Infections in Patients with Aplastic Anemia

Background: Infection is a significant cause of death in patients with aplastic anemia (AA). Methods: This was a prospective observational study that evaluated the type of infections, associated pathogens, and outcome of infectious episodes (IEs) in patients with AA who were treated at Bangladesh Shishu Hospital & Institute, Dhaka between January 2020 and December 2024. Results: Fourty patients with a median age of 7 years (range, 2-18 years) were identified. Overall, 104 IEs were documented in 40 patients (81%). The most common microbiologically documented infections were bacteremias (38%) followed by pneumonias (16%). Most patients (55%) had bacterial infections, mainly caused by gram-positive cocci. Multidrug-resistant, gram-negative bacilli also were not uncommon in this patient population. Five of 12 patients who died during the study period died of infection. All of these patients had invasive fungal infections, mostly due to molds. All five patients had prolonged and severe neutropenia. Conclusions: Infections remain a major cause of death in patients with AA. Bacterial infections, especially those caused by gram-positive cocci, constitute the main cause of IE. Invasive mold infections, however, are the major cause of death in this patient population.