NOCARDIAL INFECTIONS IN BONE-MARROW TRANSPLANT RECIPIENTS

Infections caused by Nocardia species have been infrequently described in bone marrow transplant (BMT) recipients, We reviewed six cases of nocardiosis occurring in our population of BMT recipients and the four cases previously reported in the literature. The rate of nocardial in fection at our institution was 0.2% (1 of 554) among autologous BMT re cipients and 1.7% (5 of 302) among allogeneic BMT recipients (odds rat io, 9.3 [95% confidence interval, 1.1-80.1]; P = .046). All 10 patient s had received immunosuppressive medications, and all but one allogene ic BMT recipient had acute or chronic graft-vs.-host disease (GVHD). F our patients had extensive exposure to soil or dust before nocardiosis developed. Seventy percent of the patients died, but death was less o ften due to progressive nocardial infection than to complications of G VHD and associated invasive infection with Aspergillus species. Three patients had nocardiosis despite receiving prophylaxis with trimethopr im-sulfamethoxazole (TMP-SMZ) on an intermittent basis two or three ti mes a week. These data show that nocardial infection is an important i f infrequent complication of bone marrow transplantation and is associ ated with a high rate of invasive fungal infection, TMP-SMZ prophylaxi s given intermittently does not reliably protect against infection.