One consequence of the profound immunocompromise required for HSCT is an increased risk of life-threatening opportunistic infections. More than 90% of patients experience prolonged periods of fever, and half of them have documented infections during the posttransplant course. Candida species and Aspergillus species are the most common fungi causing invasive disease, although numerous other fungi once thought to be innocuous are emerging as opportunistic pathogens (Table 2).
| Predominant Fungi | Emerging Fungi
|
| Candida albicans | Non-fumigatus Aspergillus spp
|
| Non-albicans Candida spp: | Fusarium spp
|
| C tropicalis, C glabrata, | Trichosporon spp
|
| C parapsilosis, | Acremonium spp
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| C krusei, | Scedosporium spp
|
| C lusitaniae | Zygomycetes
|
Aspergillus fumigatus
| Dematiaceous moulds
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HSCT=hematopoietic stem-cell transplant.
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Mortality is high in neutropenic patients with IFI. In patients with Aspergillus infection who have undergone allogeneic HSCT, it can exceed 90%,10 and virtually all patients with Fusarium and Trichosporon infections die.11,12 Even candidemia may be associated with a mortality rate as high as 50%.13,14
Course Number: V035D
This CME Expires on July 1, 2005; no tests will be accepted after this date.
This course is accredited by
The University of Pittsburgh School of Medicine, Center for Continuing Education and The International Immunocompromised Host Society
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