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Hou T, Bell WR, Mesa H. Invasive Fungal Infections of the Head and Neck: A Tertiary Hospital Experience. Pathogens 2024; 13:530. [PMID: 39057757 PMCID: PMC11279942 DOI: 10.3390/pathogens13070530] [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: 05/27/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
From the existing millions of fungal species, only a few cause disease. In this study, we investigated invasive fungal infections in the head and neck (H&N) over a 19-year period (2005 to 2024) at a large academic healthcare system. Among the 413 documented fungal H&N infections, 336 were noninvasive, and 77 were invasive. The highest incidence of invasive infections occurred in the sinonasal cavities, with a 15-fold difference compared to other sites. Most infections affected adults over 40 years old. The most common organisms were Mucorales (51%), hyaline molds (29%), and Candida (11%). Risk factors included malignancy, transplant, diabetes, and illicit drug use. Mortality was high in patients with malignancy and/or transplant. Infections affecting the mandible were usually a complication of osteoradionecrosis and were associated with the coinfection of Candida and Actinomyces. At other sites, infections were rare and were usually the result of penetrating injuries or immunosuppression. Treatment typically involved a combination of antifungals and surgical procedures.
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Affiliation(s)
- Tieying Hou
- Department of Laboratory Medicine and Pathology, Division of Head & Neck Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - W. Robert Bell
- Department of Laboratory Medicine and Pathology, Division of Neuropathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Hector Mesa
- Department of Laboratory Medicine and Pathology, Division of Head & Neck Pathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
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2
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McEntire CRS, Lesser CF, Venna N. Case Report and Clinical Reasoning: Fulminant Liver Failure and Invasive Aspergillosis Following Ocrelizumab Treatment in a 21 Year-Old Woman. Neurohospitalist 2023; 13:96-102. [PMID: 36531849 PMCID: PMC9755605 DOI: 10.1177/19418744221130385] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
We present the case of a 21 year-old woman with newly diagnosed relapsing-remitting multiple sclerosis who is given a single dose of ocrelizumab and placed on moderate-dose steroids with subsequent development of hepatic failure who goes on to develop highly fulminant systemic and central nervous system (CNS) aspergillosis. Ocrelizumab has no documented association with aspergillus infection, and moderate-dose steroids less often lead to such fulminant disease, but liver failure is associated with often-fatal aspergillus infection. We emphasize that liver failure is an underrecognized immune dysregulated state that predisposes to bacterial and fungal infections and suggest changes in diagnostic reasoning that could be considered in patients with multiple modalities of immunosuppression.
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Affiliation(s)
- Caleb R. S. McEntire
- Massachusetts General Hospital Department of Neurology, Boston, MA, USA
- Brigham and Women’s Hospital Division of General Neurology, Boston, MA, USA
| | - Cammie F. Lesser
- Massachusetts General Hospital Infectious Diseases Division, Boston, MA, USA
| | - Nagagopal Venna
- Massachusetts General Hospital Department of Neurology, Boston, MA, USA
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3
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Zhang Y, Dai K, Zhang Q, Huang Y, Feng Y, Bhardwaj D, Yu K, Feng J. Normal Absolute Monocyte Count in Combination with Normal/High Absolute Lymphocyte Count at the Time of Relapse is Associated with Improved Survival in Patients with Early Relapsed Acute Myeloid Leukemia. Cancer Invest 2021; 39:550-558. [PMID: 34027748 DOI: 10.1080/07357907.2021.1933013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to examine the prognostic significance of peripheral absolute monocyte count (AMC) in combination with absolute lymphocyte count (ALC) at the time of relapse in a cohort of 57 patients with early relapsed (first complete remission <12 months) acute myeloid leukemia (AML). Both univariate and multivariate Cox proportional hazard regression analyses revealed that normal AMC in combination with normal/high ALC (versus low/high AMC in combination with low ALC) was significantly associated with improved OS. We concluded that the combination of AMC and ALC could be used as a prognostic marker for survival outcomes in early relapsed AML.
