Avaliação de causas de diarréia em pacientes submetidos a transplante autólogo de células tronco hematopoéticas

Abstract

Diarrhea is a major cause of morbidity for the patients undergoing high-dose chemotherapy and autologous hematopoietic stem cell transplantation (ASCT). There are multiple causes of diarrhea in patients undergoing transplantation incluing antineoplastic chemotherapy and infections. In this study, 47 patients underwent ASCT at the HU-UFJF between May 2011 and May 2013. All patients who presented with diarrhea consented to stool sample analysis for identification of the etiological agents through specific exams in search of fungi, coccidia, intestinal parasites, Strongyloides, C. difficile, and other pathogenic bacteria. Thirty-nine patients (83%) had diarrhea, among whom 35% had diarrhea induced by chemoterapy, seven (17.5%) presented with coccidia, three (7.5%) with Candida sp., one (2.5%) with C. difficile, and one (2.5%) with Giardia lamblia. Other 30% had diarrhea for other causes. There was a tendency toward a higher incidence of diarrhea in oldest 50 years (p=0.09) and those who received lomustine, etoposide, cytarabine, and melphalan conditioning (p=0.083) and a higher number of days of neutropenia in patients with diarrhea (p=0.06); however, no risk factors were identified. The results shows the importance of correctly identifying the etiological agent and highlights the possible varieties of agents in specific populations.