Diagnosis and management of nocardiosis after bone marrow stem cell transplantation in adults: lack of lymphocyte recovery as a major contributing factor.
Fiche publication
Date publication
juin 2014
Auteurs
Membres identifiés du Cancéropôle Est :
Pr DECONINCK Eric, Dr FERRAND Christophe, Pr GARNACHE-OTTOU Francine, Dr LAROSA Fabrice, Dr MANSI Laura, Dr DAGUINDAU Etienne, Dr POUTHIER Fabienne
Tous les auteurs :
Mansi L, Daguindau E, Saas P, Pouthier F, Ferrand C, Dormoy A, Patry I, Garnache F, Rohrlich PS, Deconinck E, Larosa F
Lien Pubmed
Résumé
Hematopoietic cell transplantation (HCT) is a curative treatment for hematological malignancies. This therapeutic approach is associated with a profound immune deficiency and an increased rate of opportunistic infections. Nocardiosis is a rare bacterial infection occurring mainly in patients with deficient cell-mediated immunity, such as AIDS patients or transplant recipients. Diagnosis of nocardiosis can be challenging, as signs and symptoms are non-specific. Routine prophylaxis with trimethoprin/sulfamethoxazole (TMP/SMZ) does not prevent the risk of infection. Between May 2001 and December 2009, five cases of nocardiosis were diagnosed from the 366 allogeneic HCT recipients in our centre. Four patients developed a disseminated nocardiosis within the first year after HCT. The fifth patient presented a localized cutaneous nocardiosis. In disseminated cases, median total CD4+ T-cells were below 100 cells/muL. Naive CD4+ CD45RA+/RO- T-cells were almost undetectable. CD8(+) T-cells and NK cells were below the normal range and CD19+ B-cell reconstitution was completely deficient. In a localized case, we observed a lack of naive thymic emigrants CD4+ CD45RA+/RO- T-cells.
Référence
Pathol Biol (Paris). 2014 Jun;62(3):156-61