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Affiliation(s)
- Yu Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Kanchun Dai
- Department of Hematology and Oncology, Hwa Mei Hospital, University of Chinese Academy of Sciences (Ningbo NO. 2 Hospital), Ningbo, PR China
| | - Qianying Zhang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Yisha Huang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Yiyun Feng
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Deeksha Bhardwaj
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Kang Yu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Jianhua Feng
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China.,Department of Pediatric Hematology-Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
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4
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Danion F, Duval C, Séverac F, Bachellier P, Candolfi E, Castelain V, Clere-Jehl R, Denis J, Dillenseger L, Epailly E, Gantzer J, Guffroy B, Hansmann Y, Herbrecht JE, Letscher-Bru V, Leyendecker P, Le Van Quyen P, Ludes PO, Morel G, Moulin B, Paillard C, Renaud-Picard B, Roche AC, Sabou M, Schneider F, Solis M, Talagrand-Reboul E, Veillon F, Ledoux MP, Simand C, Herbrecht R. Factors associated with coinfections in invasive aspergillosis: a retrospective cohort study. Clin Microbiol Infect 2021; 27:1644-1651. [PMID: 33662543 DOI: 10.1016/j.cmi.2021.02.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To describe the coinfections in invasive aspergillosis (IA), to identify factors associated with coinfections, and to evaluate the impact of coinfection on mortality. PATIENTS AND METHODS We conducted a monocentric retrospective study of consecutive putative, probable, or proven IA that occurred between 1997 and 2017. All coinfections, with an onset within 7 days before or after the first sign of aspergillosis, were identified. Factors associated with coinfections and mortality were analysed by multivariable analysis. RESULTS Among the 690 patients with IA included in the study, the median age was 57 years (range 7 days to 90 years). A coinfection was diagnosed in 272/690 patients (39.4%, 95%CI 35.8-43.2). The location of this coinfection was pulmonary only in 131/272 patients (48%), bloodstream only in 66/272 patients (24%) and other/multiple sites in 75/272 patients (28%). Coinfections were bacterial (110/272 patients, 40%), viral (58/272, 21%), fungal (57/272, 21%), parasitic (5/272, 2%) or due to multiple types of pathogens (42/272, 15%). Factors associated with a coinfection in adjusted analysis were: allogeneic haematopoietic stem-cell transplantation (OR 2.3 (1.2-4.4)), other haematological malignancies (OR 2.1 (1.2-3.8)), other underlying diseases (OR 4.3 (1.4-13.6)), lymphopenia (OR 1.7 (1.1-2.5)), C-reactive protein >180 mg/L (OR 1.9 (1.2-3.0)), fever (OR 2.4 (1.5-4.1)), tracheal intubation (OR 2.6 (1.5-4.7)), isolation of two or more different Aspergillus species (OR 2.7 (1.1-6.3)), and the presence of non-nodular lesions on chest computed tomography (OR 2.2 (1.3-3.7) and OR 2.2 (1.2-4.0)). Coinfections were independently associated with a higher mortality at week 12 (adjusted HR 1.5 (1.1-1.9), p < 0.01). CONCLUSIONS Coinfections are frequent in IA patients and are associated with higher mortality.
