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Rhizomucor and Scedosporium Infection Post Hematopoietic Stem-Cell Transplant
Dania Sofia Marques,Carlos Pinho Vaz,Rosa Branca,Fernando Campilho,Catarina Lamelas,Luis Pedro Afonso,Manuel Jacome,Eduardo Breda,Eurico Monteiro,António Campos Júnior
Case Reports in Medicine , 2011, DOI: 10.1155/2011/830769
Abstract: Hematopoietic stem-cell transplant recipients are at increased risk of developing invasive fungal infections. This is a major cause of morbidity and mortality. We report a case of a 17-year-old male patient diagnosed with severe idiopathic acquired aplastic anemia who developed fungal pneumonitis due to Rhizomucor sp. and rhinoencephalitis due to Scedosporium apiospermum 6 and 8 months after undergoing allogeneic hematopoietic stem-cell transplant from an HLA-matched unrelated donor. Discussion highlights risk factors for invasive fungal infections (i.e., mucormycosis and scedosporiosis), its clinical features, and the factors that must be taken into account to successfully treat them (early diagnosis, correction of predisposing factors, aggressive surgical debridement, and antifungal and adjunctive therapies).
Antifungal Prophylaxis In Hematopoietic Stem Cell Transplant Recipients
Zlate Stojanoski,Aleksandra Pivkova,Sonja Genadieva-Stavrik,Lidija Cevreska
Macedonian Journal of Medical Sciences , 2008,
Abstract: Background. According to immunological deficit the period after hematopoietic stem cell transplantation (HSCT) can be divided in three phases: aplastic phase, phase of acute GVHD, and phase of chronic GVHD. Fungal infections are predominant in first, aplastic phase. Deep neutropenia and implantation of central venous catheter are two major risk factors contributing to infection.Aim. To retrospectively analyze fungal infections, fungal isolates and to compare success of different antifungal strategies during the first 30 days after HSCT.Material and methods. During a 7 year period (2000-2007), we have performed 128 HSCT in 120 patients with different hematological diseases. Male: 62 Female: 58. Median age: 34 years. Patients were treated in sterile room, conditioned with HEPA filters, and low microbes diet. Antifungal prophylaxis with Fluconazole 200mg, Itraconazole 200mg, or combination Fluconazole200/Itraconazole 200 (in high-risk patients) was administered from day 0 until day +100.Results. Patients treated with combination of Fluconazole200/Itraconazol200 have had only few oropharyngeal candidiasis, without signs of invasive fungal infection. There is no statistically significant difference between the prophylaxis with Fluconazole and Itraconazole, (p=0,302). Non-Albicans Candida is predominantly isolated funga (Non-Albicans Candida vs. Candida Albicans: 54% vs. 46%). There is no isolation of Aspergillus during the first phase after HSCT in our group of patients. Concluson. The rising incidence of invasive fungal infections and the currently problematic early diagnosis call for an intensive exploration of new drugs and further developments in diagnosis and treatment of invasive fungal infection.
