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Dragoi OD, Shah M, Potter V, Avenoso D, Krishnamurthy P, Abdolrasouli A, Schelenz S, Chandra J, Mehra V. Disseminated Mucormycosis and T-Cell-Depleted Allogeneic Stem Cell Transplantation: An Unusual Case Study. Acta Haematol 2024:1-7. [PMID: 39168110 DOI: 10.1159/000540640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/26/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION Invasive fungal infections are a primary cause of morbidity and mortality in patients with haematological malignancies. CASE PRESENTATION We describe an unusual clinical and radiological presentation of invasive mucormycosis (IM) in a 69-year-old patient with relapsed acute myeloid leukaemia. The patient was diagnosed with disseminated IM with involvement of the central nervous system in an atypical location, lung, spleen, muscle, bone, and heart, after having completed induction and bridging chemotherapy to allogeneic haematopoietic stem cell transplant (HSCT). Her clinical presentation was atypical with mild neurological symptoms slowly progressing over 2 months and without appropriate signs of systemic inflammation. Mucorales was eventually confirmed from bronchoalveolar lavage and subdural collection. CONCLUSION This report highlights the difficult challenges of managing disseminated IM in an immunocompromised patient, where close multidisciplinary specialist care enabled successful treatment, followed by T-cell-depleted allogeneic HSCT for a high-risk haematological malignancy.
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Affiliation(s)
| | - Mili Shah
- Department of Haematology, King's College Hospital, London, UK
| | - Victoria Potter
- Department of Haematology, King's College Hospital, London, UK
| | - Daniele Avenoso
- Department of Haematology, King's College Hospital, London, UK
| | | | | | - Silke Schelenz
- Department of Microbiology, King's College Hospital, London, UK
| | - Julie Chandra
- Department of Radiology, King's College Hospital, London, UK
| | - Varun Mehra
- Department of Haematology, King's College Hospital, London, UK
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How I perform hematopoietic stem cell transplantation on patients with a history of invasive fungal disease. Blood 2021; 136:2741-2753. [PMID: 33301030 DOI: 10.1182/blood.2020005884] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/13/2020] [Indexed: 02/08/2023] Open
Abstract
Hematopoietic transplantation is the preferred treatment for many patients with hematologic malignancies. Some patients may develop invasive fungal diseases (IFDs) during initial chemotherapy, which need to be considered when assessing patients for transplantation and treatment posttransplantation. Given the associated high risk of relapse and mortality in the post-hematopoietic stem cell transplantation (HSCT) period, IFDs, especially invasive mold diseases, were historically considered a contraindication for HSCT. Over the last 3 decades, advances in antifungal drugs and early diagnosis have improved IFD outcomes, and HSCT in patients with a recent IFD has become increasingly common. However, an organized approach for performing transplantation in patients with a prior IFD is scarce, and decisions are highly individualized. Patient-, malignancy-, transplantation procedure-, antifungal treatment-, and fungus-specific issues affect the risk of IFD relapse. Effective surveillance to detect IFD relapse post-HSCT and careful drug selection for antifungal prophylaxis are of paramount importance. Antifungal drugs have their own toxicities and interact with immunosuppressive drugs such as calcineurin inhibitors. Immune adjunct cytokine or cellular therapy and surgery can be considered in selected cases. In this review, we critically evaluate these factors and provide guidance for the complex decision making involved in the peri-HSCT management of these patients.
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Ferdjallah A, Young JAH, MacMillan ML. A Review of Infections After Hematopoietic Cell Transplantation Requiring PICU Care: Transplant Timeline Is Key. Front Pediatr 2021; 9:634449. [PMID: 34386464 PMCID: PMC8353083 DOI: 10.3389/fped.2021.634449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Despite major advances in antimicrobial prophylaxis and therapy, opportunistic infections remain a major cause of morbidity and mortality after pediatric hematopoietic cell transplant (HCT). Risk factors associated with the development of opportunistic infections include the patient's underlying disease, previous infection history, co-morbidities, source of the donor graft, preparative therapy prior to the graft infusion, immunosuppressive agents, early and late toxicities after transplant, and graft-vs.-host disease (GVHD). Additionally, the risk for and type of infection changes throughout the HCT course and is greatly influenced by the degree and duration of immunosuppression of the HCT recipient. Hematopoietic cell transplant recipients are at high risk for rapid clinical decompensation from infections. The pediatric intensivist must remain abreast of the status of the timeline from HCT to understand the risk for different infections. This review will serve to highlight the infection risks over the year-long course of the HCT process and to provide key clinical considerations for the pediatric intensivist by presenting a series of hypothetical HCT cases.