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Affiliation(s)
- François Danion
- Department of Infectious Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Céline Duval
- Department of Haematology, Institut de Cancérologie de Strasbourg (ICANS), Strasbourg, France
| | - François Séverac
- Department of Biostatistics and Public Healthcare, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; ICube, UMR7357, Université de Strasbourg, Strasbourg, France
| | - Philippe Bachellier
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Ermanno Candolfi
- Department of Parasitology and Mycology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; EA 7292, Fédération de Médecine Translationnelle, Faculté de Médecine, Strasbourg, France
| | - Vincent Castelain
- Médecine Intensive - Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Raphaël Clere-Jehl
- Médecine Intensive - Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Université de Strasbourg, Inserm UMR S1109, Strasbourg, France
| | - Julie Denis
- Department of Parasitology and Mycology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; EA 7292, Fédération de Médecine Translationnelle, Faculté de Médecine, Strasbourg, France
| | - Laurence Dillenseger
- Department of Neonatology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Eric Epailly
- Department of Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Justine Gantzer
- Department of Oncology, Institut de Cancérologie de Strasbourg (ICANS), Strasbourg, France
| | - Blandine Guffroy
- Department of Haematology, Institut de Cancérologie de Strasbourg (ICANS), Strasbourg, France; Université de Strasbourg, Inserm UMR-S1113/IRFAC, Strasbourg, France
| | - Yves Hansmann
- Department of Infectious Diseases, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Etienne Herbrecht
- Médecine Intensive - Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Valérie Letscher-Bru
- Department of Parasitology and Mycology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; EA 7292, Fédération de Médecine Translationnelle, Faculté de Médecine, Strasbourg, France
| | - Pierre Leyendecker
- Department of Radiology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pauline Le Van Quyen
- Department of Pathology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre-Olivier Ludes
- Department of Anaesthesiology, Critical Care and Perioperative Medicine, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Guillaume Morel
- Médecine Intensive - Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Bruno Moulin
- Université de Strasbourg, Inserm UMR S1109, Strasbourg, France; Department of Nephrology-Transplantation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Catherine Paillard
- Department of Paediatric Onco-Haematology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Benjamin Renaud-Picard
- Department of Respiratory Medicine and Strasbourg Lung Transplant Program, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Université de Strasbourg, Inserm UMR 1260, Strasbourg, France
| | - Anne-Claude Roche
- Department of Anaesthesiology, Critical Care and Perioperative Medicine, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marcela Sabou
- Department of Parasitology and Mycology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; EA 7292, Fédération de Médecine Translationnelle, Faculté de Médecine, Strasbourg, France
| | - Francis Schneider
- Médecine Intensive - Réanimation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Université de Strasbourg, Inserm UMR 1121, Strasbourg, France
| | - Morgane Solis
- Université de Strasbourg, Inserm UMR S1109, Strasbourg, France; Department of Virology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Emilie Talagrand-Reboul
- Department of Bacteriology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Université de Strasbourg, Faculté de Médecine, UR 7290, Strasbourg, France
| | - Francis Veillon
- Department of Radiology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marie-Pierre Ledoux
- Department of Haematology, Institut de Cancérologie de Strasbourg (ICANS), Strasbourg, France
| | - Célestine Simand
- Department of Haematology, Institut de Cancérologie de Strasbourg (ICANS), Strasbourg, France
| | - Raoul Herbrecht
- Department of Haematology, Institut de Cancérologie de Strasbourg (ICANS), Strasbourg, France; Université de Strasbourg, Inserm UMR-S1113/IRFAC, Strasbourg, France.
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Shi YF, Wang N, Huang ZY, Chen RR, Huang YS, Zhu YY, Xing CY, Liang B, Yu K, Feng JH. Normal Absolute Monocyte Count at the Time of Relapse is Associated with Improved Survival After First Salvage Therapy in Adult Patients with Early Relapsed B-Lineage Acute Lymphoblastic Leukemia. Cancer Manag Res 2020; 12:7097-7105. [PMID: 32848464 PMCID: PMC7428316 DOI: 10.2147/cmar.s264194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 07/23/2020] [Indexed: 12/03/2022] Open
Abstract
Background Peripheral monocytes, a key cell type for innate immunity, have been shown to be associated with survival in various types of hematological malignancies. However, no previous studies regarding the prognostic impact of peripheral absolute monocyte count (AMC) in early relapsed B-lineage acute lymphoblastic leukemia (B-ALL) have been reported. Methods Forty-nine cases of early relapsed adult B-ALL were reviewed. The upper (0.80 × 109/L) and lower limits (0.12 × 109/L) of the normal value for AMC were used as cut-off points. Kaplan–Meier curves and Log rank test were used for comparison of overall survival (OS). The univariate and multivariate Cox proportional hazards models were used for investigating the factors associated with OS. Results More than half (59.2%) of all patients showed a normal AMC (0.12–0.80 × 109/L). The median follow-up was 5.3 months from the start of first salvage therapy. Univariate analysis revealed that normal AMC (versus low/high AMC) at the time of relapse was a prognostic factor for improved OS (P = 0.021). On multivariate analysis, normal AMC (versus low/high AMC) at the time of relapse remained an independent prognostic factor for improved OS (hazard ratio = 0.43, P = 0.030). Conclusion AMC at the time of relapse, which can be easily derived from routine clinical laboratory testing of complete blood count, might be used as a prognostic marker for survival outcomes in adult patients with early relapsed B-ALL.
