Systemic nocardiosis following allogeneic bone marrow transplantation

Authors:
Publisher website
Google Scholar
Abstract
Five cases of systemic Nocardia infection were diagnosed among 301 allogeneic bone marrow transplant recipients. A sixth case included in this report received her transplant at another institution. The cumulative annual incidence rate of this infection was 1.75%. All patients had been treated previously for acute graft‐versus‐host disease (GVHD). At the time of diagnosis of systemic Nocardia infection, a median of 198 (range 148–1121) days after transplantation, all patients had extensive chronic GVHD and were taking 2 to 3 immunosuppressive medications. Prior to diagnosis of Nocardia infection patients had experienced multiple opportunistic infections, including infections with Mycobacterium avium‐intracellulare, Pneumocystis carinii, and cytomegalovirus antigenemia. Treatment with trimethoprim‐sulfamethoxazole (TMP‐SMX), ceftriaxone, or carbapenem antibiotics resulted in a median survival of 219 days from the time of diagnosis and an actuarial 1‐year survival of 40%. All patients who received more than 2 weeks of therapy were cured of their infections. Notably, 5/6 patients in this cohort were unable to take TMP‐SMX because of myelosuppression. In comparison with randomly selected control patients, the use of pentamidine for prevention of P. carinii infection was associated with a marginal increase in the risk of Nocardia infection. We postulate that the use of TMP‐SMX may be of benefit in the prophylaxis of infections other than P. carinii in patients with chronic GVHD.

This publication has 14 references indexed in Scilit: