ABSTRACT
Tens of thousands of patients undergo hematopoietic stem cell transplantation (HSCT)
annually, 15 to 40% of whom are admitted to the intensive care unit. Pulmonary complications
are the most life threatening conditions that develop in HSCT recipients. Both infectious
and noninfectious complications occur more frequently in allogeneic HSCT. The management
of HSCT recipients requires knowledge of their immune status, appropriate diagnostic
evaluation, and early treatment. During the preengraftment phase (0 to 30 days after
transplant), the most prevalent pathogens causing infection are bacteria and Candida species and, if the neutropenia persists, Aspergillus species. The early postengraftment phase (30 to 100 days) is characterized by cytomegalovirus
(CMV), Pneumocystis jiroveci, and Aspergillus infections. During the late posttransplant phase (> 100 days), allogeneic HSCT recipients
are at risk for CMV, community-acquired respiratory virus, and encapsulated bacterial
infections. Antigen and polymerase chain reaction assays are important for the diagnosis
of CMV and Aspergillus infections. Diffuse alveolar hemorrhage (DAH) and periengraftment respiratory distress
syndrome occur in both allogeneic and autologous HSCT recipients, usually during the
first 30 days. Bronchiolitis obliterans occurs exclusively in allogeneic HSCT recipients
with graft versus host disease. Idiopathic pneumonia syndrome occurs at any time following
transplant. Bronchoscopy is usually helpful for the diagnosis of the infectious pulmonary
complications and DAH.
KEYWORDS
Aspergillosis - bone marrow transplantation - cytomegalovirus infection - diffuse
alveolar hemorrhage - idiopathic pneumonia syndrome - periengraftment respiratory
distress syndrome - pneumonia - respiratory insufficiency
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Bekele AfessaM.D.
Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine
200 First St., SW, Rochester, MN 55905
Email: Afessa.bekele@mayo.edu