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Affiliation(s)
- Yi-Fen Shi
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Na Wang
- Health Care Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Zi-Yang Huang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Rong-Rong Chen
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Yi-Sha Huang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Yi-Yi Zhu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Chong-Yun Xing
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Bin Liang
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Kang Yu
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Jian-Hua Feng
- Department of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China.,Department of Pediatric Hematology-Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
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Martino R, Garrido A, Santaliestra M, García-Cadenas I, Novelli S, Saavedra SD, Esquirol A, Granell M, Briones J, Moreno C, Brunet S, Giménez A, Hidalgo A, Sánchez F, Sierra J. Low Rate of Invasive Fungal Infections During Induction and Consolidation Chemotherapy for Adults with De Novo Acute Myeloid Leukemia Without Anti-mold Prophylaxis: Single-Center 2002-2018 Empirical/Pre-emptive Approach. Mycopathologia 2020; 185:639-652. [PMID: 32564177 DOI: 10.1007/s11046-020-00461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
Broad-spectrum antifungal prophylaxis is currently considered the standard of care for adults with de novo AML for the prevention of invasive fungal infections (IFIs), especially invasive pulmonary aspergillosis (IPA). Because fluconazole has been used in our center as anti-yeast prophylaxis, we sought to analyze in detail the incidence of IFIs over a 17-year period, as well as their impact on outcome. A standardized protocol of patient management, including serum galactomannan screening and thoracic CT-guided diagnostic-driven antifungal therapy, was used in all patients. A total of 214 consecutive adults with de novo AML who were treated in 3 CETLAM (Grupo Cooperativo para el Estudio y Tratamiento de las Leucemias Agudas y Mielodisplasias) protocols from 2002 to 2018 were included. The 90-day incidence of any IFI (including possible cases) was 11% (95% CI 4-15%), most cases occurred during induction chemotherapy (8%, 95% CI 4-12%), and most cases were probable/proven IPA (8%, 95% CI 3-13%). Developing an IFI during induction and consolidation had no impact on 1-year survival. A case-control study with 23 cases of IPA and 69 controls identified induction/re-induction chemotherapy, chronic pulmonary disease and age > 60 years/poor baseline performance status as potential pretreatment risk factors. The current study proves that inpatient induction and consolidation chemotherapy for de novo AML can be given in areas with "a priori" high-burden of airborne molds with fluconazole prophylaxis, while the selective use of anti-mold prophylaxis in patients at very high risk may further reduce the incidence of IFI in this specific clinical scenario.
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Affiliation(s)
- Rodrigo Martino
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain.
