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A Prospective Study of Infectious Diseases Following Bone Marrow Transplantation: Emergence of Aspergillus and Cytomegalovirus as the Major Causes of Mortality

Published online by Cambridge University Press:  02 January 2015

Phillip K. Peterson ,
Philip McGlave ,
Norma K.C. Ramsay ,
Frank Rhame ,
Eve Cohen ,
Guy S. Perry III ,
Anne I. Goldman  and
John Kersey
Phillip K. Peterson*
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
Philip McGlave
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
Norma K.C. Ramsay
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
Frank Rhame
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
Eve Cohen
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
Guy S. Perry III
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
Anne I. Goldman
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
John Kersey
Affiliation:
Departments of Medicine, Pediatrics, Laboratory Medicine/Pathology, the Division of Biometry, and the Bone Marrow Transplantation Unit, University of Minnesota Health Sciences Center, Minneapolis, Minnesota
*
Department of Medicine, University of Minnesota Hospitals, Minneapolis, MN 55455
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Abstract

We performed a prospective study of infections following bone marrow transplantation in 50 patients treated for aplastic anemia or hematologic malignancy. Early, continuous prophylaxis with trimethoprim/sulfamethoxazole and oral nystatin, and empiric intravenous antimicrobial therapy during febrile granulocytopenic episodes were standard treatment for all patients. The use of trimethoprim/sulfamethoxazole did not appear to adversely affect donor marrow engraftment. Serious gram-negative bacillary and systemic Candida infections were uncommon. Although gram-positive bacterial infections were frequent, they were rarely associated with mortality. Aspergillosis emerged as the single most important infection, contributing to the death of nine patients. Cytomegalovirus diseases developed in 13 patients, seven of whom died. Patient age and chronic myelogenous leukemia were risk factors for the development of fatal infections. This study demonstrates that although certain serious infections can be controlled, there is a critical need for effective measures to prevent and treat aspergillosis and cytomegalovirus disease in these seriously compromised hosts.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 4 , Issue 2 , April 1983 , pp. 81 - 89
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1983

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