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Overview of infections following hematopoietic cell transplantation

Author
John R Wingard, MD
Section Editor
Kieren A Marr, MD
Deputy Editor
Anna R Thorner, MD

INTRODUCTION

Hematopoietic cell transplant (HCT) recipients, especially those who have received allogeneic transplants, are at substantial risk for a variety of infections depending upon their degree of immunosuppression and exposures to pathogens, as well as the time elapsed since transplantation. Patients can develop bacterial, fungal, viral, and/or parasitic infections. Infection in HCT recipients is associated with high morbidity and mortality.

The term "hematopoietic cell transplantation" will be used throughout this topic as a general term to cover transplantation of progenitor cells from any source (eg, bone marrow, peripheral blood, umbilical cord blood). Possible sources for these cells include the patient’s own cells (autologous); an identical twin (syngeneic, human leukocyte antigen [HLA] identical); a sibling, related, or unrelated donor (allogeneic; HLA identical, haploidentical, or mismatched); or umbilical cord blood (UCB; HLA identical, haploidentical, or mismatched). (See "Sources of hematopoietic stem cells".)

An overview of infections following HCT will be presented here and will be organized by risk period and clinical syndrome; the syndromes discussed are often infectious in nature but may also have noninfectious etiologies. The evaluation for infection and prevention of infection in HCT recipients is discussed separately. (See "Evaluation for infection before hematopoietic cell transplantation" and "Prevention of infections in hematopoietic cell transplant recipients" and "Prophylaxis of invasive fungal infections in adult hematopoietic cell transplant recipients" and "Prevention of viral infections in hematopoietic cell transplant recipients" and "Immunizations in hematopoietic cell transplant candidates and recipients".)

RISK OF INFECTION

It is important to identify the population at high risk for infections and also the magnitude of and period of maximum risk in order to predict which patients are most likely to benefit from targeted diagnosis, prophylaxis, and/or preemptive therapy. The risk of infection results from the sum of the interaction of three factors (figure 1):

The intensity of exposure to and the relative virulence of the offending microorganisms

                            

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Literature review current through: Nov 2016. | This topic last updated: Mon May 09 00:00:00 GMT 2016.
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