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Fungal infections in patients with acute leukemia
Abstract:
We reviewed the records of 32 patients with acute leukemia and proved invasive fungal infections to determine the clinical and pathologic characteristics of systemic mycosis in patients undergoing intensive induction chemotherapy. The incidence of invasive fungal infections among our patients was at least 27 percent, and Candida and Aspergillus accounted for the majority of these infections. Patients with systemic candidiasis generally had prolonged severe neutropenia, fever refractory to antibiotics, and evidence of mucosal colonization by fungi. At autopsy, Candida was always widely disseminated. Patients with aspergillosis generally had neutropenia, fever, and pulmonary infiltrates at the time of admission to the hospital and, at autopsy, their infections were primarily confined to the lungs. Patients infected with both Candida and Aspergillus had clinical and pathologic findings that were a combination of the features of each type of infection. A diagnosis of invasive fungal infection was established before death in only nine of the patients, all of whom had systemic candidiasis. Four of these patients were successfully treated and survived their hospitalization. The reasons for frequently misdiagnosing and unsuccessfully treating systemic mycosis in patients with acute leukemia are examined, and suggestions are made for improved management of patients at high risk for these infections. These suggestions are based upon recognition of the clinical settings in which fungal infections occur, the aggressive use of invasive diagnostic procedures, and the early empiric use of amphotericin B.
Insights
Invasive fungal infections, primarily Candida and Aspergillus, affect at least 27% of acute leukemia patients undergoing chemotherapy. Early diagnosis and empiric amphotericin B are crucial for improved outcomes in these high-risk patients.
Area of Science:
- Mycology
- Hematology
- Oncology
Background:
- Intensive induction chemotherapy for acute leukemia increases susceptibility to invasive fungal infections.
- Systemic mycosis poses a significant threat to immunocompromised patients, complicating treatment and prognosis.
Purpose of the Study:
- To determine the clinical and pathologic characteristics of systemic mycosis in acute leukemia patients.
- To identify factors contributing to misdiagnosis and treatment failure.
- To propose strategies for improved management of invasive fungal infections.
Main Methods:
- Retrospective review of medical records for 32 acute leukemia patients with proven invasive fungal infections.
- Analysis of clinical presentation, pathologic findings, and treatment outcomes.
- Autopsy findings were correlated with clinical diagnoses.
Main Results:
- Invasive fungal infections occurred in at least 27% of patients, with Candida and Aspergillus being the most common pathogens.
- Systemic candidiasis presented with neutropenia, refractory fever, and mucosal colonization; infections were widely disseminated at autopsy.
- Aspergillosis typically presented with neutropenia, fever, and pulmonary infiltrates, with lung-confined infections at autopsy.
- Diagnosis was established pre-mortem in only nine patients (all with candidiasis), with four successfully treated.
- Combined Candida and Aspergillus infections showed mixed clinical and pathologic features.
Conclusions:
- Invasive fungal infections are common and often underdiagnosed in acute leukemia patients receiving chemotherapy.
- Successful management requires prompt diagnosis through invasive procedures and early empiric treatment with amphotericin B.
- Recognizing specific clinical settings and implementing aggressive diagnostic and therapeutic strategies can improve survival rates.