Music Therapy for Patients Who Have Undergone Hematopoietic Stem Cell Transplant  [PDF]
Chelsea G. Ratcliff,Sarah Prinsloo,Michael Richardson,Laura Baynham-Fletcher,Richard Lee,Alejandro Chaoul,Marlene Z. Cohen,Marcos de Lima,Lorenzo Cohen
Evidence-Based Complementary and Alternative Medicine , 2014, DOI: 10.1155/2014/742941
Abstract: Objectives. This study examines the short- and long-term QOL benefits of a music therapy intervention for patients recovering from hematopoietic stem cell transplantation (HSCT). Methods. Ninety allogeneic HSCT patients, after transplant, were randomized to receive ISO-principle (i.e., mood matching) based music therapy (MT; ), unstructured music (UM; ), or usual care (UC; ) for four weeks. The ISO principle posits that patients may shift their mood from one state to another by listening to music that is “equal to” the individual’s initial mood state and subsequently listening to music selections that gradually shift in tempo and mood to match the patient’s desired disposition. Participants in MT and UM groups developed two audio CDs to help them feel more relaxed and energized and were instructed to use the CDs to improve their mood as needed. Short-term effects on mood and long-term effects on QOL were examined. Results. MT and UM participants reported improved mood immediately after listening to CDs; the within-group effect was greater for UM participants compared to MT participants. Participant group was not associated with long-term QOL outcomes. Conclusions. Music listening improves mood acutely but was not associated with long-term benefits in this study. 1. Introduction Allogeneic hematopoietic stem cell transplantation (HSCT) is used to treat a variety of malignant diseases. The procedure is regarded as one of the most difficult oncologic interventions due to the common and intense side effects of high dose chemotherapy and graft-versus-host disease such as organ toxicity (e.g., pulmonary and cardiac), osteoporosis, infection, cataracts, and infertility [1–8]. Not surprisingly, HSCT has been associated with diminished quality of life (QOL), especially in the first 100 days after transplant period [2–5]. The period of lowest white blood cell count, nadir, which typically occurs within the first 30 days after transplant, has been identified as the time when patients report the greatest symptom distress [9] although patients may report symptom distress for as long as 3–5 years after transplant [10]. The acute complications of HSCT may prevent patients from participating in common symptom management interventions [6]. Thus, finding effective methods to alleviate distress and improve coping skills and emotional well-being may improve post-transplant QOL as well as reduce symptom distress [2, 7, 8, 11]. Music therapy, which requires minimal physical exertion, may be an ideal intervention for helping HSCT patients manage their emotions and control
Invasive aspergillosis in hematopoietic stem cell transplant recipients: a retrospective analysis
Carvalho-Dias, Viviane Maria Hessel;Sola, Caroline Bonamin Santos;Cunha, Clóvis Arns da;Shimakura, Sílvia Emiko;Pasquini, Ricardo;Queiroz-Telles, Flávio de;
Brazilian Journal of Infectious Diseases , 2008, DOI: 10.1590/S1413-86702008000500008
Abstract: invasive aspergillosis (ia) currently is an important cause of mortality in subjects undergoing hematopoietic stem cell transplants (hsct) and is also an important cause of opportunistic respiratory and disseminated infections in other types of immunocompromised patients. we examined the medical records of 24 cases of proven and probable invasive aspergillosis (ia) at the hospital de clinicas of the federal university of parana, brazil, from january 1996 to october 2006. during this period occurred a mean of 2.2 cases per year or 3.0 cases per 100 hstc transplants. there was a significant relationship between structural changes in the bone marrow transplant (bmt) unit and the occurrence of ia cases (p=0.034, relative risk (rr) = 2.47). approximately 83% of the patients died due to invasive fungal infection within 60 days of follow up. some factors tended to be associated with mortality, but these associations were not significant. these included corticosteroid use, neutropenia (<100 cells/mm3) at diagnosis, patients that needed to change antifungal therapy because of toxicity of the initial first-line regimen and disseminated disease. these factors should be monitored in bmt units to help prevent ia. physicians should be aware of the risk factors for developing invasive fungal infections and try to reduce or eliminate them. however, once this invasive disease begins, appropriate diagnostic and treatment measures must be implemented as soon as possible in order to prevent the high mortality rates associated with this condition.
Successful Management of Multifactorial Colitis in a Recipient of Hematopoietic Stem Cell Transplant: A Case Report
Khalid A. Al-Anazi,Asma M. Al-Jasser,Amal Abdulwahab,Entezam Sahovic
Clinical Medicine : Case Reports , 2008,
Abstract: Recipients of allogeneic hematopoietic stem cell transplant can develop life-threatening complications at any time following their transplants. These complications require repeated clinical assessment, appropriate and thorough screening as well as a comprehensive management approach.We report a young adult male who received a sibling allograft in the second complete remission of his acute lymphoblastic leukemia at King Faisal Specialist Hospital and Research Centre in Riyadh. The patient developed severe colitis which was caused by: acute exacerbation of chronic graft versus host disease of the lower gastrointestinal tract, cytomegalovirus disease of the colon and a superadded Salmonella infection caused by food poisoning. The multifactorial colitis was properly investigated and successfully managed. To our knowledge, this is the first case of multifactorial colitis in a recipient of hematopoietic stem cell transplant.
