Fungemia in the immunocompromised host. Changing patterns, antigenemia, high mortality

Area of Science:

• Medical Mycology
• Infectious Diseases
• Clinical Microbiology

Background:

• Fungemias pose a significant threat to immunocompromised patients.
• Understanding the epidemiology and risk factors of fungemias is critical for patient management.
• Candida species are common causes of fungemia in hospitalized patients.

Purpose of the Study:

• To review fungemias in immunocompromised patients at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1974 and 1977.
• To analyze the incidence, causative agents, risk factors, and outcomes of fungemias.
• To evaluate diagnostic methods and treatment efficacy.

Main Methods:

• Retrospective review of 110 immunocompromised patients with fungemia.
• Analysis of patient demographics, underlying conditions, and treatments.
• Evaluation of diagnostic methods including blood cultures and serologic tests.

Main Results:

• Candida tropicalis fungemia incidence increased annually.
• Leukemia or lymphoma were common in patients with C. tropicalis and Candida albicans fungemia.
• Total parenteral nutrition was associated with Candida parapsilosis fungemia.
• A passive hemagglutination-inhibition test for circulating antigen showed promise.
• Overall mortality was high (79%), with C. parapsilosis having lower mortality (23%).
• High-dose amphotericin B treatment had limited success.

Conclusions:

• Fungemia is a severe, often fatal condition in immunocompromised patients.
• C. tropicalis and C. albicans are significant pathogens, often linked to hematologic malignancies.
• C. parapsilosis fungemia is associated with total parenteral nutrition.
• Diagnostic challenges persist, but antigen detection may aid in management.
• Treatment outcomes, even with amphotericin B, remain poor for many fungemia cases.