Emilia Hardak1,2, Eyal Fuchs3,4,5, Yuval Geffen6, Tsila Zuckerman7,8, Ilana Oren9,7,8. 1. Division of Pulmonary Medicine, Rambam Health Care Campus, P.O. Box 9602, 31096, Haifa, Israel. e_hardak@rambam.health.gov.il. 2. Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. e_hardak@rambam.health.gov.il. 3. Division of Pulmonary Medicine, Rambam Health Care Campus, P.O. Box 9602, 31096, Haifa, Israel. eyalfu@gmail.com. 4. Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. eyalfu@gmail.com. 5. Division of Pulmonology, Rambam Health Care Campus, 8, Ha'Aliya Street, 3525408, Haifa, Israel. eyalfu@gmail.com. 6. Clinical Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel. 7. Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel. 8. Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. 9. Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.
Abstract
BACKGROUND: Patients with hematological malignancies and allogeneic hematopoietic stem-cell transplant recipients carry a high risk of rare (non-Aspergillus molds and non-Candida yeasts) invasive fungal infections (IFI). METHODS: We retrospectively evaluated and described the patient profile, clinical manifestations, isolated species, treatment and outcome of patients with hematological malignancies diagnosed with these rare IFIs during 15 years in a large single hemato-oncology center. RESULTS: Eighty-seven patients with hematological malignancies treated in our center had at least one positive culture or molecular identification of a rare fungus. Ninety-three isolates were considered the etiological agents of the infection. The most common underlying hematological malignancy was acute myeloid leukemia, 36 patients (41.4%). Eighty patients (91%) received chemotherapy less than 30 days prior to IFI diagnosis. The most frequent site of infection was the respiratory tract: 34 patients (39%) had pulmonary and 19 patients (22%) had a sinusal or nasopharyngeal infections. Disseminated infection, defined as positive blood cultures or parallel infection in multiple organ systems, was documented in 20 patients (23%). The most common fungal species were Fusarium (35%) and Zygomycetes (25%). Coinfection with more than one fungus was noted in 20 patients (23%). Forty-seven of 87 patients (54%) in this study died within 90 days of IFI diagnosis. CONCLUSIONS: Rare IFIs in patients with hematological malignancy become increasingly frequent. Early identification with traditional and molecular methods is important in management of these patients.
BACKGROUND:Patients with hematological malignancies and allogeneic hematopoietic stem-cell transplant recipients carry a high risk of rare (non-Aspergillus molds and non-Candida yeasts) invasive fungal infections (IFI). METHODS: We retrospectively evaluated and described the patient profile, clinical manifestations, isolated species, treatment and outcome of patients with hematological malignancies diagnosed with these rare IFIs during 15 years in a large single hemato-oncology center. RESULTS: Eighty-seven patients with hematological malignancies treated in our center had at least one positive culture or molecular identification of a rare fungus. Ninety-three isolates were considered the etiological agents of the infection. The most common underlying hematological malignancy was acute myeloid leukemia, 36 patients (41.4%). Eighty patients (91%) received chemotherapy less than 30 days prior to IFI diagnosis. The most frequent site of infection was the respiratory tract: 34 patients (39%) had pulmonary and 19 patients (22%) had a sinusal or nasopharyngeal infections. Disseminated infection, defined as positive blood cultures or parallel infection in multiple organ systems, was documented in 20 patients (23%). The most common fungal species were Fusarium (35%) and Zygomycetes (25%). Coinfection with more than one fungus was noted in 20 patients (23%). Forty-seven of 87 patients (54%) in this study died within 90 days of IFI diagnosis. CONCLUSIONS: Rare IFIs in patients with hematological malignancy become increasingly frequent. Early identification with traditional and molecular methods is important in management of these patients.
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