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Invasive oral aspergillosis in immunocompromised patients with leukemia
Abstract:
The clinicopathologic characteristics of invasive oral aspergillosis in 16 immunocompromised patients who developed this infection during antileukemic chemotherapy are described. The primary site of the infection was the marginal gingiva, there was severe spontaneous pain, and the patients developed spiking fever and granulocytopenia. Necrotic ulceration of the gingiva rapidly extended to the contiguous mucosa, muscle, and bone. Microscopically, the necrotic tissue contained thrombotic vascular infarcts and there were hyphae that showed frequent transverse septa and dichotomous branching. The invasive organisms were not responsive to amphotericin B in the absence of remission of the leukemia and restoration of the depressed host defenses. In 15 patients who showed improvement of hematologic status, oral aspergillosis was controlled by the combination of antifungal chemotherapy and debridement of necrotic tissues.
Insights
Invasive oral aspergillosis in immunocompromised patients during chemotherapy presents with gingival necrosis and fever. Successful treatment requires leukemia remission, antifungal drugs, and tissue debridement.
Area of Science:
- Infectious Diseases
- Hematology
- Oncology
Background:
- Invasive oral aspergillosis is a severe opportunistic infection.
- It frequently affects immunocompromised patients, particularly those undergoing antileukemic chemotherapy.
- Early recognition and management are crucial for patient outcomes.
Purpose of the Study:
- To describe the clinicopathologic features of invasive oral aspergillosis in immunocompromised patients.
- To evaluate treatment responses to antifungal therapy and surgical intervention.
Main Methods:
- Retrospective analysis of 16 immunocompromised patients with invasive oral aspergillosis during antileukemic chemotherapy.
- Detailed review of clinical presentations, histopathologic findings, and treatment outcomes.
Main Results:
- The infection primarily affected the marginal gingiva, characterized by severe pain, fever, and granulocytopenia.
- Histopathology revealed necrotic ulceration with thrombotic vascular infarcts and characteristic Aspergillus hyphae.
- Amphotericin B was ineffective without leukemia remission and restored host defenses.
- Fifteen patients achieved disease control with antifungal chemotherapy and debridement following hematologic improvement.
Conclusions:
- Invasive oral aspergillosis in this cohort presented with distinct clinical and histopathologic features.
- Treatment success is contingent upon achieving leukemia remission and restoring host immune function.
- A combination of antifungal chemotherapy and surgical debridement is effective for managing the infection.