Fusarium Infection in Hematopoietic Stem Cell Transplant Recipients

Abstract

To characterize the epidemiology and prognostic factors of invasive fusariosis in hematopoietic stem cell transplant (HSCT) recipients, the records of HSCT recipients from 9 hospitals (7 in Brazil and 2 in the United States) were retrospectively reviewed. Sixty-one cases were identified: 54 in allogeneic HSCT recipients and 7 in autologous HSCT recipients. The incidence of fusariosis among allogeneic HSCT recipients varied between a range of 4.21-5.0 cases per 1000 in human leukocyte antigen (HLA)--matched related transplant recipients to 20.19 cases per 1000 in HLA-mismatched transplant recipients. The median time period between transplantation and diagnosis of fusariosis was 48 days. Among allogeneic HSCT recipients, a trimodal distribution was observed: a first peak before engraftment, a second peak at a median of 62 days after transplantation, and a third peak >1 year after transplantation. The actuarial survival was 13% (median, 13 days). Persistent neutropenia was the single prognostic factor for death identified by multivariate analysis.

Fungal Infections in Transplant and Oncology Patients

“…Pneumocystosis, endemic fungal infections, and cryptococcosis were rarely encountered in the HSCT population. Consistent with prior reports [4][5][6][7], mortality was high and one-year survival was low for HSCT patients with IFI. Fusarium infections and IA were associated with the lowest one year survival (6% and 25%, respectively); however, survival among patients with zygomycosis (28%) and IC (34%) was not substantially better.…”

“…On the other hand, Scedosporium infections were more likely to occur within the first 30 days post-transplant [5]. Similarly, nearly half (46%) of patients with fusariosis were neutropenic at the time of diagnosis and the median time from transplant to diagnosis was 64 days [6]. …”

High-dose caspofungin combination antifungal therapy in patients with hematologic malignancies and hematopoietic stem cell transplantation

“…In the past decade, a considerable shift has occurred in the fungal species causing disease in immunosuppressed patients. [29][30][31] Infections caused by fungi such as Aspergillus terreus, Fusarium species, Scedosporium apiospermum, Pseudallescheria boydii, Paecilomyces species, and black molds are of particular concern as these difficult-to-treat infections are often refractory to conventional amphotericin B-based antifungal therapy. [32][33][34][35] Despite most of these molds being susceptible to the newer antifungals, the use of voriconazole alone is associated with a o50% response rate.…”

Invasive Fungal Infections in Patients with Acute Leukemia and Hematopoietic Stem Cell Transplant Recipients

“…Overall risk for IA is low in ASCT represents (1-2%) because there is only a brief period of immunosupression and neutropenia in these patients [46]. In allo-HCT recipients, the risk for IA is substantially higher with a trimodal incidence distribution [32,[47][48]. The first peak occurs during the pre-engraftment period where the main risk factor is prolonged neutropenia which is similar to neutropenic patients with leukemia who did not receive transplantation.…”