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Invasive filamentous fungal infections in allogeneic hematopoietic stem cell transplant recipients after recovery from neutropenia: Clinical, radiologic, and pathologic characteristics

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Abstract

Invasive filamentous fungal infection (IFFI) is an important cause of mortality in allogeneic hematopoietic stem cell transplant (HSCT) recipients. We reviewed 22 consecutive cases of IFFI in allogeneic HSCT recipients at Roswell Park Cancer Institute. IFFI was diagnosed after neutrophil recovery in 21 patients (95%). All had received corticosteroids within 1 month prior to IFFI diagnosis. Fourteen (64%) presented with dyspnea, and only 7 (32%) were febrile. Aspergillus species were isolated in 18 (82%) cases. Thirty day mortality after IFFI diagnosis was associated with a higher mean daily dose of corticosteroids (P = 0.02) and receiving OKT3 (P = 0.01) within 1 month prior to IFFI diagnosis and serum creatinine >2 mg/dl at the time of diagnosis (P = 0.004). Histopathologic material from biopsy or autopsy was available in 15 patients (68%). In 8 (53%), the predominant lung histopathology was an acellular coagulative necrosis and hyphal angioinvasion was observed in some of these cases. These findings have generally been observed in neutropenic patients but not in non-neutropenic HSCT recipients. The predominance of coagulative necrosis in our series may reflect the high doses of corticosteroids used to treat graft-versus-host disease (GVHD), which may have disabled leukocyte trafficking and hyphal killing.

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Authors and Affiliations

  1. Department of Medicine, School of Medicine and Biochemical Sciences, SUNY at Buffalo, Buffalo, NY

    Aasma Shaukat, Faris Bakri, Paul Young, Theresa Hahn, Maria R. Baer, Meir Wetzler, James L. Slack, Peter Loud, Myron Czuczman, Philip L. McCarthy & Brahm H. Segal

  2. Departments of Medicine, Roswell Park Cancer Institute, Buffalo, NY

    Theresa Hahn, Donna Ball, Maria R. Baer, Meir Wetzler, James L. Slack, Myron Czuczman, Philip L. McCarthy & Brahm H. Segal

  3. Diagnostic Radiology, Roswell Park Cancer Institute, Buffalo, NY

    Peter Loud

  4. Immunocompromised Host Section, Pediatric Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    Thomas J. Walsh

  5. Division of Infectious Diseases, Roswell Park Cancer Institute, Elm and Carolton Streets, Buffalo, NY, 14263, USA

    Brahm H. Segal

Authors
  1. Aasma Shaukat
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  2. Faris Bakri
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  3. Paul Young
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  4. Theresa Hahn
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  5. Donna Ball
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  6. Maria R. Baer
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  7. Meir Wetzler
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  8. James L. Slack
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  9. Peter Loud
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  10. Myron Czuczman
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  11. Philip L. McCarthy
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  12. Thomas J. Walsh
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  13. Brahm H. Segal
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Correspondence to Brahm H. Segal.

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Shaukat, A., Bakri, F., Young, P. et al. Invasive filamentous fungal infections in allogeneic hematopoietic stem cell transplant recipients after recovery from neutropenia: Clinical, radiologic, and pathologic characteristics. Mycopathologia 159, 181–188 (2005). https://doi.org/10.1007/s11046-004-5495-0

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  • DOI: https://doi.org/10.1007/s11046-004-5495-0

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