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Phycomycosis infection in acute leukaemia
1Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi.
Abstract:
Fungal infections are increasingly being reported in patients with acute leukaemia on intensive induction chemotherapy protocols. The common fungi seen are candida, aspergillus and mucormycosis. We have seen 3 cases of mucormycosis over the last 4 years. All 3 patients had acute leukaemia-two had acute lymphoblastic and one acute myeloid leukaemia. All patients were in neutropenic phase after induction chemotherapy. Features suggestive of fungal infection were fever and development or progression of pulmonary infiltrates despite antibiotic therapy. Repeated body fluid cultures were negative in two patients. In the first patient, the diagnosis was confirmed after biopsy of a palatal mass; he was treated successfully with amphotericin-B. In two patients the diagnosis was confirmed at autopsy. A high degree of suspicion in febrile, neutropenic cancer patients on chemotherapy and early administration of amphotericin-B may improve the outcome. With dissemination, the prognosis is poor.
Insights
Mucormycosis is a serious fungal infection affecting patients with acute leukemia undergoing chemotherapy. Early diagnosis and treatment with amphotericin-B are crucial for improving outcomes in these vulnerable patients.
Area of Science:
- Mycology
- Hematology
- Infectious Diseases
Background:
- Fungal infections, particularly mucormycosis, pose a significant threat to immunocompromised patients undergoing intensive chemotherapy for acute leukemia.
- Conventional treatments often involve broad-spectrum antibiotics, but invasive fungal infections require specific antifungal agents.
Observation:
- Three cases of mucormycosis were observed in patients with acute leukemia (two acute lymphoblastic leukemia, one acute myeloid leukemia) during the neutropenic phase post-chemotherapy.
- Clinical presentations included fever and pulmonary infiltrates unresponsive to antibiotics; body fluid cultures were frequently negative.
- Diagnosis was confirmed via biopsy in one patient, leading to successful treatment, while two cases were diagnosed post-mortem.
Findings:
- Mucormycosis diagnosis in acute leukemia patients can be challenging due to non-specific symptoms and negative cultures.
- Early detection through high clinical suspicion in febrile, neutropenic patients is critical.
- Timely administration of amphotericin-B is associated with improved survival rates.
Implications:
- Increased vigilance for mucormycosis in acute leukemia patients receiving chemotherapy is warranted.
- Prompt initiation of appropriate antifungal therapy, such as amphotericin-B, can significantly impact patient prognosis.
- Disseminated mucormycosis carries a poor prognosis, emphasizing the need for early intervention.