Pneumonias due to Pneumocystis carinii, cytomegalovirus, Candida, or Aspergillus are associated with high mortality rates after blood and marrow transplantation despite treatment. Attention has been directed at prophylactic strategies to decrease the incidence of these infections. These approaches represent the major advances in management of life-threatening infection, and have led to improved survival after transplantation. Prophylactic trimethoprim-sulfamethoxazole for Pneumocystis carinii is inexpensive, easy to administer, and is one of the best examples of effective prevention of life-threatening pneumonia in marrow transplantation. Dapsone appears to be an acceptable alternative to patients unable to tolerate this combination of agents. Several strategies are effective in decreasing the incidence of cytomegalovirus pneumonia in high-risk groups, such as allogeneic marrow recipients. Among these approaches are the use of seronegative or leukocyte-depleted blood products for seronegative marrow recipients, and high-dose acyclovir for seropositive recipients. Additionally, recent studies demonstrate the value of early treatment with ganciclovir for recipients with viremia or asymptomatic positive vital culture from bronchoalveolar lavage. Imidazoles, such as fluconazole, reduce the incidence of candidiasis; however, prevention of Aspergillus infections remains a challenge. Thus, chemoprophylaxis may prevent several common infectious causes of pneumonia after blood and marrow transplantation. Challenges remain, such as defining optimal drug dosing, selection of patients, and control of invasive fungal infections.
|Original language||English (US)|
|Number of pages||6|
|Journal||Seminars in Respiratory and Critical Care Medicine|
|State||Published - Sep 1996|
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine