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An Outbreak of Invasive Aspergillosis Among Allogeneic Bone Marrow Transplants: A Case-Control Study

Published online by Cambridge University Press:  02 January 2015

Coleman Rotstein ,
K. Michael Cummings ,
John Tidings ,
Kathleen Killion ,
Eileen Powell ,
Tracy L. Gustafson  and
Donald Higby
Coleman Rotstein*
Affiliation:
Departments of Medical Oncology and Cancer Control and Epidemiology, Roswell Park Memorial Institute, Buffalo, New York Division of Infectious Diseases, State University of New York at Buffalo, Buffalo, New York Director of Infectious Disease Division, Bureau of Epidemiology, Texas Department of Health, Austin, Texas
K. Michael Cummings
Affiliation:
Departments of Medical Oncology and Cancer Control and Epidemiology, Roswell Park Memorial Institute, Buffalo, New York Division of Infectious Diseases, State University of New York at Buffalo, Buffalo, New York Director of Infectious Disease Division, Bureau of Epidemiology, Texas Department of Health, Austin, Texas
John Tidings
Affiliation:
Departments of Medical Oncology and Cancer Control and Epidemiology, Roswell Park Memorial Institute, Buffalo, New York Division of Infectious Diseases, State University of New York at Buffalo, Buffalo, New York Director of Infectious Disease Division, Bureau of Epidemiology, Texas Department of Health, Austin, Texas
Kathleen Killion
Affiliation:
Departments of Medical Oncology and Cancer Control and Epidemiology, Roswell Park Memorial Institute, Buffalo, New York Division of Infectious Diseases, State University of New York at Buffalo, Buffalo, New York Director of Infectious Disease Division, Bureau of Epidemiology, Texas Department of Health, Austin, Texas
Eileen Powell
Affiliation:
Departments of Medical Oncology and Cancer Control and Epidemiology, Roswell Park Memorial Institute, Buffalo, New York Division of Infectious Diseases, State University of New York at Buffalo, Buffalo, New York Director of Infectious Disease Division, Bureau of Epidemiology, Texas Department of Health, Austin, Texas
Tracy L. Gustafson
Affiliation:
Departments of Medical Oncology and Cancer Control and Epidemiology, Roswell Park Memorial Institute, Buffalo, New York Division of Infectious Diseases, State University of New York at Buffalo, Buffalo, New York Director of Infectious Disease Division, Bureau of Epidemiology, Texas Department of Health, Austin, Texas
Donald Higby
Affiliation:
Departments of Medical Oncology and Cancer Control and Epidemiology, Roswell Park Memorial Institute, Buffalo, New York Division of Infectious Diseases, State University of New York at Buffalo, Buffalo, New York Director of Infectious Disease Division, Bureau of Epidemiology, Texas Department of Health, Austin, Texas
*
Department of Medical Oncology, Roswell Park Memorial Institute, 666 Elm Street, Buffalo, NY 14263
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Abstract

Between April 1982 and March 1983,10 of 26 (38.4%) allogeneic bone marrow transplant recipients housed on a newly opened bone marrow transplant unit developed invasive aspergillosis. By contrast, between September 1977 and March 1982, only 3 of 46 (6%) transplant recipients developed invasive aspergillosis. A case-control study to identify host factors related to Aspergillus infection found that aspergillosis was more common in patients with chronic myelogenous leukemia and aplastic anemia, older patients, patients having cytomegalovirus disease, patients who experienced prolonged granulocytopenia, patients conditioned with ara-C (100-200 mg/day), and patients who received longer duration of antimicrobial therapy. A series of logistic regression analyses revealed that underlying disease was the single best predictor of Aspergillus infection. This study demonstrates that underlying disease is an important risk factor for aspergillosis and that special measures may be warranted when transplanting certain patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 6 , Issue 9 , September 1985 , pp. 347 - 355
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1985