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Affiliation(s)
- Asmaa Ferdjallah
- Department of Pediatrics, Division of Blood and Marrow Transplantation and Cellular Therapy, University of Minnesota, Minneapolis, MN, United States
| | - Jo-Anne H Young
- Department of Medicine, Division of Infectious Disease and International Medicine, Program in Transplant Infectious Disease, University of Minnesota, Minneapolis, MN, United States
| | - Margaret L MacMillan
- Department of Pediatrics, Division of Blood and Marrow Transplantation and Cellular Therapy, University of Minnesota, Minneapolis, MN, United States
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Huang YR, Xie CQ, Tong JF, Zhang XH, Xu Y, Yuan XG. Successful treatment with matched unrelated donor peripheral blood stem cell transplantation for very severe aplastic anemia in presence of active infections: A case report. Medicine (Baltimore) 2020; 99:e19807. [PMID: 32243414 PMCID: PMC7220413 DOI: 10.1097/md.0000000000019807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Very severe aplastic anemia (vSAA) with active infections is always fatal. Adequate infection control before hematopoietic stem cell transplantation is recommended. PATIENT CONCERNS A 38-year-old woman with vSAA suffered from acute perforated appendicitis and invasive pulmonary fungal infection, and she failed to respond to intense antimicrobial therapies. DIAGNOSIS She was diagnosed with refractory vSAA with stubborn acute perforated appendicitis and invasive pulmonary fungal infection. INTERVENTIONS We successfully completed an emergent reduced intensity conditioning-matched unrelated donor (MUD)-peripheral blood stem cell transplantation (PBSCT) as a salvage therapy in the presence of active infections. The conditioning regimens consisted of reduced cyclophosphamide 30 mg/kg/day from day-5 to day-3, fludarabine 30 mg/m/day from day-5 to day-3 and porcine-antilymphocyte immunoglobulin 15 mg/kg/day from day-4 to day-2 without total body irradiation. Cyclosporin A, mycophenolate mofetil and short-term methotrexate were administered as graft-versus-host disease (GVHD) prophylaxis. Neutrophils and platelets were engrafted on day+15 and day+21. Appendiceal abscess and severe pneumonia developed after neutrophil engraftment, which were successfully managed with intense antimicrobial therapy and surgical intervention. OUTCOMES Only limited cutaneous chronic GVHD was observed 5 months after transplantation. The patient still lives in a good quality of life 2 years after transplantation. LESSONS Active infections may be no longer a contraindication to hematopoietic stem cell transplantation for some patients with vSAA.
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Sakai T, Sato K, Kikuchi T, Obata M, Konuma Y. A Radical Approach to Acute Lymphoblastic Leukemia Treatment: A Case Study of a Veterinarian Specializing in Livestock who Developed Disseminated Mucormycosis during Induction Therapy. Intern Med 2020; 59:261-266. [PMID: 31941872 PMCID: PMC7008056 DOI: 10.2169/internalmedicine.3314-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mucormycosis has emerged as the third-most common fungal mycosis and is one of the most fatal molds. We herein report a case study of a 30-year-old woman who was a veterinarian, specializing in livestock, who developed disseminated mucormycosis during induction therapy for acute lymphoblastic leukemia. We successfully used a radical approach for treatment, including a surgical procedure and allogeneic transplantation, with continuous administration of antifungal agents. Reports of successful treatments are extremely rare, and our case has had the longest documented remission from disseminated disease. We speculate that our case's occupational environment may represent a risk factor for development of mucormycosis.
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Affiliation(s)
- Toshiro Sakai
- Department of Hematology and Oncology, Asahikawa Red Cross Hospital, Japan
| | - Ken Sato
- Department of Hematology and Oncology, Asahikawa Red Cross Hospital, Japan
| | - Tomoki Kikuchi
- Department of Hematology and Oncology, Asahikawa Red Cross Hospital, Japan
| | - Masahiko Obata
- Department of Hematology and Oncology, Asahikawa Red Cross Hospital, Japan
| | - Yuichi Konuma
- Department of Hematology and Oncology, Asahikawa Red Cross Hospital, Japan
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Ochi T, Katayama Y, Okatani T, Imanaka R, Kyo K, Itagaki M, Katsutani S, Iwato K, Asaoku H. Successful haploidentical stem cell transplantation with prophylactic administration of liposomal amphotericin B after invasive pulmonary zygomycosis. Med Mycol Case Rep 2017; 18:1-4. [PMID: 28725544 PMCID: PMC5501889 DOI: 10.1016/j.mmcr.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 11/02/2022] Open
Abstract
A 54-year-old woman with acute myeloid leukemia (AML) achieved complete remission by induction chemotherapy, but developed zygomycosis after consolidation therapy. As zygomycosis could not be cured by liposomal amphotericin B and micafungin, left lower lobectomy was performed. As AML relapsed 7 months after onset, she received haploidentical stem cell transplantation under administration of liposomal amphotericin B. Despite experiencing severe acute graft-versus-host disease, she remains alive with no relapse of either zygomycosis or AML.
