Meyers J D
Am J Med. 1986 Jul 28;81(1A):27-38. doi: 10.1016/0002-9343(86)90511-5.
Infection in marrow transplant recipients is determined primarily by the evolving immunologic milieu of each patient. Profound neutropenia and disruption of anatomic barriers are the most important risk factors for bacterial and fungal infections in the initial period after transplant. After this period, the occurrences of acute and then chronic graft-versus-host disease (GVHD) are the most important influences on the risk of infection. Major infections after the period of initial engraftment include viral infections (especially cytomegalovirus), fungal infections (due to Aspergillus and Candida), and rarely protozoal infections. GVHD appears to increase both the incidence and severity of cytomegalovirus infection. Bacterial infections also continue to occur, due predominantly to coagulase-negative Staphylococcus, as in the neutropenic period. Patients with chronic GVHD have continued abnormalities of host defenses, which may be further suppressed by treatment for GVHD. Major efforts have been directed toward preventing infection. In the neutropenic period, these include use of the protective environment, which has also been associated with a lower incidence of acute GVHD among patients who received transplants for aplastic anemia. The use of seronegative blood products is highly effective in preventing primary cytomegalovirus infection among seronegative patients. Among patients being treated for chronic GVHD, trimethoprim/sulfamethoxazole prophylaxis has been associated with a lower risk of infection.
骨髓移植受者的感染主要取决于每位患者不断变化的免疫环境。严重中性粒细胞减少和解剖屏障破坏是移植后初期细菌和真菌感染的最重要危险因素。在此期间之后，急性和慢性移植物抗宿主病（GVHD）的发生是对感染风险的最重要影响因素。初次植入期后的主要感染包括病毒感染（尤其是巨细胞病毒）、真菌感染（由曲霉菌和念珠菌引起），原生动物感染很少见。GVHD似乎会增加巨细胞病毒感染的发生率和严重程度。细菌感染也会继续发生，主要是凝固酶阴性葡萄球菌，与中性粒细胞减少期情况相同。慢性GVHD患者的宿主防御持续异常，可能会因GVHD治疗而进一步受到抑制。主要努力方向是预防感染。在中性粒细胞减少期，这些措施包括使用保护环境，这也与接受再生障碍性贫血移植的患者中急性GVHD发生率较低有关。使用血清阴性血液制品在预防血清阴性患者的原发性巨细胞病毒感染方面非常有效。在接受慢性GVHD治疗的患者中，甲氧苄啶/磺胺甲恶唑预防与较低的感染风险相关。
