Infectious Complications in Patients with Combined Immunodeficiency Diseases Receiving Bone Marrow Transplants

Immunologic reconstitution was achieved in 8 of 12 patients with combined immunodeficiency diseases receiving transplants of allogeneic bone marrow. Long-term survival with successful reconstitution occurred in 4 patients. One of the remaining patients died of accidental complications and 7 of infections: 3 of gram-negative bacillary septicaemia, 2 of Pneumocystis carinii pneumonia, 1 of parainfluenza virus and Pseudomonas aeruginosa pneumonia and 1 of cytomegalovirus and Pseudomonas aeruginosa pneumonia. 58 separate episodes of infections occurred in the 12 patients. Predisposing factors included severe underlying disease, malnutrition, long-term exposure to resistant hospital organisms, and graft-versus-host disease. Gram-negative bacilli were the most frequent cause of infection. In every instance of septicaemia, identical organisms were isolated from blood and stool cultures. Isolation of patients in laminar air flow rooms prevented colonization and infection with exogenous organisms in contrast to isolation of patients in conventional hospital rooms. Patients not colonized with exogenous bacteria developed infections with their own endogenous flora.