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Affiliation(s)
- Testuro Ochi
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1, Seiryomachi, Aoba-ku Sendai-shi, Miyagi 980-0872, Japan
| | - Yuta Katayama
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Takeshi Okatani
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Ryota Imanaka
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Kohei Kyo
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Mitsuhiro Itagaki
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Shinya Katsutani
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Koji Iwato
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Hideki Asaoku
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
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Boğa C, Bolaman Z, Çağırgan S, Karadoğan İ, Özcan MA, Özkalemkaş F, Saba R, Sönmez M, Şenol E, Akan H, Akova M. Recommendations for Risk Categorization and Prophylaxis of Invasive Fungal Diseases in Hematological Malignancies: A Critical Review of Evidence and Expert Opinion (TEO-4). Turk J Haematol 2017; 32:100-17. [PMID: 26316478 PMCID: PMC4451478 DOI: 10.4274/tjh.2014.0277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This is the last of a series of articles on invasive fungal infections prepared by opinion leaders in Turkey. The aim of these articles is to guide clinicians in managing invasive fungal diseases in hematological malignancies and stem cell transplantation based on the available best evidence in this field. The previous articles summarized the diagnosis and treatment of invasive fungal disease and this article aims to explain the risk categorization and guide the antifungal prophylaxis in invasive fungal disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Hamdi Akan
- Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey Phone: +90 532 424 26 40 E-mail:
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Seo E, Kim H, Koh KN, Im HJ, Seo JJ. Successful Allogeneic Hematopoietic Stem Cell Transplantation for a Patient with Very Severe Aplastic Anemia During Active Invasive Fungal Infection. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2016. [DOI: 10.15264/cpho.2016.23.1.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Euri Seo
- Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeri Kim
- Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Nam Koh
- Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Joon Im
- Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Jin Seo
- Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
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Lim SJ, Lim MJ, Raptis A, Hou JZ, Farah R, Marks S, Im A, Dorritie K, Sehgal A, Agha M, Lim SH. Outcome of acute myeloid leukemia patients with pulmonary nodules of uncertain etiology receiving allogeneic hematopoietic progenitor cell transplant. Eur J Haematol 2015; 96:55-9. [DOI: 10.1111/ejh.12547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Sara J. Lim
- Adult Hematopoietic Stem Cell Transplant Program; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Matthew J. Lim
- Adult Hematopoietic Stem Cell Transplant Program; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Anastasios Raptis
- Adult Hematopoietic Stem Cell Transplant Program; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Jing-Zhou Hou
- Adult Hematopoietic Stem Cell Transplant Program; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Rafic Farah
- Adult Hematopoietic Stem Cell Transplant Program; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Stanley Marks
- Adult Hematopoietic Stem Cell Transplant Program; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Annie Im
- Adult Hematopoietic Stem Cell Transplant Program; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Kathleen Dorritie
- Adult Hematopoietic Stem Cell Transplant Program; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Alison Sehgal
- Adult Hematopoietic Stem Cell Transplant Program; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Mounzer Agha
- Adult Hematopoietic Stem Cell Transplant Program; University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Seah H. Lim
- Adult Hematopoietic Stem Cell Transplant Program; University of Pittsburgh Medical Center; Pittsburgh PA USA
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García-Ruiz JC, Olazábal I, Adán Pedroso RM, López-Soria L, Velasco-Benito V, Sánchez-Aparicio JA, Navajas A, Montejo M, Moragues MD. Disseminated fusariosis and hematologic malignancies, a still devastating association. Report of three new cases. Rev Iberoam Micol 2015; 32:190-6. [PMID: 25936697 DOI: 10.1016/j.riam.2014.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/12/2014] [Accepted: 11/21/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Fungi of the genus Fusarium are primarily plant pathogens and saprobes that produce disseminated infections in immunologically deficient humans. After aspergillosis, disseminated fusariosis is the second most common cause of invasive infection by filamentous fungi in patients with hematologic malignancies or those undergoing transplants of hematopoietic progenitors. AIMS Disseminated fusariosis (DF) is considered an extremely rare infection and has reached a stable incidence rate, but its high mortality rate and the lack of an optimal management protocol have raised increasing interest in this mycosis. METHODS We present three cases of DF produced by Fusarium oxysporum species complex, Fusarium solani species complex and the highly unusual Fusarium dimerum in patients with advanced hematological malignancies diagnosed in our hospital between 2007 and 2011. The species level identification of the Fusarium isolates was established by sequencing their TEF1 gene. RESULTS The isolates showed low susceptibility to most of the antifungal agents analyzed, except that observed for F. dimerum to amphotericin B (AmB) and terbinafine, and F. oxysporum species complex to AmB. Interestingly, the strain of F. solani species complex exhibited high MIC values for AmB and voriconazole, notwithstanding these drugs were used for treatment with good results. Other relevant aspects to be considered in the treatment of DF are surgically cleaning foci of infection, withdrawing presumably contaminated catheters and recovery from neutropenia. CONCLUSIONS The prevention of infection in colonized patients, the maintenance of a high level of diagnostic suspicion for early diagnosis, and the combined, vigorous and prolonged use of L-AmB and voriconazole are essential to decrease the mortality rate of this devastating infection.
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Affiliation(s)
- Juan Carlos García-Ruiz
- Servicio de Hematología y Hemoterapia, BioCruces Health Research Institute, Hospital Universitario Cruces, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain
| | - Iñigo Olazábal
- Servicio de Hematología y Hemoterapia, BioCruces Health Research Institute, Hospital Universitario Cruces, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain
| | - Rosa María Adán Pedroso
- Servicio de Pediatría, BioCruces Health Research Institute, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Leyre López-Soria
- Servicio de Microbiología, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Verónica Velasco-Benito
- Servicio de Anatomía Patológica, BioCruces Health Research Institute, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | | | - Aurora Navajas
- Servicio de Pediatría, BioCruces Health Research Institute, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Miguel Montejo
- Unidad de Enfermedades Infecciosas, Hospital Universitario Cruces, BioCruces Health Research Institute, Universidad del País Vasco (UPV/EHU), Barakaldo, Bizkaia, Spain
| | - María-Dolores Moragues
- Departamento de Enfermería, Escuela de Enfermería, Universidad del País Vasco UPV/EHU, Leioa, Bizkaia, Spain.
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Liu M, Li Y, Zhang Y, Zhao X, Zhai B, Zhang Q, Wang L, Zhao Y, Li H, Wang Q, Gao C, Huang W, Yu L. Secondary antifungal prophylaxis in hematological malignancy patients with previous invasive fungal disease: a retrospective analysis. PLoS One 2014; 9:e115461. [PMID: 25531544 PMCID: PMC4274009 DOI: 10.1371/journal.pone.0115461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/23/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Invasive fungal disease (IFD) causes morbidity and mortality in patients with hematological malignancy. Recurrence of IFD after chemotherapy or hematopoietic stem cell transplantation (HSCT) is associated with poor prognosis. The present study aimed to investigate the efficacy of different strategies of secondary antifungal prophylaxis (SAP) for IFD and choose an appropriate SAP regimen. METHODS Clinical data of patients with previous IFD who underwent chemotherapy or HSCT between Jan 2008 and Jun 2013 were retrospectively reviewed and followed up to 180 days post-chemotherapy or HSCT. The clinical characteristics and diagnosis were analyzed according to the diagnostic criteria for IFD. The efficacy of different strategies for SAP and risk factors influencing the failure of SAP were evaluated. RESULTS Of the 164 patients enrolled, 121 patients received SAP regimen (73.78%), and IFD recurred in 40 patients: 16.5% (20/121) in SAP group and 46.5% (20/43) in non-SAP group. In SAP group, 58 received SAP agents which were proven effective for their previous IFD, while other 63 patients received other broad-spectrum antifungal agents. There was no significant difference in the recurrence rates between these two subgroups (13.8% (8/58) vs 19.0% (12/63), P = 0.437). The IFD recurrence rates were statistically significant between patients with allogeneic HSCT and chemotherapy or autologous HSCT (25% vs 8.2%, P = 0.013). Multivariate analysis indicated that allogeneic HSCT was the independent risk factor of IFD recurrence after SAP. CONCLUSIONS Secondary antifungal prophylaxis is necessary to prevent IFD recurrence in patients with hematological malignancy, especially for patients in the setting of allogeneic HSCT.
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Affiliation(s)
- Mingjuan Liu
- Department of Hematology and BMT center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
- Department of Hematology, the 309th Hospital of Chinese People's Liberation Army, 17 Heishanhu Road, Beijing 100091, China
| | - Yan Li
- Department of Hematology and BMT center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
- Department of Hematology, Hainan Branch of Chinese PLA General Hospital, Linwang Street of Sanya City, Hainan province, 572013, China
| | - Yongqing Zhang
- Department of Hematology, the 309th Hospital of Chinese People's Liberation Army, 17 Heishanhu Road, Beijing 100091, China
| | - Xiaoli Zhao
- Department of Hematology and BMT center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Bing Zhai
- Department of Hematology and BMT center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Qingyi Zhang
- Department of Hematology and BMT center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Lijun Wang
- Department of Hematology and BMT center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Yu Zhao
- Department of Hematology and BMT center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Honghua Li
- Department of Hematology and BMT center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Quanshun Wang
- Department of Hematology and BMT center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Chunji Gao
- Department of Hematology and BMT center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Wenrong Huang
- Department of Hematology and BMT center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
- Department of Hematology, Hainan Branch of Chinese PLA General Hospital, Linwang Street of Sanya City, Hainan province, 572013, China
- * E-mail: (LY); (WRH)
| | - Li Yu
- Department of Hematology and BMT center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
- * E-mail: (LY); (WRH)
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Chowdhary A, Meis J, Guarro J, de Hoog G, Kathuria S, Arendrup M, Arikan-Akdagli S, Akova M, Boekhout T, Caira M, Guinea J, Chakrabarti A, Dannaoui E, van Diepeningen A, Freiberger T, Groll A, Hope W, Johnson E, Lackner M, Lagrou K, Lanternier F, Lass-Flörl C, Lortholary O, Meletiadis J, Muñoz P, Pagano L, Petrikkos G, Richardson M, Roilides E, Skiada A, Tortorano A, Ullmann A, Verweij P, Cornely O, Cuenca-Estrella M. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi. Clin Microbiol Infect 2014; 20 Suppl 3:47-75. [DOI: 10.1111/1469-0691.12515] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 12/13/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022]
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13
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Katragkou A, Pana ZD, Perlin DS, Kontoyiannis DP, Walsh TJ, Roilides E. Exserohilum infections: review of 48 cases before the 2012 United States outbreak. Med Mycol 2014; 52:376-86. [PMID: 24682112 DOI: 10.1093/mmy/myt030] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Exserohilum species are soilborne fungi that have been uncommon causes of human disease. The ongoing outbreak in the United States warrants improved understanding of this pathogen. We systematically reviewed all cases of Exserohilum spp. infections published before the outbreak in 2012 in order to provide a better understanding of the organism and its wider spectrum of human disease. Cases of Exserohilum infections were retrieved by searching PubMed. Demographic data, underlying conditions, microbiology, clinical manifestations, therapy, and outcome were recorded and analyzed. Forty-eight evaluable cases were identified from 1975 to 2012. The number of reported cases increased more than twofold during the study period (P < 0.01). Most cases occurred in the southern United States, India, and Israel. Median age of patients was 25 years, with a male predominance. Most infections were due to E. rostratum (60.4%), followed by E. longirostratum (6.3%) and E. mcginnisii (2%), while 31.3% were unidentified species. The most frequent underlying conditions were immunosuppression (27.2%), trauma (16.6%), and atopy (12.5%). Exserohilum disease manifested as systemic (73%), cutaneous (25%), corneal (16.7%), and subcutaneous (10.4%) infection. Antifungal therapy consisted mainly of amphotericin B (44%) alone or combined with a triazole. Surgery was used in 48% of cases and was combined with antifungal therapy in 31%. The all-cause mortality was 23%, which was higher in patients with preexisting immunosuppression (56.2%; odds ratio 15.4; 95% confidence interval, 2.7-88.6). This review of the pre-outbreak reported cases highlights several aspects of epidemiology, clinical presentation, risk factors, and management of this unusual pathogen.
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Affiliation(s)
- Aspasia Katragkou
- Infectious Diseases Unit, 3rd Department of Pediatrics, Aristotle University School of Medicine, Hippokration Hospital, Thessaloniki, Greece
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Lee JY, Jung CW, Kim K, Jang JH. Impact of previous invasive pulmonary aspergillosis on the outcome of allogeneic hematopoietic stem cell transplantation. THE KOREAN JOURNAL OF HEMATOLOGY 2012; 47:255-9. [PMID: 23320003 PMCID: PMC3538796 DOI: 10.5045/kjh.2012.47.4.255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/05/2012] [Accepted: 11/14/2012] [Indexed: 12/03/2022]
Abstract
Background Invasive pulmonary aspergillosis (IPA) is one of the major complications encountered by patients receiving chemotherapy for hematologic malignancies. The prolonged period of intense immunosuppression following allogeneic hematopoietic stem cell transplantation (HSCT) may increase the risk of IPA recurrence in patients with a history of IPA. We evaluated the impact of a history of IPA on allogeneic HSCT outcome, and examined the incidence of IPA after HSCT. Methods This retrospective study included 22 patients with a history of IPA prior to receiving allogeneic HSCT at the Samsung Medical Center from 1995 to 2007. Diagnosis of IPA was defined as proven (N=5), probable (N=0), or possible (N=17). Results All 22 patients received amphotericin-based regimens to treat pre-transplant IPA. Secondary antifungal prophylaxis was administered to 10 patients during HSCT. The development of post-transplant IPA was observed in 2 patients. One of the patients died from septic shock within 2 days of the diagnosis of possible IPA. The other patient recovered from IPA, but eventually had a relapse of the primary disease. Of the 22 patients, the overall 2-year survival rate was 63% (95% confidence interval [CI]: 41-85), and the transplant-related mortality rate was 19% (95% CI: 0-38). Conclusion Our results suggest that a history of IPA prior to HSCT does not have an adverse impact on transplant outcomes, although the small number of cases was a limitation in this study. Future studies involving a larger number of cases are needed to further examine this issue.
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Affiliation(s)
- Ji Yean Lee
- Division of Hematology-Oncology, Department of Medicine, SAM Cancer Hospital, Seoul, Korea
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15
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Failure of haematopoietic recovery overcome by SCT despite invasive mucormycosis infection. Bone Marrow Transplant 2011; 47:591-2. [PMID: 21666738 DOI: 10.1038/bmt.2011.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Secondary antifungal prophylaxis in hematological malignancies in a tertiary medical center. Int J Hematol 2010; 92:725-31. [DOI: 10.1007/s12185-010-0723-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 11/02/2010] [Accepted: 11/07/2010] [Indexed: 11/25/2022]
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17
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Derber C, Elam K, Bearman G. Invasive sinonasal disease due to dematiaceous fungi in immunocompromised individuals: case report and review of the literature. Int J Infect Dis 2010; 14 Suppl 3:e329-32. [PMID: 20594890 DOI: 10.1016/j.ijid.2010.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 04/12/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022] Open
Abstract
Invasive dematiaceous fungal sinusitis is an uncommon and aggressive disease in immunocompromised individuals. We report a unique case of invasive Exserohilum sinusitis in a pregnant, immunocompromised woman. After treating the woman with pregnancy-induced aplastic anemia and invasive Exserohilum sinusitis and pulmonary disease, we performed a Medline/PubMed review of invasive dematiaceous fungal sinonasal disease in immunocompromised individuals. Twelve cases of proven and one case of probable invasive sinonasal dematiaceous fungal disease in immunocompromised patients are reported in the English-language literature. The majority of patients had underlying hematological conditions. The crude mortality was high, with over half of the patients dying from presumed complications of the underlying immunosuppression. Successful outcomes were associated with surgical debridement, aggressive antifungal use, and a reduction of immunosuppression. The optimal treatment for immunocompromised patients with invasive dematiaceous fungal disease is not known. The role of newer triazoles, posaconazole and voriconazole, appears promising, however more clinical data are needed. Definitive diagnosis requires tissue biopsy and successful treatment is associated with reduction of immunosuppression, aggressive surgical debulking, and systemic antifungal therapy.
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Affiliation(s)
- Catherine Derber
- Department of Medicine, Division of Infectious Diseases, Virginia Commonwealth University Medical Center, 1101 East Marshall Street, Richmond, VA 23298-0049, USA
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18
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Vehreschild JJ, Sieniawski M, Reuter S, Arenz D, Reichert D, Maertens J, Böhme A, Silling G, Martino R, Maschmeyer G, Rüping MJ, Ullmann AJ, Cornely OA. Efficacy of caspofungin and itraconazole as secondary antifungal prophylaxis: analysis of data from a multinational case registry. Int J Antimicrob Agents 2009; 34:446-50. [DOI: 10.1016/j.ijantimicag.2009.06.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 06/12/2009] [Accepted: 06/15/2009] [Indexed: 10/20/2022]
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19
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Zhang P, Song A, Wang Z, Feng S, Qiu L, Han M. Hematopoietic SCT in patients with a history of invasive fungal infection. Bone Marrow Transplant 2008; 43:533-7. [DOI: 10.1038/bmt.2008.356] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Aki Z, Sucak G, Yeğin Z, Güzel Ö, Erbaş G, Şenol E. Hematopoietic Stem Cell Transplantation in Patients With Active Fungal Infection: Not a Contraindication for Transplantation. Transplant Proc 2008; 40:1579-85. [DOI: 10.1016/j.transproceed.2008.03.149] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Revised: 01/29/2008] [Accepted: 03/11/2008] [Indexed: 01/05/2023]
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21
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Crassard N, Hadden H, Pondarré C, Hadden R, Galambrun C, Piens M, Pracros J, Souillet G, Basset T, Berthier J, Philippe N, Bertrand Y. Invasive aspergillosis and allogeneic hematopoietic stem cell transplantation in children: a 15-year experience. Transpl Infect Dis 2008; 10:177-83. [DOI: 10.1111/j.1399-3062.2008.00304.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Cornely OA, Böhme A, Reichert D, Reuter S, Maschmeyer G, Maertens J, Buchheidt D, Paluszewska M, Arenz D, Bethe U, Effelsberg J, Lövenich H, Sieniawski M, Haas A, Einsele H, Eimermacher H, Martino R, Silling G, Hahn M, Wacker S, Ullmann AJ, Karthaus M. Risk factors for breakthrough invasive fungal infection during secondary prophylaxis. J Antimicrob Chemother 2008; 61:939-46. [DOI: 10.1093/jac/dkn027] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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23
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Grigg A, Slavin M. Minimizing the risk of recurrent or progressive invasive mold infections during stem cell transplantation or further intensive chemotherapy. Transpl Infect Dis 2008; 10:3-12. [PMID: 17605732 DOI: 10.1111/j.1399-3062.2007.00259.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The risk of recurrence or progression of prior invasive fungal infection, predominantly due to molds, is 11-33% during subsequent stem cell transplantations or myelosuppressive chemotherapy, with a high mortality. Risk factors at the time of transplant include active infection and having received <6 weeks of antifungal therapy, while after transplant prolonged neutropenia and graft-versus-host disease requiring aggressive immunosuppression are important. The use of peripheral blood stem cells has been associated with a lower risk. Minimal data are available regarding the role of preventative strategies such as surgical resection of pulmonary lesions and prophylactic granulocyte transfusions during neutropenia, the optimal duration of antifungal prophylaxis, and the appropriate monitoring strategy. This article critically evaluates these issues and provides recommendations for the secondary prophylaxis of invasive mold infections.
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Affiliation(s)
- A Grigg
- Department of Clinical Haematology and Bone Marrow Transplantation, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
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Allinson K, Kolve H, Gumbinger HG, Vormoor HJ, Ehlert K, Groll AH. Secondary antifungal prophylaxis in paediatric allogeneic haematopoietic stem cell recipients. J Antimicrob Chemother 2008; 61:734-42. [DOI: 10.1093/jac/dkm521] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hill BT, Kondapalli L, Artz A, Smith S, Rich E, Godley L, Odenike O, Pursell KJ, Larson RA, Stock W, van Besien K. Successful allogeneic transplantation of patients with suspected prior invasive mold infection. Leuk Lymphoma 2007; 48:1799-805. [PMID: 17786717 DOI: 10.1080/10428190701534390] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Prior invasive fungal infection (IFI) has historically limited the use of allogeneic stem cell transplantation for patients with hematologic malignancies. Transplantation of such patients frequently resulted in recurrent infection and high mortality rates. Several new antifungal agents have been introduced over the past 5 years with broader spectra of activity against molds such as Aspergillus and a favorable toxicity profile. In this study, we present a series of 16 consecutive patients with hematologic malignancy and prior invasive fungal infection who underwent allogeneic transplantation. Of these patients, the majority of whom were treated with voriconazole and/or caspofungin, only four experienced recurrent fungal infection and recurrent fungal infection was the primary cause of death in only one patient. The estimated 45% 2-year survival in this series is similar to that for other patients with high risk hematologic malignancy undergoing stem cell transplantation. We conclude that suspected prior invasive fungal infection should not preclude the use of allogeneic stem cell transplantation.
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Affiliation(s)
- Brian T Hill
- Department of Internal Medicine, Cancer Research Center, University of Chicago, IL, USA
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26
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Togitani K, Kobayashi M, Sakai M, Uemura Y, Taguchi H, Morita T, Sugihara S, Sano A, Nishimura K. Ethmoidal sinusitis caused by Exserohilum rostratum in a patient with malignant lymphoma after non-myeloablative allogeneic peripheral blood stem cell transplantation. Transpl Infect Dis 2007; 9:137-41. [PMID: 17462000 DOI: 10.1111/j.1399-3062.2007.00212.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe a patient with aggressive lymphoma who contracted an ethmoidal sinus infection due to Exserohilum rostratum after non-myeloablative allogeneic peripheral blood stem cell transplantation. E. rostratum is an extremely rare causative pathogen of invasive fungal infection. Phylogenetic tree analysis of the D1/D2 domains within the LSU rDNA identified the molecular structure of isolates. We believe this is the first description of E. rostratum infection in a patient who underwent hematopoietic stem cell transplantation.
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Affiliation(s)
- K Togitani
- Department of Hematology and Respiratory Medicine, Kochi Medical School, Kochi University, Kochi, Japan
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27
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Nosari A, Ravini M, Cairoli R, Cozzi P, Marbello L, Marenco P, Grillo G, Morra E. Surgical resection of persistent pulmonary fungus nodules and secondary prophylaxis are effective in preventing fungal relapse in patients receiving chemotherapy or bone marrow transplantation for leukemia. Bone Marrow Transplant 2007; 39:631-5. [PMID: 17384656 DOI: 10.1038/sj.bmt.1705655] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Antifungal therapy may be unable to eradicate invasive mycosis in leukemia patients. The presence of persisting pulmonary nodules owing to mycosis seems to increase the risk of fungal relapse after chemotherapy and transplant procedures. Between 1997 and 2004, 10 acute leukemia patients underwent pulmonary surgery for invasive mycosis. The median time from diagnosis of mycosis to surgery was 135 days (range 21-147). Three patients underwent emergency surgery, owing to hemoptysis. In the other seven patients with nodule/cavitation remaining after antifungal treatment, surgery (three wedge resections, four lobectomies) was scheduled before transplant. Pathologic examination confirmed two aspergillosis and three zygomycosis. The only side effect was pneumothorax in one case. Nine patients were considered cured. Six patients underwent bone marrow transplantation (three allogeneic, three autologous) with antifungal prophylaxis without relapse during the transplant procedure. In selected patients scheduled for bone marrow transplantation, surgical resection of localized pulmonary fungus nodules combined with antifungal prophylaxis seem to be an effective treatment for preventing mycotic relapse.
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MESH Headings
- Adult
- Aged
- Antifungal Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Aspergillosis/drug therapy
- Aspergillosis/etiology
- Aspergillosis/prevention & control
- Aspergillosis/surgery
- Bone Marrow Transplantation/adverse effects
- Female
- Humans
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/therapy
- Lung Diseases, Fungal/drug therapy
- Lung Diseases, Fungal/etiology
- Lung Diseases, Fungal/prevention & control
- Lung Diseases, Fungal/surgery
- Male
- Middle Aged
- Mucormycosis/drug therapy
- Mucormycosis/etiology
- Mucormycosis/prevention & control
- Mucormycosis/surgery
- Recurrence
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Affiliation(s)
- A Nosari
- Department of Hematology, Niguarda Ca'Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
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Adler A, Yaniv I, Samra Z, Yacobovich J, Fisher S, Avrahami G, Levy I. Exserohilum: an emerging human pathogen. Eur J Clin Microbiol Infect Dis 2006; 25:247-53. [PMID: 16511679 DOI: 10.1007/s10096-006-0093-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Exserohilum is a dematiaceous fungus that may cause a spectrum of diseases in humans, including skin and corneal infection, invasive disease, and allergic fungal sinusitis. The aim of this work is to describe two new cases of Exserohilum infection and to review the literature. The review yielded 33 cases of Exserohilum infection, of which 23 were reported since 1993. Most occurred in regions with hot climates, such as India, Israel, and the southern USA. Impaired immunity was present in the majority of patients with invasive and skin infections, whereas local trauma and atopy were the predisposing factors in those with corneal infections and allergic fungal sinusitis, respectively. Surgical debridement was the principal mode of therapy for allergic fungal sinusitis. Amphotericin B was the initial single antifungal agent used in all cases of invasive disease; the response rate was low but improved with the addition of triazole agents. Outcome appeared to be better than for other mold infections and depended mainly on the underlying diseases.
