Deep-seated mycosis as a complication in bone marrow transplantation patients

Achieving control of opportunistic fungal infections which occur during the course of immunosuppressive therapy is one of the key factors deciding the success or failure of bone marrow transplantation (BMT). A review was conducted of autopsied patients who had undergone BMT at the University of California at Los Angeles Medical Center in the USA between 1985 and 1994. The incidence of complication by deep‐seated mycoses was determined, and the causative fungal species and invaded organs were elucidated. Deep fungal infections were found to have occurred in 31.5% (47/149 cases) of the BMT patients, and disseminated disease was found in approximately one‐quarter of the infected cases. The findings suggest that BMT patients, who require the use of potent immunosuppressive agents, show increased susceptibility to the development of more serious, and widespread diffuse fungal infections. The most commonly detected causative fungi were Aspergillus species and Candida species. In addition, it was found that the incidence of candidosis had decreased markedly in recent years; conversely, aspergillosis had increased. It was surmised that these findings reflect the development of antifungal agents which are effective against candidosis and have enabled a reduction in the incidence of this disease even in BMT patients, whereas aspergillosis remains difficult to treat. In consideration of these findings regarding the manifestation of deep‐seated mycosis in BMT patients, we conclude that in order to increase the success rate of BMT it will be essential to establish safe and effective methods for the prevention and treatment of aspergillosis. Zusammenfassung. Bei den in der Zeit von 1985–94 im Los Angeles Medical Center der University of California, USA, knochenmarktransplantierten Patienten wurden die Sektionsprotokolle auf tieflokalisierte Mykosen, die beteiligten Pilzarten und die befallenen Organe durchmustert. Bei 47/149 Fällen (31.5%) wurden Pilzinfektionen gefunden, bei etwa einem Viertel waren Disseminierungen nachweisbar. Die häufigsten Erreger waren Aspergillus‐ und Candida‐Arten. Die Häufigkeit der Candidose nahm in den letzten Jahren ab, die Aspergillose‐Häufigkeit dagegen zu, was auf die verbesserten Behandlungsmöglichkeiten der Candidose zurückgeführt wird. Die Notwendigkeit, die Aspergillose‐Behandlung und ‐Vorbeugung zu verbessern, wird betont.