![]() In addition to innate immune defects, increasing age, waning cellular immunity, organ dysfunction, fragile skin, and prior antibiotic exposure may all contribute to the progression of preexisting infection, including aspergillosis, as well as to the risk for new infections during the posttransplant period. Other underlying diseases such as primary immunodeficiency, for example, may predispose to progression or reactivation of antecedent infections, and individuals with myelodysplastic syndrome who are neutropenic at the time of transplant are at an increased risk of infection and mortality. Further, antileukemic agents have been shown to diminish antibody response to primary antigens, thereby increasing susceptibility to bacterial pathogens even in the absence of neutropenia. In addition to neutropenia, other factors that increase risk for invasive aspergillosis include advanced or refractory acute myelogenous leukemia, high-risk myelodysplastic syndrome, chronic neutropenia prior to chemotherapy, iron overload secondary to repeated peripheral blood transfusions, and prior fungal infection. Profound neutropenia (<500 cells/mm 3) of greater than 10-day duration is considered a strong risk factor for bacterial and invasive fungal infection. Acute leukemia, for example, predisposes to neutropenia and other defects of innate immunity. Infection risk is very much impacted by the disease for which the patient is being transplanted and also by the presence of preceding infections.
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