Abstract：
BACKGROUND: Endemic mycoses after hematopoietic stem cell transplantation (HSCT) are rarely reported. We aimed to comprehensively review the clinical presentation and outcomes of endemic mycoses in this immunocompromised population.
METHODS: Multiple databases were reviewed from inception through May 31, 2023 using endemic fungi as keywords (e.g., coccidioides, histoplasma, blastomyces, talaromyces, and paracoccidioides). Only hematopoietic transplants were included.
RESULTS: There were 16 publications on endemic mycoses after HSCT that reported nine unique cases of histoplasmosis, seven coccidioidomycosis, and two talaromycosis. No cases of paracoccidioides and blastomycoses were identified. Fifteen cases were allogeneic hematopoietic transplant recipients and three were autologous. Many were male (14/18, 77.8%) and overall median age was 50 (range 21-75) years. Among the 16 patients with coccidiodomycosis or histoplasmosis, fever, cytopenias and disseminated disease were the most common clinical presentations, with median onset of 8 or 12 months after HSCT, respectively. Likewise, the two HSCT patients with talaromycosis presented with disseminated disease at 12 and 48 months after transplantation. The vast majority were not on effective azole prophylaxis at the time of presentation, and many had recent intensification of immunosuppression. Nine of 18 patients died (50%), and all deaths occurred among patients with disseminated endemic mycoses.
CONCLUSIONS: Endemic mycoses among HSCT are uncommon. Onset was late, after discontinuation of azole prophylaxis, or was associated with intensification of immunosuppression. Disseminated disease was a common presentation, manifested by fever and cytopenias. Attributable mortality was high, and emphasizes the need for a high index of clinical suspicion so that prompt diagnosis and treatment is provided.
METHODS: Multiple databases were reviewed from inception through May 31, 2023 using endemic fungi as keywords (e.g., coccidioides, histoplasma, blastomyces, talaromyces, and paracoccidioides). Only hematopoietic transplants were included.
RESULTS: There were 16 publications on endemic mycoses after HSCT that reported nine unique cases of histoplasmosis, seven coccidioidomycosis, and two talaromycosis. No cases of paracoccidioides and blastomycoses were identified. Fifteen cases were allogeneic hematopoietic transplant recipients and three were autologous. Many were male (14/18, 77.8%) and overall median age was 50 (range 21-75) years. Among the 16 patients with coccidiodomycosis or histoplasmosis, fever, cytopenias and disseminated disease were the most common clinical presentations, with median onset of 8 or 12 months after HSCT, respectively. Likewise, the two HSCT patients with talaromycosis presented with disseminated disease at 12 and 48 months after transplantation. The vast majority were not on effective azole prophylaxis at the time of presentation, and many had recent intensification of immunosuppression. Nine of 18 patients died (50%), and all deaths occurred among patients with disseminated endemic mycoses.
CONCLUSIONS: Endemic mycoses among HSCT are uncommon. Onset was late, after discontinuation of azole prophylaxis, or was associated with intensification of immunosuppression. Disseminated disease was a common presentation, manifested by fever and cytopenias. Attributable mortality was high, and emphasizes the need for a high index of clinical suspicion so that prompt diagnosis and treatment is provided.
摘要：
背景：造血干细胞移植（HSCT）后地方性真菌病的报道很少。我们旨在全面审查该免疫功能低下人群中地方性真菌病的临床表现和结果。
方法：从开始到2023年5月31日，使用地方性真菌作为关键字审查了多个数据库（例如，球虫,组织等离子体，胚芽,talaromyces，和副球菌）。仅包括造血移植。
结果：有16篇关于HSCT后地方性真菌病的出版物报道了9例独特的组织胞浆菌病病例，七个球孢子菌病，和两个塔拉真菌病。未发现副球菌和胚细胞病的病例。15例为异基因造血移植受者，3例为自体移植受者。许多人是男性（14/18，77.8％），总体中位年龄为50（范围21-75）岁。在16例球虫病或组织胞浆菌病患者中，发烧,血细胞减少和播散性疾病是最常见的临床表现，HSCT后的中位发病时间为8或12个月，分别。同样，2例HSCT患者在移植后12个月和48个月出现播散性疾病.绝大多数患者在就诊时没有进行有效的唑类药物预防，许多人最近加强了免疫抑制。18名患者中有9人死亡（50%），所有死亡均发生在播散性地方性真菌病患者中。
结论：HSCT中的地方性真菌病并不常见。起病晚了,停用唑类药物预防后，或与免疫抑制的加剧有关。播散性疾病是常见的表现，表现为发烧和血细胞减少症。归因死亡率很高，并强调需要高的临床怀疑指数，以便提供及时的诊断和治疗。
方法：从开始到2023年5月31日，使用地方性真菌作为关键字审查了多个数据库（例如，球虫,组织等离子体，胚芽,talaromyces，和副球菌）。仅包括造血移植。
结果：有16篇关于HSCT后地方性真菌病的出版物报道了9例独特的组织胞浆菌病病例，七个球孢子菌病，和两个塔拉真菌病。未发现副球菌和胚细胞病的病例。15例为异基因造血移植受者，3例为自体移植受者。许多人是男性（14/18，77.8％），总体中位年龄为50（范围21-75）岁。在16例球虫病或组织胞浆菌病患者中，发烧,血细胞减少和播散性疾病是最常见的临床表现，HSCT后的中位发病时间为8或12个月，分别。同样，2例HSCT患者在移植后12个月和48个月出现播散性疾病.绝大多数患者在就诊时没有进行有效的唑类药物预防，许多人最近加强了免疫抑制。18名患者中有9人死亡（50%），所有死亡均发生在播散性地方性真菌病患者中。
结论：HSCT中的地方性真菌病并不常见。起病晚了,停用唑类药物预防后，或与免疫抑制的加剧有关。播散性疾病是常见的表现，表现为发烧和血细胞减少症。归因死亡率很高，并强调需要高的临床怀疑指数，以便提供及时的诊断和治疗。