The monitoring of hematopoietic stem cell transplant donors and recipients from endemic areas for malaria
Inoue, Juliana;Machado, Clarisse Martins;Lima, Giselle Fernandes Maciel de Castro;Nascimento, Maria de Jesus Costa;Colturato, Vergílio Rensi;Di Santi, Silvia Maria;
Revista do Instituto de Medicina Tropical de S?o Paulo , 2010, DOI: 10.1590/S0036-46652010000500012
Abstract: malaria is an unusual complication after hematopoietic stem cell transplantation in non-endemic countries. however, transplant candidates, recipients and donors living in endemic regions frequently report previous episodes of malaria. this fact could represent an important risk for immunosuppressed recipients that could develop severe malaria cases. we report a case of hematopoietic stem cell transplant (hsct) in which the donor had a history of previous malaria, and close monitoring was performed before and after procedure by parasitological and molecular tests. the donor presented plasmodium vivax in thick blood smears one month after transplant and was treated according to brazilian health ministry guidelines. the polymerase chain reaction (pcr) was able to detect malaria infection in the donor one week earlier than thick blood film. even without positive results, the recipient was pre-emptively treated with chloroquine in order to prevent the disease. we highlight the importance of monitoring recipients and donors in transplant procedures with the aim of reducing the risk of malaria transmission.
UPDATE ON THE ROLE OF AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANT IN FOLLICULAR LYMPHOMAS  [cached]
Mónica Cabrero,Alba Redondo,Alejandro Martin,Dolores Caballero
Mediterranean Journal of Hematology and Infectious Diseases , 2012, DOI: 10.4084/mjhid.2012.
Abstract: Follicular lymphoma (FL) remains incurable despite advances in new strategies of treatment, including monoclonal antibodies (MoAb). Except for early stages, FL is characterized by responses to treatments and systematic relapses. The main objective in this disease is to achieve a better progression free survival (PFS) and to increase overall survival (OS), mainly in young patients. In order to improve the results of conventional chemotherapy, autologous stem cell transplant (ASCT) is a feasible treatment in these patients. In this moment, ASCT is not recommended as first line treatment, except for transformed FL, but is a good strategy as salvage therapy with an improved PFS and OS. New drugs have been introduced to enhance responses of ASCT, but nowadays they are not part of conventional conditioning regimen.
Hematopoietic stem cell transplantation induces immunologic tolerance in renal transplant patients via modulation of inflammatory and repair processes  [cached]
Wu Duojiao,Qi Guisheng,Wang Xuanchuan,Xu Ming
Journal of Translational Medicine , 2012, DOI: 10.1186/1479-5876-10-182
Abstract: Background Inducing donor-specific tolerance in renal transplant patients could potentially prevent allograft rejection and calcineurin inhibitor nephrotoxicity. Combined kidney and hematopoietic stem cell transplant from an HLA-matched donor is an exploratory and promising therapy to induce immune tolerance. Investigtion of molecular mechanisms involved in the disease is needed to understand the potential process of cell therapy and develop strategies to prevent this immunologic rejection. Methods We enrolled nine patients in a clinical study in which cryopreserved donor hematopoietic stem cells were infused on days 2, 4, and 6 after kidney transplantation. One month post-transplant, 4 plasma samples were collected from combined transplants (C + Tx), and 8 plasma samples from patients with kidney transplantation alone (Tx). High abundance proteins in plasma were depleted and the two-dimensional liquid chromatography-tandem mass spectrometry coupled with iTRAQ labeling was utilized to identify the protein profiling between the two groups. Clusters of up- and down-regulated protein profiles were submitted to MetaCore for the construction of transcriptional factors and regulation networks. Results and Discussion Among the 179 identified proteins, 65 proteins were found in C + Tx with at least a 2-fold change as compared with Tx. A subset of proteins related to the complement and coagulation cascade, including complement C3a,complement C5a, precrusors to fibrinogen alpha and beta chains,was significantly downregulated in C + Tx. Meanwhile, Apolipoprotein-A1(ApoA1), ApoC1, ApoA2, ApoE, and ApoB were significantly lower in Tx compared to C + Tx. Gene ontology analysis showed that the dominant processes of differentially expressed proteins were associated with the inflammatory response and positive regulation of plasma lipoprotein particle remodeling. Conclusions Thus, our study provides new insight into the molecular events in the hematopoietic stem cell-induced immunologic tolerance.
