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Published online by Cambridge University Press: 05 November 2013
Risk factors for infectioninclude the degree and duration of neutropenia; profoundpan-immunosuppression; disruption of mucosal barrier by radiochemotherapy;HLA mismatch; central venous access; donor prior exposures; and especiallycord blood transplants. Inadequate immunoglobulin (especially IgG2 and IgG4)production increases risk of infection with encapsulated organisms despitetotal Ig levels in the normal range after transplant.
Please see Chapter 22 forspecific pulmonary infections.
General time frames of when infection is likely to occur
Days 0 to 30: Infections related to conditioning regimen and neutropenia (bacteremia of GI or catheter-related origin), invasive aspergillosis related to neutropenia, candidemia.
Days 30 to 80: Classic opportunistic infections (cytomegalovirus [CMV],Pneumocystis jiroveci pneumonia [PCP], toxoplasmosis, nocardiosis, invasive aspergillosis, and other invasive mold infections related to severe GVHD).
Day 180+: Encapsulated organisms (especially in patients with chronic GVHD), varicella zoster virus (VZV), PCP.
Figure 18.1 outlines theperiod of major host dei cits and infections that occur during allogeneicHSCT in relation to the deployment of targeted pathogen-specii cprophylactic, preemptive, and empiric therapies. Risk for infectiouscomplications is temporally dependent, and it may be signii cantly decreasedby prophylactic, preemptive, or empiric therapy. The risk of certaininfections after transplantation is highly associated with ongoingimmunologic manipulation as seen with the therapy for GVHD (Figure 18.1;linkages denoted by vertical arrows).
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