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Invasive fungal infections in lymphoproliferative disorders: a monocentric retrospective experience
Anna Maria Nosari1, Maria Luisa Pioltelli, Marta Riva
1Division of Hematology.
Abstract:
Invasive fungal infections (IFIs) seem to be a relevant cause of morbidity and mortality in patients with chronic lymphoproliferative disorders. We studied retrospectively the epidemiology, clinical manifestations and outcome of invasive fungal infections in 42 patients with lymphoproliferative diseases, treated between January 2004 and February 2012 for probable or proven IFI. In our entire population (1355 patients) of chronic lymphoproliferative malignancies, the incidence of probable/proven IFI was 3% (molds 2.3%, yeasts 0.5%, mixed infections 0.2%). Eight patients developed a yeast infection documented by blood cultures in seven cases and by the microscopic observation of Candida spp. in the vitreum after vitrectomy in one case. Among molds we diagnosed three proven infections by histologic evidence of Aspergillus spp. (n = 2) and Mucor (n = 1) in the lung and 28 probable mycoses. Three mixed infections from both molds and yeasts were also observed. Twenty-two cases showed positivity of galactomannan antigen in the serum (n = 16), in bronchoalveolar lavage (BAL) fluid (n = 4) or in both (n = 2). Cultures were positive in 11 cases. The overall rate of response to therapy was 64%. Fungal-attributable mortality rate was 17%, with a significant difference between molds and yeasts (16% vs. 25%, p = 0.03). At univariate analysis, the only risk factors related to mortality were severe and prolonged neutropenia (p = 0.003) and age (p = 0.03). Among molds, the rapid start of antifungals was probably partially responsible, together with new drugs, for the reduction of mortality, despite the severe immunosuppression of these patients.
Insights
Invasive fungal infections (IFIs) are a significant threat in chronic lymphoproliferative disorders. Early antifungal treatment and new drugs improved survival rates, despite severe immunosuppression.
Area of Science:
- Hematology
- Infectious Diseases
- Mycology
Background:
- Invasive fungal infections (IFIs) contribute significantly to morbidity and mortality in patients with chronic lymphoproliferative disorders.
- Understanding the epidemiology and outcomes of IFIs in this vulnerable population is crucial for improving patient care.
Purpose of the Study:
- To retrospectively analyze the epidemiology, clinical manifestations, and outcomes of invasive fungal infections in patients with lymphoproliferative diseases.
- To identify risk factors associated with mortality from IFIs in this patient cohort.
Main Methods:
- Retrospective study of 42 patients with lymphoproliferative diseases treated for probable or proven IFIs between January 2004 and February 2012.
- Analysis of incidence, types of fungal pathogens (molds, yeasts, mixed), diagnostic methods (blood cultures, galactomannan antigen, histology), and treatment responses.
- Univariate analysis to identify risk factors for mortality.
Main Results:
- The incidence of probable/proven IFIs was 3% in the overall population of chronic lymphoproliferative malignancies (molds 2.3%, yeasts 0.5%).
- Yeast infections occurred in 8 patients, while mold infections (Aspergillus, Mucor) and mixed infections were also observed.
- The overall response rate to therapy was 64%, with a fungal-attributable mortality rate of 17%. Molds had a lower mortality rate (16%) compared to yeasts (25%).
- Severe neutropenia and advanced age were significant risk factors for mortality.
- Rapid initiation of antifungal therapy, including newer drugs, likely contributed to reduced mortality from mold infections.
Conclusions:
- Invasive fungal infections pose a serious risk in patients with chronic lymphoproliferative disorders.
- Prompt diagnosis and aggressive antifungal treatment, especially for mold infections, are critical for improving outcomes.
- Managing neutropenia and considering age are important factors in mitigating IFI-related mortality.
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