What is Bone Marrow Transplant-Related Infection?
Bone marrow transplant-related infection is defined as infections encountered following a bone marrow transplant.
A bone marrow transplant is a minimally invasive procedure performed to replace bone marrow that has been destroyed or damaged by chemotherapy, infection, or disease with healthy bone marrow stem cells. The procedure involves collecting bone marrow cells through a needle inserted into a bone, usually the pelvic bone. The cells are then transferred by an infusion (or reinfused, if autologous) into the patient’s bloodstream. Bone marrow transplants may use cells from your own body (autologous transplant) or from a donor (allogeneic transplant). A bone marrow transplant is also referred to as a stem cell transplant.
Bone marrow is the soft, fatty tissue inside your bones and is involved in the generation of new blood cells such as RBC, WBC, and platelets. These blood cells are involved in oxygen transport, fighting infection, and blood clotting to prevent excessive bleeding. Bone marrow contains a high number of stem cells or precursor cells that have the potential to replicate and transform into cells of any tissue. It may be aspirated and concentrated to form a biologic therapy agent that is particularly useful for the healing of bone, cartilage, and tendon or as a special therapy for patients with certain cancers or other conditions.
Why Do Infections Occur After a Bone Marrow Transplant?
Many of the infections that occur following your bone marrow transplant result from having the bone marrow eliminated by medicines or radiation just prior to the transplant. Others may be side effects of the conditioning treatments themselves. Chemotherapy and some other treatments weaken your body’s immune system. This is particularly true of treatment provided for a bone marrow/stem cell transplant because the bone marrow is part of the immune system. When your immune system is weakened, your body cannot protect itself as well against germs. Most of these germs already live in your body. When your immune system is strong, these germs do not make you sick. But after a transplant, they can cause an infection. Bone marrow transplanted-related infections are more common after allogeneic bone marrow transplants than autologous transplants, specifically in patients with graft-versus-host-disease (GVHD). If you receive stem cells from a donor, the transplanted stem cells may attack your body. This is referred to as GVHD.
What are the Causes of Bone Marrow Transplant-Related Infection?
The usual causes of infection following a bone marrow transplant include:
- Month 1: Bacteria, fungi, herpes simplex virus (HSV)
- Month 2: Cytomegalovirus (CMV), other viruses, bacteria, and fungi
- Month 3: Varicella-zoster virus (VZV), fungi, bacteria, or a community-acquired respiratory virus
Bacterial infections are the major complications after a bone marrow transplant. These include bloodstream infections (BSI), followed by pneumonia and gastrointestinal infections, including Clostridium difficile and typhlitis infections. Enterobacteriaceae are the most frequent pathogens causing about 25% of BSI each, followed by enterococci, P. aeruginosa, and viridans streptococci. Bacterial pneumonia is also common after bone marrow transplant, and Gram-negatives are predominant. Clostridium difficile infection affects approximately 15% of bone marrow transplant recipients, being more frequent in cases of allogeneic than an autologous transplant.
Aspergillosis is the most common type of fungal infection in bone marrow transplant patients, followed by Candida infection and mucormycosis, but other types of fungal infections are also possible.
The common viral infections in bone marrow transplant patients include cytomegalovirus (CMV), Epstein-Barr virus (EBV), adenovirus (ADV), human herpesvirus 6 (HHV-6), varicella zoster virus (VZV), and herpes simplex virus (HSV).
What are the Signs and Symptoms of Bone Marrow Transplant-Related Infection?
Some of the signs and symptoms of bone marrow transplant-related infection include:
- Fatigue
- Hair loss
- Weight loss
- Diarrhea
- Nausea and vomiting
- Reduced platelet count, making it difficult for your blood to clot
- Reduced red blood cells, resulting in anemia
- Lung damage
- Bone damage
- Early menopause
- Infertility
- Sexual health problems
- Thyroid problems
- Muscle pain
- Joint pain
- Cataracts
- Breathing problems
- Dry eyes
- Dry mouth
- Liver inflammation
- Skin changes, including scleroderma
What is the Treatment Involved With Bone Marrow Transplant-Related Infection?
For the first six weeks after transplant, until the freshly transfused stem cells start producing white blood cells (engraftment), you are high likely to contract serious infections. Bacterial infections are the most common during this period. Fungal and viral infections can be life-threatening. Any infection can cause an extended hospital stay, delay or prevent engraftment, and/or cause permanent organ damage. Antibiotics, antifungal medicines, and antiviral medicines are commonly given to try to prevent serious infection in the immunosuppressed patient.
What are the Preventive Measures/Lifestyle Changes Involved with the Management of Bone Marrow Transplant-Related Infection?
After your bone marrow transplant, your physician and dietitian will provide a series of guidelines on diet and lifestyle changes, good hygiene practices, and other recommendations to effectively manage bone marrow transplant-related infections. These include:
- Following food safety practices to prevent foodborne infections
- Consuming a wide range of healthy foods, such as fruits, whole grains, vegetables, legumes, fish, poultry, lean meats, and healthy fats, such as olive oil
- Restricting salt intake
- Limiting alcohol consumption
- Refraining from grapefruit and grapefruit juice because of their effect on a group of immunosuppressive medications
- Regular physical activity to strengthen your bones and muscles, control your weight, increase your endurance, and keep your body healthy
- Wearing sunscreen when outside, refraining from smoking, and having regular cancer screening to keep cancer under check
- Frequently washing your hands with soap and water after using the bathroom, after sexual contact, after touching soiled clothes or linens, before taking oral medicines, before and after preparing food, before eating, after touching pets or animals, and after sneezing, blowing your nose, or coughing
- Avoiding close exposure to people with respiratory illness
- Avoiding crowded areas where you are unable to maintain a safe distance from people and wearing a facemask if necessary
- Keeping your home clean and free from dust and avoiding dusty environments such as construction sites as it increases your chances of exposure to molds
- Avoiding wood-burning fireplaces as the wood contains the fungus
- Avoiding or minimizing direct contact with your pets or animals to prevent pet/animal-transmitted infections
- Limiting visitors for the first few months to avoid the risk of transmission of cold or flu-like symptoms
- Avoid swimming or playing in recreational water such as whirlpools, ponds, hot tubs, steam baths, or saunas