Epidemiology of Fungal infections in Hematopoietic Stem Cell Transplant Recipients in the 1990's



Concomitant with advances in the diagnosis and prevention of Herpes viruses infections (especially CMV) is stem cell transplant (SCT) recipients, fungi have emerged as a major cause of infection-related death. Previous studies have documented a decrease in candidal infections and as increase is invasive aspergillosis (IA) at the Fred Hutchinson Cancer Research Center (FHCRC) from 1991-1993. To describe the epidemiology of mould infections at FHCRC throughout the 1990'x, this study was perforated. Methods: We reviewed microbiology and pathology records of FHCRC patients from 1993 to 1999. Clinical records were reviewed and infections were defined as proven, probable, or possible according to Mycoses Study Group criteria. The 1-year cumulative incidence of IA was determined by year of transplant. Results: 342 cases of IA (213 proven, 118 probable, I 1 possible) were identified. The overall incidence of proven and probable IA in SCT recipients was 6.5%. This ranged from 9.5% in allogeneic patients to 1.2% in autologous patients. Recipients of mismatched or unrelated grafts had a higher incidence than recipients of matched-related grafts (I0.7% vs. 8%). The median day of diagnosis in allograft recipients was 73 days after SCT. Although A. fumigates remained the most frequent pathogen, A. niger and A. flavus were isolated at increased frequency in the latter 1990'x. Infections caused by Zygomycetes and Fusarium app. have increased subsequent to 1995, but those caused by Pseudoallescheria, `endemic mycoses' and Cryprococcus app. remain infrequent. Conclusions: In our center, IA has approximately doubled is incidence compared to the late 1980'x. This increase is most apparent in high-risk allograft recipients, who develop IA late after SCT. Moulds other than A. fumigates appear to be increasing causes of invasive disease.

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IDSA 38th
    • IDSA 38th