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Affiliation(s)
- A Adler
- Unit of Pediatric Infectious Diseases and Hospital Infection Control, Schneider Children's Medical Center of Israel, 14 Kaplan Street, POB 559, Petah Tiqva, 49202, Israel.
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29
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Dvorak CC, Steinbach WJ, Brown JMY, Agarwal R. Risks and outcomes of invasive fungal infections in pediatric patients undergoing allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2005; 36:621-9. [PMID: 16044133 DOI: 10.1038/sj.bmt.1705113] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Invasive fungal infections (IFI) are the leading cause of infectious mortality in adult patients undergoing hematopoietic cell transplantation (HCT) after myeloablative conditioning, but the extent of this problem in the pediatric population is unclear. We retrospectively examined risk factors for IFI among 120 consecutive pediatric patients undergoing allogeneic HCT at a single center. The incidence of proven or probable IFI in pediatric patients during the first year after allogeneic HCT was 13%, comparable to the rate reported in adult patients; however, unlike IFI in adult patients, the majority of IFI in children occurred within the first month after transplantation. The primary risk factors for IFI were duration of neutropenia, age greater than 10 years, transplant for severe aplastic anemia or Fanconi anemia, and high-dose corticosteroid administration for 10 days or longer. IFI were more likely to be successfully treated (42%, 5/12 patients) in pediatric HCT recipients when compared to previous reports of adult recipients. Nonrelapse mortality was estimated at 17% (20/120 patients) after allogeneic HCT, of which 35% (seven patients) were directly attributed to IFI. Thus, IFI is a significant cause of nonrelapse mortality in children undergoing allogeneic HCT and more effective strategies are needed to prevent and treat IFI.
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Affiliation(s)
- C C Dvorak
- Division of Pediatric Hematology, Oncology, and Bone Marrow Transplantation, Stanford University School of Medicine, Palo Alto, CA 94304, USA.
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Ifran A, Kaptan K, Beyan C. Efficacy of caspofungin in prophylaxis and treatment of an adult leukemic patient with invasive pulmonary aspergillosis in allogeneic stem cell transplantation. Mycoses 2005; 48:146-8. [PMID: 15743435 DOI: 10.1111/j.1439-0507.2004.01077.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Summary Invasive aspergillosis is a major problem in the management of immunocompromised patients, its prevalence is rising and it is still a major cause of death in this group. The clinical success rate with classical drugs is far away from expectations. New drugs are needed in the treatment of this complication. Belonging to the new class of echinocandins, caspofungin is a newly introduced and promising drug in this fatal situation. We report a patient with acute myeloid leukemia who had invasive pulmonary aspergillosis during induction therapy being treated with amphotericin B in first step and afterwards with caspofungin. The patient received consolidation therapy and allogeneic stem cell transplantation while using caspofungin, and did not experience any adverse effect related to drug. Many side effects, e.g. derangements in liver and kidney functions, hypokalemia, infusion-related side effects and especially thrombocytopenia, which are common with amphotericin B treatment are no longer problem with caspofungin. The efficacy of caspofungin in terms of regression of pulmonary lesions and control of fever is quite successful. The optimal therapies for opportunistic fungal infections are still debated, and further evaluation is needed.
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Abstract
PURPOSE OF REVIEW Invasive fungal infections have become the leading infectious cause of death in recipients of hematopoietic cell transplantation. Several factors have led to a renaissance in the study of invasive fungal infections. The growing incidence of both commonly encountered as well as emerging pathogens and the lethality of these infections coupled with the unprecedented number of available broad-spectrum antifungal drugs has lent a renewed vigor and enthusiasm to attempts to understand the pathogenesis of these diseases and, by doing so, improve prevention, diagnosis, and treatment. The following is a review of the primary research published from 2003 to the present that is pertinent to invasive fungal infection in the setting of hematopoietic cell transplantation. RECENT FINDINGS The main themes of published primary research during 2003 to the present include the efficacy and tolerability of antifungal prophylaxis, epidemiologic analyses of risk factors following nonmyeloablative preparative regimens, and more-detailed analyses of nonmyeloid immune responses. SUMMARY Although few definitive recommendations emerged from the studies during the review period, these investigations do contribute to a greater understanding of the immunobiology of invasive fungal infection and of the utility and limitations of newer antifungal agents in the prophylaxis or treatment of invasive fungal infection.
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Affiliation(s)
- Janice M Y Brown
- Division of Bone Marrow Transplantation, Department of Medicine, Stanford University School of Medicine, Stanford, California 94305, USA.
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