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Ana Garrido
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Marta Santaliestra
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Irene García-Cadenas
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Silvana Novelli
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Silvanna Daniella Saavedra
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Albert Esquirol
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Miquel Granell
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Javier Briones
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Carolina Moreno
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Salut Brunet
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Ana Giménez
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Alberto Hidalgo
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Fernando Sánchez
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jorge Sierra
- Division of Clinical Hematology, Department of Radiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Av. Mas Casanovas, 90, 08041, Barcelona, Spain
- Department of Microbiology, Hospital de la Sant Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
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7
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Xiao H, Tang Y, Cheng Q, Liu J, Li X. Risk Prediction and Prognosis of Invasive Fungal Disease in Hematological Malignancies Patients Complicated with Bloodstream Infections. Cancer Manag Res 2020; 12:2167-2175. [PMID: 32273756 PMCID: PMC7102877 DOI: 10.2147/cmar.s238166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/02/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose In patients with hematologic malignancies (HM), bloodstream infections (BSI) and invasive fungal disease (IFD) remain important complications causing considerable mortality and morbidity. At present, the morbidity of IFD and the strategies to initiate antifungal treatment in HM patients with BSI remain unclear. Patients and Methods Patient characteristics, infection-related variables, and therapy-related features of 1374 HM patients with proven BSI from three hospitals were reviewed to investigate the epidemiology, risk factors and prognosis of IFD. Results The morbidity of proven and probable IFD in HM patients with BSI was 11.2%, and the mortality of those patients was 40.5%. Existing IFD risk scores were not accurate enough in distinguishing these patients benefiting from antifungal prophylaxis. Multivariate logistic regression identified age >45 years, profound neutropenia, hypoproteinemia, and use of vasopressors as independent variables associated with IFD morbidity in HM patients with BSI. In patients with proven and probable IFD patients, age >45 years, Pitt bacteremia score >3, use of vasopressors, abnormal blood coagulation, and initiation of antifungal therapy within 72 hrs after the onset of fever were independent prognostic factors. The mortality was significantly reduced in patients with high-risk factors of IFD if they initiate antifungal treatment within 72 hrs after the onset of fever compared to the patients not. Conclusion The morbidity and mortality of IFD increase significantly in HM patients with BSI. Early antifungal therapy may improve prognosis in HM patients with BSI complicated with IFD risk factors.
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Affiliation(s)
- Han Xiao
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yishu Tang
- Department of Emergency, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Qian Cheng
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Jing Liu
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Xin Li
- Department of Hematology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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8
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Koehler P, Salmanton-García J, Gräfe SK, Koehler FC, Mellinghoff SC, Seidel D, Steinbach A, Cornely OA. Baseline predictors influencing the prognosis of invasive aspergillosis in adults. Mycoses 2019; 62:651-658. [PMID: 31066092 DOI: 10.1111/myc.12926] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 03/19/2019] [Accepted: 03/28/2019] [Indexed: 12/13/2022]
Abstract
Invasive aspergillosis (IA) is a serious hazard to haematological and critical care patients. Impactful risk factors for developing IA have been characterised; however, systematic analysis of baseline prognostic factors for treatment course of IA is missing. To understand prognostic variables, we analysed original articles identifying baseline factors that predict treatment outcome in patients with IA. PubMed database was searched for publications since database inception until May 2018. Inclusion criteria were published baseline prognostic factors present at the diagnosis of IA. In total, 58 studies from 267 centres reported 7320 patients with IA and 40 different predictors. Unfavourable predictors in medical history were kidney (7.4%, 10/136) and liver failure (3.7%, 5/136), ICU admission (3.7%, 5/136) and uncontrolled underlying disease (3.7%, 5/136). Regarding state of immunosuppression, negative outcome predictors were prolonged neutropenia (12.5%, 17/136), corticosteroid treatment (8.1%, 11/136) and graft-vs-host disease (3.7%, 5/136). On the pathogen side, relevant predictors were galactomannan positivity (8.1%, 11/136), Aspergillus terreus infection (2.2%, 3/136) and lack of amphotericin B susceptibility (1.5%, 2/136). IA-specific predictors were disseminated disease (5.1%, 7/136) and CNS involvement (2.9%, 4/136). Imaging results associated with negative outcome were multiple consolidations (2.9%, 4/136), bipulmonary lesions (2.2%, 3/136) and pleural effusion (2.2%, 3/136). At diagnosis of IA, most frequently identified predictors of outcome were neutropenia, corticosteroid use, elevated galactomannan, renal failure and disseminated disease. The predictors may be used to identify patients at high risk for treatment failure and to stratify neglected patient groups for clinical trials.
