Stem Cell Transplant Patients and Fungal Infections

As a stem cell transplant patient, you have new opportunities for a healthy and full life. Stem cell transplants

[PDF - 3 pages] have many benefits, but they also have risks. Because stem cell transplants destroy and rebuild your immune system, they increase your risk for fungal infections.
There are two main types of stem cell transplants:

Stem cells from your own body (also called an autologous transplant).
Stem cells from a donor (also called an allogeneic transplant). The donor can be a family member or someone unrelated to you.

There are different reasons for receiving either type of transplant. You and your healthcare provider will discuss your options and choose the treatment that’s best for you.

What you need to know about fungal infections

A transplant using stem cells from a donor increases your risk for fungal infection more than a transplant that uses stem cells from your own body. If your stem cells come from another person, you will need to take anti-rejection medication. This medication weakens your immune system.¹
Chemotherapy and radiation lower your white blood cell count. As you recover from your transplant, your white blood cell count can become very low, also known as neutropenia

[PDF - 4 pages]. During this time, your body will have trouble fighting infections, including fungal infections.²
Graft-versus-host disease (GVHD). If you receive stem cells from a donor, the transplanted stem cells may attack your body. This is known as graft-versus-host disease, which can increase your risk for fungal infection.³ The steroid medications given to treat graft-versus-host disease can also increase the chance of getting a fungal infection. ⁴
Fungal infections can range from mild to life-threatening. Some fungal infections are mild skin rashes, but others can be deadly, like fungal pneumonia. Because of this, it’s important to seek treatment as soon as possible to try to avoid serious infection.
Fungal infections can look like bacterial or viral infections. If you’re taking medicine to fight an infection and you aren’t getting better, ask your doctor about testing you for a fungal infection.
Fungal infections can happen any time after your transplant. Fungal infections can happen days, weeks, or months after the stem cell transplant. If you develop GVHD, you’re at risk for a longer period of time.⁵
Some types of fungal infections are more common than others in stem cell transplant patients. Aspergillosis is the most common type of fungal infection in stem cell transplant patients, followed by Candida infection and mucormycosis, but other types of fungal infections are also possible.¹
Your hospital stay matters. After your transplant, you may need to stay in the hospital for a long time. While there, you may need to have procedures that can increase your chance of getting a fungal infection. Please see the following sites for more information:

Where you live (geography) matters. Some disease-causing fungi are more common in certain parts of the world. If you live in or visit these areas, you may be more likely to get these infections than the general population. For more information on travel-related illnesses, please see the CDC Traveler’s Health site.
Indoor mold. You may be at higher risk for getting sick from indoor mold. For more information about indoor mold, please visit CDC's Basic Facts about Mold.

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Preventing fungal infections in stem cell transplant patients

Fungi are difficult to avoid because they are a natural part of the environment. Fungi live outdoors in soil, on plants, trees, and other vegetation. They are also on many indoor surfaces and on your skin. However, there may be some ways for you to lower the chances of getting a serious fungal infection.
Learn about fungal infections. There are different types of fungal infections. Learning about them can help you and your healthcare provider recognize the symptoms early, which may prevent serious illness.
Get additional medical care if necessary. Fungal infections often resemble other illnesses. Visiting your healthcare provider may help with faster diagnosis and may prevent serious illness.
Testing for early infection can help lower your risk for some types of fungal infection. Some patients may benefit from blood tests to detect fungal infections like aspergillosis before symptoms appear.⁶ Talk to your doctor to determine if this type of test is right for you.
Antifungal medication. Your healthcare provider may prescribe medication to prevent fungal infections. Scientists are still learning about which transplant patients are at highest risk and how to best prevent fungal infections. ^7,8
Protect yourself from the environment. As you recover after surgery and start doing your normal activities again, there may be some ways to lower your chances of getting a serious fungal infection by trying to avoid disease-causing fungi in the environment.^9,10 It’s important to note that although these actions are recommended, they have not been proven to prevent fungal infections.

Try to avoid areas with a lot of dust like construction or excavation sites.
Stay inside during dust storms.
Stay away from areas with bird and bat droppings. This includes places like chicken coops and caves.
Wear gloves when handling materials such as soil, moss, or manure.
Wear shoes, long pants, and a long-sleeved shirt when doing outdoor activities such as gardening, yard work, or visiting wooded areas.

References

Kontoyiannis DP, Marr KA, Park BJ, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database. Clinical Infectious Diseases 2010;50:1091-100.
Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia. Cancer 2004;100:228-37.
Fukuda T, Boeckh M, Carter RA, et al. Risks and outcomes of invasive fungal infections in recipients of allogeneic hematopoietic stem cell transplants after nonmyeloablative conditioning. Blood 2003;102:827-33.
Thursky K, Byrnes G, Grigg A, Szer J, Slavin M. Risk factors for post-engraftment invasive aspergillosis in allogeneic stem cell transplantation. Bone marrow transplantation 2004;34:115-21.
Wingard JR, Hsu J, Hiemenz JW. Hematopoietic stem cell transplantation: an overview of infection risks and epidemiology. Hematology/oncology clinics of North America 2011;25:101-16.
Maertens J, Van Eldere J, Verhaegen J, Verbeken E, Verschakelen J, Boogaerts M. Use of circulating galactomannan screening for early diagnosis of invasive aspergillosis in allogeneic stem cell transplant recipients. The Journal of infectious diseases 2002;186:1297-306.
McCoy D, Depestel DD, Carver PL. Primary antifungal prophylaxis in adult hematopoietic stem cell transplant recipients: current therapeutic concepts. Pharmacotherapy 2009;29:1306-25.
Rogers TR, Slavin MA, Donnelly JP. Antifungal prophylaxis during treatment for haematological malignancies: are we there yet? British journal of haematology 2011;153:681-97.
Avery RK, Michaels MG, Practice ASTIDCo. Strategies for safe living after solid organ transplantation. American journal of transplantation 2013;13 Suppl 4:304-10.
CDC. Guidelines for Preventing Opportunistic Infections Among Hematopoietic Stem Cell Transplant Recipients. MMWR 2000;49:1-128.