Subject(s)
Alemtuzumab/adverse effects , Colitis/diagnosis , Cytomegalovirus Infections/diagnosis , Immunosuppressive Agents/adverse effects , Meningitis, Listeria/diagnosis , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Virus Activation , Adult , Colitis/etiology , Cytomegalovirus Infections/etiology , Humans , Magnetic Resonance Imaging , Male , Meningitis, Listeria/etiologyABSTRACT
Antifungal treatment in the hematological patient has reached a high complexity with the advent of new antifungals and diagnostic tests, which have resulted in different therapeutic strategies. The use of the most appropriate treatment in each case is essential in infections with such a high mortality. The availability of recommendations as those here reported based on the best evidence and developed by a large panel of 48 specialists aimed to answer when is indicated to treat and which agents should be used, considering different aspects of the patient (risk of fungal infection, clinical manifestations, galactomanann test, chest CT scan and previous prophylaxis) may help clinicians to improve the results.
Subject(s)
Antifungal Agents/therapeutic use , Hematologic Diseases/complications , Mycoses/complications , Mycoses/drug therapy , Humans , Leukemia/complications , Mycoses/microbiology , Myelodysplastic Syndromes/complications , RiskABSTRACT
Invasive fungal infections (IFIs) continue to cause considerable morbidity and mortality in haematopoietic stem cell transplant recipients. The epidemiology of IFI has changed since the late 1980s, with a trend towards a reduction in invasive infection due to opportunistic yeasts and an increase in invasive mould infections, particularly by Aspergillus spp. Since the introduction of fluconazole for prophylaxis, the incidence rate of invasive candidiasis is close to 5% and the risk factors related to invasive candidiasis are gastrointestinal tract colonisation, cytomegalovirus disease and a prior episode of bacteraemia. The highest risk for invasive aspergillosis was observed in older patients and patients with graft-versus-host disease and immunosuppressive therapy, steroid use (>1-2 mg/kg/day), persistent neutropenia and certain types of transplantation (cord blood transplant, allogeneic mismatched or T-cell depletion). In those cases, rational preventive measures must be implemented and vigilance is necessary in order to diagnose infection as soon as possible.
Subject(s)
Hematopoietic Stem Cell Transplantation/adverse effects , Mycoses/epidemiology , Age Factors , Antifungal Agents/therapeutic use , Chemoprevention/methods , Humans , Immunocompromised Host , Mycoses/microbiology , Mycoses/mortality , Risk FactorsABSTRACT
The morbidity and mortality associated with infections in stem cell transplantation (SCT) has decreased considerably in recent years because of increasing knowledge of related risk factors, immune recovery, and the pattern of infection according to the phase of evolution of SCT, and the introduction of new and more effective antimicrobial agents. These advances, together with the use of peripheral blood stem cells, T-lymphoid cell depletion, stimulating factors, and more potent immunosuppressors has reduced SCT mortality and broadened the indications for this treatment. Nevertheless, infection continues to a prominent complication in these patients.