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Affiliation(s)
- Philipp Koehler
- Department I of Internal Medicine, Faculty of Medicine, ECMM Excellence Centre for Medical Mycology, University Hospital of Cologne, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Jon Salmanton-García
- Department I of Internal Medicine, Faculty of Medicine, ECMM Excellence Centre for Medical Mycology, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Stefanie K Gräfe
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Felix C Koehler
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Sibylle C Mellinghoff
- Department I of Internal Medicine, Faculty of Medicine, ECMM Excellence Centre for Medical Mycology, University Hospital of Cologne, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Danila Seidel
- Department I of Internal Medicine, Faculty of Medicine, ECMM Excellence Centre for Medical Mycology, University Hospital of Cologne, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Angela Steinbach
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, Faculty of Medicine, ECMM Excellence Centre for Medical Mycology, University Hospital of Cologne, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.,Clinical Trials Centre Cologne, ZKS Köln, Cologne, Germany
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9
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Kontoyiannis DP, Selleslag D, Mullane K, Cornely OA, Hope W, Lortholary O, Croos-Dabrera R, Lademacher C, Engelhardt M, Patterson TF. Impact of unresolved neutropenia in patients with neutropenia and invasive aspergillosis: a post hoc analysis of the SECURE trial. J Antimicrob Chemother 2019; 73:757-763. [PMID: 29194488 DOI: 10.1093/jac/dkx423] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/17/2017] [Indexed: 12/19/2022] Open
Abstract
Background Historically, baseline neutropenia and lack of neutrophil recovery have been associated with poor outcomes in invasive aspergillosis (IA). It is unclear how treatment with the new Aspergillus-active triazoles isavuconazole and voriconazole affects outcomes in neutropenic patients with IA. Methods A post hoc analysis of the Phase 3 SECURE trial assessed patients with neutropenia (neutrophil count <0.5 × 109/L for >10 days at baseline) with IA (proven/probable) who had received either isavuconazole or voriconazole. The primary endpoint was all-cause mortality (ACM) through day 42. ACM in patients with resolved versus unresolved neutropenia at day 7 and overall success at end of treatment (EOT) were also assessed. Results One hundred and forty-two patients with neutropenia and IA were included (isavuconazole n = 78, voriconazole n = 64). ACM through day 42 (primary endpoint), day 7 and EOT were higher for patients with unresolved versus resolved neutropenia at each timepoint (day 42, unresolved: 45.0% isavuconazole, 45.2% voriconazole; resolved: 5.0% isavuconazole, 5.9% voriconazole; day 7, unresolved: 31.0% isavuconazole, 29.8% voriconazole; resolved: 5.0% isavuconazole, 5.9% voriconazole; EOT, unresolved: 48.6% isavuconazole, 36.4% voriconazole; resolved: 5.0% isavuconazole, 14.3% voriconazole). ACM was significantly higher for isavuconazole-treated patients with unresolved versus resolved neutropenia (day 7, P = 0.031; day 42, P < 0.001; EOT, P < 0.001). In voriconazole-treated patients, ACM was significantly higher among patients with unresolved versus resolved neutropenia at day 42 (P = 0.002) and numerically higher at day 7 and EOT (P > 0.05 for both). Conclusions Isavuconazole had comparable efficacy and safety to voriconazole in neutropenic patients with IA. Resolution of neutropenia was associated with improved outcomes.
