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Nosocomial Invasive Aspergillosis in Lymphoma Patients Treated with Bone Marrow or Peripheral Stem Cell Transplants

Published online by Cambridge University Press:  21 June 2016

Peter C. Iwen ,
Elizabeth C. Reed ,
James O. Armitage ,
Philip J. Bierman ,
Anne Kessinger ,
Julie M. Vose ,
Mark A. Arneson ,
Barbara A. Winfield  and
Gail L. Woods
Peter C. Iwen*
Affiliation:
Departments of Pathology and Microbiology, University of Nebraska Medical Center Omaha, Nebraska
Elizabeth C. Reed
Affiliation:
Internal Medicine, University of Nebraska Medical Center Omaha, Nebraska
James O. Armitage
Affiliation:
Internal Medicine, University of Nebraska Medical Center Omaha, Nebraska
Philip J. Bierman
Affiliation:
Internal Medicine, University of Nebraska Medical Center Omaha, Nebraska
Anne Kessinger
Affiliation:
Internal Medicine, University of Nebraska Medical Center Omaha, Nebraska
Julie M. Vose
Affiliation:
Internal Medicine, University of Nebraska Medical Center Omaha, Nebraska
Mark A. Arneson
Affiliation:
Internal Medicine, University of Nebraska Medical Center Omaha, Nebraska
Barbara A. Winfield
Affiliation:
Infection Control, University of Nebraska Medical Center Omaha, Nebraska
Gail L. Woods
Affiliation:
Departments of Anthology and Laboratory Medicine, The Medical College of Pennsylvania, Philadelphia, Pennsylvania
*
Department of Pathology and Microbiology, University of Nebraska Medical Center, 600 S. 42nd St., Omaha, NE 68198-6495
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Abstract

Objectives:

To determine the prevalence of aspergillosis in lymphoma patients housed in a protective environment while undergoing a bone marrow transplant or peripheral stem cell transplant and its relation to lymphoma type, type of transplant, period of neutropenia, method of diagnosis, species of Aspergillus, and the use of empiric amphotericin B.

Design:

Clinical, autopsy, and microbiology records were reviewed retrospectively to determine the presence or absence of invasive aspergillosis. All positive specimens underwent further review to determine parameters outlined above.

Setting:

The review took place at the University of Nebraska Medical Center with lymphoma patients housed in the oncology/hematology special care unit, which consists of 30 single-patient rooms under positive pressure with high-efficiency particulate air filtration.

Patients:

4 17 lymphoma patients admitted to the oncology/hematology special care unit who underwent 427 courses of high-dose chemotherapy with or without total body irradiation followed by a stem cell rescue.

Results:

Twenty-two cases (5.2%) of nosocomial invasive aspergillosis (14 caused by Aspergillus flavus, 2 by Aspergillus terreus, 2 by Aspergillus fumigatus, and 4 by characteristic histology) were diagnosed. The prevalence of disease according to transplant was 8.7% for allogeneic bone marrow transplant (2/23 treatments), 5.6% for autologous peripheral stem cell transplant (9/161), and 4.5% for autologous bone marrow transplant (11/243). Fifteen patients were presumptively diagnosed prior to death (68.2%) most commonly by histologic examination of skin biopsies. All 22 patients received amphotericin B therapy, 17 prior to aspergillosis diagnosis, and 7 (31.8%) survived. No patient with disseminated disease survived.

Conclusions:

Even when housing lymphoma patients undergoing myeloablative therapy in a protective environment containing high-efficiency particulate air filtration, there was a risk of developing aspergillosis. These data also showed that antemortem diagnosis with aggressive amphotericin B therapy was most effective in the management of infected lymphoma patients when engraftment occurred and the disease did not become disseminated.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 14 , Issue 3 , March 1993 , pp. 131 - 139
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1993

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