant Recipients
Surveys and Questionnaires
Cause of Death
Histology
Therapeutics
Morbidity
Delivery of Health Care

ASJC Scopus subject areas

  • Transplantation
  • Microbiology (medical)
  • Immunology

Cite this

Invasive fungal disease in allogeneic hematopoietic stem cell transplant recipients : An autopsy-driven survey. / Sinkó, J.; Csomor, J.; Nikolova, R.; Lueff, S.; Kriván, G.; Reményi, P.; Bátai, Á; Masszi, T.

In: Transplant Infectious Disease, Vol. 10, No. 2, 04.2008, p. 106-109.

Research output: Article

Sinkó, J. ; Csomor, J. ; Nikolova, R. ; Lueff, S. ; Kriván, G. ; Reményi, P. ; Bátai, Á ; Masszi, T. / Invasive fungal disease in allogeneic hematopoietic stem cell transplant recipients : An autopsy-driven survey. In: Transplant Infectious Disease. 2008 ; Vol. 10, No. 2. pp. 106-109.
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