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References

1.Bortin, MM, Gale, RP, Rimm, AA: Allogeneic bone marrow transplantation for 144 patients with severe aplastic anemia. JAMA 1981;245:1132–1139.CrossRefGoogle ScholarPubMed
2.Bortin, M, Rimm, A: Severe combined immunodeficiency. Characterization of the disease and results of transplantation (Advisory Committee of the International Bone Marrow Transplant Registry). JAMA 1977;238:591–600.CrossRefGoogle Scholar
3.Thomas, ED, Buckner, CD, Clift, RA, et al: Marrow transplantation for acute nonlymphoblastic leukemia in first remission. N Engl J Med 1979;301:597–599.CrossRefGoogle ScholarPubMed
4.Thomas, ED. Sanders, JE, Flournoy, N, et al: Marrow transplantation for patients with acute lymphoblastic leukemia in remission. Blood 1979;54:468–476.CrossRefGoogle ScholarPubMed
5.McGlave, PB, Arthur, DC, Weisdorf, D, et al: Allogeneic bone marrow transplantation as treatment for accelerating chronic myelogenous leukemia. Blood 1984;63:219–222.CrossRefGoogle ScholarPubMed
6.Champlin, R, Ho, W, Arenson, E, et al: Allogeneic bone marrow transplantation for chronic myelogenous leukemia in chronic or accelerated phase. Blood 1982;60:1038–1041.CrossRefGoogle ScholarPubMed
7.Goldman, JN, Baughan, A: Application of bone marrow transplantation in chronic granulocytic leukemia. Clin Hematol 1983;12:739–753.CrossRefGoogle Scholar
8.Rappeport, JM, Parkman, R, Newburger, P, et al: Correction of infantile agranulocytosis by allogeneic bone marrow transplantation. Am J Med 1980;68:605–609.CrossRefGoogle ScholarPubMed
9.Meyers, JD, Thomas, ED: Infection complicating bone marrow transplantation, in Rubin, RH, Young, LS (eds): Clinical Approach to Infection in the Compromised Host. New York, Plenum Medical, 1981, pp 507–551.Google Scholar
10.Winston, DJ, Gale, RP, Meyer, DV, et al: Infectious complications of human bone marrow transplantation. Medicine 1979;58:1–31.CrossRefGoogle ScholarPubMed
11.Bardana, EJ Jr: The clinical spectrum of aspergillosis—Part 1: Epidemiology, pathogenicity, infection in animals and immunology of Aspergillus. CRC Crit Rev Clin Lab Sci 1980;13:21–83.CrossRefGoogle Scholar
12.Fisher, BD, Armstrong, D, Yu, B, et al: Invasive aspergillosis: Progress in early diagnosis and treatment. Am J Med 1981;71:571–577.CrossRefGoogle ScholarPubMed
13.Gustafson, TL, Schaffner, W, Laely, GB, et al: Invasive aspergillosis in renal transplant recipients: Correlation with corticosteroid therapy. J Infect Dis 1983;148:230–238.CrossRefGoogle ScholarPubMed
14.Gurwith, MJ, Stinson, EB, Remington, JS: Aspergillus infection complicating cardiac transplantations: Report of five cases. Arch Intern Med 1971;120:541–545.CrossRefGoogle Scholar
15.Peterson, PK, McGlave, P, Ramsay, NKC, et al: A prospective study of infectious diseases following bone marrow transplantation: Emergence of Aspergillus and cytomegalovirus as the major causes of mortality. Infect Control 1983;4:81–89.CrossRefGoogle ScholarPubMed
16.Aisner, J, Schimpff, SC, Bennett, JE, et al: Aspergillus infections in cancer patients: Association with fireproofing materials in a new hospital. JAMA 1976;235:411–412.CrossRefGoogle Scholar
17.Lentino, JR, Rosenkranz, MA, Michaels, JA, et al: Nosocomial aspergillosis: A retrospective review of airborne disease secondary to road construction and contaminated air conditioners. Am J Epidemiol 1982;116:430–437.CrossRefGoogle ScholarPubMed
18.Sarubbi, FA, Kopf, HB, Wilson, MB, et al: Increased recovery of Aspergillus flavus from respiratory specimens during hospital construction. Am Rev Respir Dis 1982;125:33–38.Google ScholarPubMed
19.Gerson, SL, Talbot, GH, Hurwitz, S, et al: Prolonged granulocytopenia: The major risk factor for invasive pulmonary aspergillosis in patients with acute leukemia. Ann Intern Med 1984;100:345–351.CrossRefGoogle ScholarPubMed
20.Aisner, J, Murillo, J, Schimpff, S, et al: Invasive aspergillosis in acute leukemia: Correlation with nose cultures and antibiotic use. Ann Intern Med 1979;90:4–9.CrossRefGoogle ScholarPubMed
21.Arnow, PM, Andersen, RL, Maindus, PD, et al: Pulmonary aspergillosis during hospital renovation. Am Rev Respir Dis 1978;118:49–53.Google Scholar
22.Speck, B, Bortin, MM, Champlin, R, et al: Allogeneic bone marrow transplantation for chronic myelogenous leukemia. Lancet 1984;1:665–668.CrossRefGoogle Scholar
23.Weiss, RB, Muggia, FM: Cytotoxic drug-induced pulmonary disease: Update 1980. Am J Med 1980;68:259–266.CrossRefGoogle ScholarPubMed
24.Haupt, HM, Hutchins, GM, Moore, GW: Ara-C lung: Noncardiogenic pulmonary edema complicating cytosine arabinoside therapy of leukemia. Am J Med 1981;70:256–261.CrossRefGoogle ScholarPubMed
25.Bodey, GP, Hersh, EM, Valdivesco, M, et al: Effects of cytotoxic and immunosuppressive agents on the immune system. Postgrad Med 1975;67:67–74.CrossRefGoogle Scholar
26.Hersh, EM: Immunosuppressive agents, in Sartorelli, AC and Joans, DJ (eds): Antineoplastics and Immunosuppressive Agents. New York, Springer-Verlag, Inc, 1974, pp 577–617.Google Scholar
27.Quinnan, GV, Ennis, FA: Cell-mediated immunity in cytomegalovirus infections—A review. Comp Immunol Microbiol Infect Dis 1980;3:283–290.CrossRefGoogle ScholarPubMed
28.Dekker, AW, Rozenberg-Arska, M, Sixma, JJ, et al: Prevention of infection by trimethoprim-sulfamethoxazole plus amphotericin B in patients with acute nonlymphocytic leukemia. Ann Intern Med 1981;95:555–559.CrossRefGoogle Scholar
29.Bender, JW, Saral, R, Braine, HG: Hematologic recovery in patients treated with amphotericin B after bone marrow transplantation. Blood 1981;58(suppl):170a.Google Scholar
30.Rhame, FS, Streifel, AJ, Kersey, JH Jr, et al: Extrinsic risk factors for pneumonia in die patient at high risk of infection. Am J Med 1984;76(5A):42–52.CrossRefGoogle Scholar
31.Aisner, J, Schimpff, SC, Wiernik, PH: Treatment of invasive aspergillosis: Relation of early diagnosis and treatment to response. Ann Intern Med 1977;86:539–543.CrossRefGoogle ScholarPubMed
32.Weiner, MH, Talbot, GH, Gerson, SL, et al: Antigen detection in the diagnosis of invasive aspergillosis: Utility in controlled blind trials. Ann Intern Med 1983;99:777–782.CrossRefGoogle Scholar