BRAIN-ABSCESS FOLLOWING MARROW TRANSPLANTATION - EXPERIENCE AT THE FRED-HUTCHINSON-CANCER-RESEARCH-CENTER, 1984-1992

The etiology of brain abscess in patients undergoing marrow transplant ation at the Fred Hutchinson Cancer Research Center in Seattle was ass essed in a retrospective review. Fifty-eight patients with histology- or culture-proven brain abscess diagnosed between January 1984 and Mar ch 1992 were identified. A fungus was isolated in 92% of cases. Asperg illus species were the most prevalent fungi (58% of cases), and Candid a species were second in frequency (33%); sporadic cases were caused b y Rhizopus, Absidia, Scopulariopsis, and Pseudallescheria species. Bac teria were involved in fewer than 10% of cases. There was no appreciab le variation from year to year in the incidence of brain abscess over this period. Aspergillus brain abscess was associated with concomitant pulmonary disease (87% of cases), whereas candida brain abscess often occurred in association with fungemia (63% of cases) or neutropenia ( 63%). Mortality was high (97%); the risk of death was unrelated to eti ology or therapeutic regimen. Since the etiology of brain abscess in p atients undergoing marrow transplantation is primarily fungal, the dev elopment of better antifungal therapeutic and/or prophylactic modaliti es is warranted.