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W Garrett Nichols

Publications and source records attributed to W Garrett Nichols.

24 records · Page 2Linked to original sources
PubMed2003

Combating infections in hematopoietic stem cell transplant recipients.

Infections with a diverse group of microorganisms remain the leading causes of morbidity and mortality after hematopoietic stem cell transplantation. Importantly, the epidemiology of infectious complications has shifted substantially with changes in antimicrobial prophylaxis, conditioning regimens and graft manipulation, such that invasive mould infections and late viral infections are now the over-riding concerns. New antivirals and antifungals have entered clinical practice and hold considerable promise for improved outcomes.

Bacterial Infections↗
PubMed2003

Immunosuppressive effects of beta-herpesviruses.

Immunomodulatory effects of human beta-herpesviruses have been reported in vitro and in vivo. Clinical studies suggest that beta-herpesvirus infection may increase the risk for other infections, the severity of infection, or the tempo of disease progression. An increased incidence of bacterial and fungal infections, and graft rejection, have been reported in association with cytomegalovirus (CMV), and human herpesviruses type 6 and type 7 infections have been implicated as risk factors for CMV infection and graft rejection. Beta-herpesviruses may also interact with HIV-1 and hepatitis C. To prove a causal relationship between beta-herpesviruses and specific clinical outcomes, randomized trials, with selective suppression of the virus, are required. Such trials have been performed for CMV and showed a reduction in bacterial and fungal infections as well as rejection in selected solid organ transplant recipients. More trials are needed to evaluate whether the effects seen in observational studies are truly related.

Betaherpesvirinae↗
PubMed2002

High risk of death due to bacterial and fungal infection among cytomegalovirus (CMV)-seronegative recipients of stem cell transplants from seropositive donors: evidence for indirect effects of primary CMV infection.

The impact of cytomegalovirus (CMV) serostatus (seropositive [(+)] or seronegative [(-)]) of the donor (D) and recipient (R) on mortality after allogeneic non-T cell-depleted stem cell transplantation (SCT) in the era of preemptive therapy was assessed among 1750 patients by means of multivariable Cox regression models. In an analysis that included only pre-SCT variables, D(+)/R(+) and D(+)/R(-) patients had the highest risk for mortality. After neutropenia or the occurrence of CMV disease was controlled for, only D(+)/R(-) patients remained at a significantly higher risk for mortality. Mortality due to bacteremia or invasive fungal infection was higher among D(+)/R(-) (18.3%) than D(-)/R(-) (9.7%) patients (P <.001). Thus, CMV serostatus remains associated with mortality; neutropenia due to ganciclovir administration and CMV disease explain the association with mortality among seropositive recipients. However, in D(+)/R(-) subjects, mortality appears to be associated with bacterial and fungal infection, indicating a possible immunomodulatory effect of primary CMV infection that was undetected despite intensive monitoring.

Adolescent↗
PubMedDate not supplied

Management of infectious complications in the hematopoietic stem cell transplant recipient.

Despite impressive accomplishments in supportive care over the past decade, infections with a diverse group of microorganisms remain leading causes of morbidity and mortality after hematopoietic stem cell transplantation. The epidemiology of infectious complications has shifted substantially in the past decade with changes in antimicrobial prophylaxis, conditioning regimens, and graft manipulation, such that invasive mould infections and late viral infections are now the overriding concerns. Individual patient risk for infections is predicated on multiple disease-specific, patient-specific, and transplant-related factors but often tracks with the cumulative level of immunosuppression (such as dose of corticosteroids used for the treatment of graft vs host disease [GVHD]). New antivirals and antifungals have entered clinical practice and hold considerable promise for improved outcomes.

Antibiotic Prophylaxis↗