Differential outcome of neurological HCMV infection in two hematopoietic stem cell transplant recipients  [cached]
Colombo Anna,Giorgiani Giovanna,Rognoni Vanina,Villani Paola
BMC Infectious Diseases , 2012, DOI: 10.1186/1471-2334-12-238
Abstract: Background Human cytomegalovirus (HCMV) infection of the central nervous system (CNS) is a rare but life threatening condition which may follow hematopoietic stem cell transplantation. Diagnosis, monitoring and treatment approaches rely on anecdotal reports. Case presentations The different outcomes of HCMV CNS disease in an adult and a pediatric T-cell depleted hematopoietic stem cell transplant (HSCT) recipient are reported. In the first case, HCMV encephalitis emerged in the context of simultaneous impairment of the T- and B-cell immunity. Antiviral treatment only reduced viral load in peripheral blood and the patient died. In the second case, an HCMV radiculopathy was observed and antiviral treatment was adjusted on the basis of intrathecal drug level. In addition, donor HCMV-specific cytotoxic T lymphocytes (CTLs) were infused. Viral load in the CNS decreased and the patient recovered from the acute event. In neither case were drug-resistant HCMV variants observed in blood or CNS samples. Conclusions T-cell depleted HSCT appears a predisposing condition for CNS HCMV infection since never observed in other HSCT recipients at our center in the last 15 years. Intensive diagnostic approaches and timely aggressive combination treatments might improve clinical outcome in these patients.
Factors associated with bacteremia due to multidrug-resistant Gram-negative bacilli in hematopoietic stem cell transplant recipients
Garnica, M.;Maiolino, A.;Nucci, M.;
Brazilian Journal of Medical and Biological Research , 2009, DOI: 10.1590/S0100-879X2009000300010
Abstract: the epidemiology of bacteremia developing during neutropenia has changed in the past decade, with the re-emergence of gram-negative (gn) bacteria and the development of multidrug resistance (mdr) among gn bacteria. we conducted a case-control study in order to identify factors associated with bacteremia due to multidrug-resistant gram-negative (mdrgn) isolates in hematopoietic stem cell transplant recipients. ten patients with mdrgn bacteremia were compared with 44 patients with gn bacteremia without mdr. bacteremia due to burkholderia or stenotrophomonas sp was excluded from analysis (3 cases), because the possibility of intrinsical resistance. infection due to mdrgn bacteria occurred in 2.9% of 342 hematopoietic stem cell transplant recipients. klebsiella pneumoniae was the most frequent mdrgn (4 isolates), followed by pseudomonas aeruginosa (3 isolates). among non-mdrgn, p. aeruginosa was the most frequent agent (34%), followed by escherichia coli (30%). the development of gn bacteremia during the empirical treatment of febrile neutropenia (breakthrough bacteremia) was associated with mdr (p < 0.001, odds ratio = 32, 95% confidence interval = 5_190) by multivariate analysis. bacteremia due to mdrgn bacteria was associated with a higher death rate by univariate analysis (40 vs 9%; p = 0.03). we were unable to identify risk factors on admission or at the time of the first fever, but the occurrence of breakthrough bacteremia was strongly associated with mdrgn bacteria. an immediate change in the antibiotic regimen in such circumstances may improve the prognosis of these patients.
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