Version May 2024
| Syndrome | Preengraftment, <3 weeks | Immediate postengraftment, 3 weeks to 3 months | Late postengraftment, >3 months |
| CNS manifestations | |||
| Localized | Bacteria, molds, Candida spp, stroke, drug toxicity | Bacteria, toxoplasmosis, molds, tumor relapse, drug toxicity | Bacteria, molds, PML, tumor relapse, drug toxicity, PRES |
| Diffuse | Bacteria, HSV, Candida spp, drug toxicity | HHV-6, CMV, Cryptococcus spp, drug toxicity | VZV, drug toxicity |
| Ocular manifestations | Candida spp, molds | CMV, Pneumocystis jirovecii (formerly P. carinii), toxoplasmosis | VZV, CMV |
| Sinusitis | Bacteria, molds, respiratory viruses | Bacteria, molds, respiratory viruses | Bacteria, molds, respiratory viruses |
| Mucositis, mucosal ulcerations | |||
| Infectious | HSV, Candida spp, agents of mucormycosis | HSV, Candida spp, agents of mucormycosis, CMV (esophagitis), Aspergillus spp (small or large intestine) | HSV, Candida spp, agents of mucormycosis, CMV (esophagitis), Aspergillus spp (small or large intestine) |
| Other | GVHD, drug toxicity | GVHD, drug toxicity | GVHD, drug toxicity |
| Pneumonia | |||
| Localized | Bacteria, Aspergillus spp, other molds, pulmonary embolism, hemorrhage | Bacteria, Aspergillus spp, other molds, Nocardia spp, TB, NTM, tumor relapse | Bacteria, Aspergillus spp, other molds, Nocardia spp, VZV, EBV-associated PTLD, pulmonary calcinosis |
| Diffuse | Respiratory viruses, HSV, conditioning regimen, acute GVHD, pulmonary edema, radiation pneumonitis, alveolar hemorrhage, ARDS, hypersensitivity drug reaction, idiopathic interstitial pneumonitis, leukoagglutinin reaction, fluid overload, congestive heart failure | CMV, P. jirovecii, respiratory viruses, Legionella spp, Mycoplasma pneumoniae, Cryptococcus spp, adenovirus, TB, NTM, acute GVHD, radiation pneumonitis, idiopathic interstitial pneumonitis, ARDS, hypersensitivity drug reaction, pulmonary VOD, congestive heart failure | Chronic GVHD, EBV-associated lymphoma, ARDS, hypersensitivity drug reaction, alveolar proteinosis, radiation pneumonitis, idiopathic interstitial pneumonitis, COP (formerly BO or BOOP), congestive heart failure |
| Esophagitis | Candida spp, HSV, drug toxicity | CMV, drug toxicity, HSV | Drug toxicity |
| Diarrhea/colitis | Bacteria (Clostridioides difficile, Clostridium septicum), neutropenic enterocolitis (typhlitis), drug toxicity, bleeding, infarction, enteroviruses | Bacteria (C. difficile, C. septicum), CMV, enteroviruses, drug toxicity, acute GVHD, bleeding, infarction | CMV, bacteria (C. difficile, C. septicum), enteroviruses, drug toxicity, acute or chronic GVHD, bleeding, infarction |
| Hepatitis | Bacteria, HSV, chronic disseminated candidiasis, hepatic SOS (formerly veno-occlusive disease), drug toxicity, acute GVHD, conditioning regimen | HBV, HCV, HEV, EBV, HSV, CMV, HHV-6, P. jirovecii, chronic disseminated candidiasis (hepatosplenic candidiasis), SOS, drug toxicity, acute GVHD, conditioning regimen | HBV, HCV, HEV, EBV, VZV, drug toxicity, chronic GVHD |
| Hemorrhagic cystitis | Adenovirus (rarely), cyclophosphamide toxicity | BK virus, CMV, adenovirus, cyclophosphamide toxicity | BK virus |
| Nephritis | Bacteria | BK virus, CMV, adenovirus | BK virus, JC virus |
| Skin lesions | Bacteria, HSV, Candida spp, molds, acute GVHD, drug toxicity | Bacteria, Candida spp, molds, VZV, HHV-6, NTM, acute GVHD, drug toxicity | VZV, molds, chronic GVHD, drug toxicity |
| Bone marrow suppression | CMV, HHV-6, graft failure, drug toxicity, acute GVHD | CMV, HHV-6, graft failure, drug toxicity, acute GVHD | Parvovirus, CMV, HHV-6, graft failure, drug toxicity, chronic GVHD |
| Bloodstream infection | Bacteria, Candida spp | Bacteria (especially coagulase-negative staphylococci), Candida spp | Streptococcus pneumoniae, Neisseria meningitidis |
| Shock (including septic shock) | Bacteria (eg, alpha-hemolytic streptococci, Pseudomonas aeruginosa), anaphylaxis, adrenal insufficiency, cardiovascular complications | Same as for the preengraftment period | Same as for the preengraftment period, Streptococcus pneumoniae, Neisseria meningitidis |
| Fever without localizing signs | Bacterial sepsis, HSV, respiratory viruses, molds, chronic disseminated candidiasis, tumor fever, drug fever, adrenal insufficiency, acute GVHD, CVL-associated infection | Bacterial sepsis, sinusitis, CMV, EBV, HHV-6, respiratory viruses, molds, chronic disseminated candidiasis, tumor fever, drug fever, acute GVHD, CVL-associated infection | Bacterial sepsis, sinusitis, CMV, EBV, HHV-6, respiratory viruses, molds, chronic disseminated candidiasis, tumor fever, drug fever, chronic GVHD, pulmonary, cardiac, CVL-associated infection |
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