Marcela Campo1, Russell E Lewis, Dimitrios P Kontoyiannis. 1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Abstract
BACKGROUND: Fusarium species cause severe infections in patients with hematologic malignancies. Few data are available concerning the outcome of fusariosis in the era of the expanding antifungal armamentarium. METHODS: We retrospectively identified patients with hematologic malignancy and positive cultures for Fusarium species at the MDACC (1998-2009). The diagnosis of proven or probable fusariosis was made according to modified EORTC/MSG criteria. RESULTS: Forty-four cases (75% proven) were identified over study period. Most (71%) patients had uncontrolled hematological malignancy and 21 patients (47%) received hematopoietic stem cell transplantation (85% allogeneic). Most patients (82%) were neutropenic at diagnosis (75% < 100/mm(3)). Patients had overlapping clinical syndromes: sinus 27%, pulmonary 75%, skin 68%, fungemia 36% and disseminated infection 70%. Bacterial (54%), fungal (36%) and viral (27%) co-infections were common. Most patients (84%) received combination therapy (typically a lipid formulation of amphotericin B and a triazole) with a mean duration of 28 days. Mortality at 12 weeks was 66%; 50% of deaths were attributable to Fusarium. Factors associated with increased likelihood of death at 12 weeks, included albumin <3.5 mg/dL, fungemia, and ICU admission; neutrophil recovery and fusariosis limited to skin were associated with improved survival (P < 0.05). Fungemia with Fusarium spp (OR 15.9; 1.1-231; P = 0.042) was the only risk factor independently associated with 12-week mortality with only 1/17 (6%) of patients still alive at 12 weeks. CONCLUSIONS: Fusariosis, although uncommon, continues to have poor prognosis in neutropenic leukemic patients who present with fungemia. 2010. Published by Elsevier Ltd.
BACKGROUND: Fusarium species cause severe infections in patients with hematologic malignancies. Few data are available concerning the outcome of fusariosis in the era of the expanding antifungal armamentarium. METHODS: We retrospectively identified patients with hematologic malignancy and positive cultures for Fusarium species at the MDACC (1998-2009). The diagnosis of proven or probable fusariosis was made according to modified EORTC/MSG criteria. RESULTS: Forty-four cases (75% proven) were identified over study period. Most (71%) patients had uncontrolled hematological malignancy and 21 patients (47%) received hematopoietic stem cell transplantation (85% allogeneic). Most patients (82%) were neutropenic at diagnosis (75% < 100/mm(3)). Patients had overlapping clinical syndromes: sinus 27%, pulmonary 75%, skin 68%, fungemia 36% and disseminated infection 70%. Bacterial (54%), fungal (36%) and viral (27%) co-infections were common. Most patients (84%) received combination therapy (typically a lipid formulation of amphotericin B and a triazole) with a mean duration of 28 days. Mortality at 12 weeks was 66%; 50% of deaths were attributable to Fusarium. Factors associated with increased likelihood of death at 12 weeks, included albumin <3.5 mg/dL, fungemia, and ICU admission; neutrophil recovery and fusariosis limited to skin were associated with improved survival (P < 0.05). Fungemia with Fusarium spp (OR 15.9; 1.1-231; P = 0.042) was the only risk factor independently associated with 12-week mortality with only 1/17 (6%) of patients still alive at 12 weeks. CONCLUSIONS:Fusariosis, although uncommon, continues to have poor prognosis in neutropenic leukemicpatients who present with fungemia. 2010. Published by Elsevier Ltd.
Authors: A M Tortorano; A Prigitano; M C Esposto; V Arsic Arsenijevic; J Kolarovic; D Ivanovic; L Paripovic; L Klingspor; I Nordøy; P Hamal; S Arikan Akdagli; C Ossi; A Grancini; C Cavanna; G Lo Cascio; C Scarparo; A Candoni; M Caira; M Drogari Apiranthitou Journal: Eur J Clin Microbiol Infect Dis Date: 2014-05-03 Impact factor: 3.267