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Affiliation(s)
- Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Kathleen Mullane
- Department of Medicine/Section of Infectious Diseases, University of Chicago, Chicago, IL, USA
| | - Oliver A Cornely
- Department I for Internal Medicine, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Clinical Trials Centre, University of Cologne (ZKS Köln), Cologne, Germany
| | | | - Olivier Lortholary
- Université Paris Descartes, Centre d'Infectiologie Necker Pasteur, Paris, France
| | | | | | | | - Thomas F Patterson
- Infectious Disease, UT Health San Antonio and the South Texas Veterans Health Care System, San Antonio, TX, USA
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10
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Tang L, Wang N, Xing C, Zhuang Q, Liang B, Sun L, Chen Y, Qian Y, Shen Z, Jiang S, Yu K, Feng J. Effect of absolute monocyte count post-transplant on the outcome of patients with acute myeloid leukemia undergoing myeloablative allogeneic hematopoietic stem cell transplant with busulfan and cyclophosphamide conditioning. Leuk Res 2018; 69:60-65. [PMID: 29660493 DOI: 10.1016/j.leukres.2018.04.006] [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: 12/09/2017] [Revised: 03/19/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022]
Abstract
Peripheral monocytes have recently been evaluated as a prognostic factor in different types of hematological malignancies. This study assessed the prognostic value of absolute monocyte count (AMC) post-transplant on the clinical outcomes of 59 patients with acute myeloid leukemia (AML) who had undergone myeloablative conditioning (MAC) allogeneic hematopoietic stem cell transplant (allo-HSCT) with busulfan and cyclophosphamide (Bu/Cy). Kaplan-Meier analysis showed that patients with a high AMC (≥ 0.57 × 109/L) on post-transplant day (PTD) 15 had a significantly worse overall survival (OS) compared to patients with a low AMC (< 0.57 × 109/L) on PTD 15 (P = .0049). Univariate Cox proportional hazard analyses revealed that only high AMC on PTD 15 was a poor prognostic factor for OS (P = .008) and post-relapse survival (P = .030). We conclude that AMC ≥ 0.57 × 109/L on PTD 15 is associated with more deaths in patients with AML who have undergone MAC allo-HSCT with Bu/Cy.
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Affiliation(s)
- Liyuan Tang
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Na Wang
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Chongyun Xing
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Qiang Zhuang
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Bin Liang
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Lan Sun
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Yi Chen
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Yan Qian
- Division of Pediatric Hematology-Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Zhijian Shen
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Songfu Jiang
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | - Kang Yu
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China.
| | - Jianhua Feng
- Division of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China; Division of Pediatric Hematology-Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China.
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11
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Camplesi M, Silva HM, Arantes AM, Costa CR, Ataides FS, Silva TC, Reis MDPCD, Silva MDRR. Invasive fungal infection in patients with hematologic disorders in a Brazilian tertiary care hospital. Rev Soc Bras Med Trop 2017; 50:80-85. [PMID: 28327806 DOI: 10.1590/0037-8682-0191-2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 02/07/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: Invasive fungal infections (IFIs) are an important complication in immunocompromised individuals, particularly neutropenic patients with hematological malignancies. In this study, we aimed to verify the epidemiology and diagnosis of IFIs in patients with hematologic problems at a tertiary hospital in Goiânia-GO, Brazil. METHODS: Data from 117 patients, involving 19 cases of IFIs, were collected. The collected data included diagnosis methods, demographics, clinical characteristics, and in vitro susceptibility to different antifungal agents. Among the 19 cases, 12 were classified as proven IFI and 7 as probable invasive aspergillosis with detection of galactomannan in blood and presence of lung infiltrates in radiographic images. Logistic regression analysis showed that the proven and probable IFIs were associated with increased risk of death. Statistical analysis demonstrated that age, sex, and underlying disease were not independently associated with risk of death in IFI patients. RESULTS: Most bloodstream isolates of Candida spp. exhibited low minimum inhibitory concentrations (MICs) to all antifungal agents tested. Voriconazole and amphotericin had the lowest MICs for Aspergillus spp. and Fusarium spp., but Fusarium spp. showed the least susceptibility to all antifungals tested. Amphotericin B, fluconazole, and itraconazole were found to be inactive in vitro against Acremonium kiliense; but this fungus was sensitive to voriconazole. CONCLUSIONS: Considering the high number of IFI cases, with crude mortality rate of 6%, we could conclude that IFIs remain a common infection in patients with hematological malignancies and underdiagnosed ante mortem. Thus, IFIs should be monitored closely.
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Affiliation(s)
- Milton Camplesi
- Departamento de Biomedicina, Universidade Paulista, Goiânia, GO, Brasil
| | - Hildene Meneses Silva
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical, Universidade Federal de Goiás, Goiânia, GO, Brasil
| | | | - Carolina Rodrigues Costa
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical, Universidade Federal de Goiás, Goiânia, GO, Brasil
| | - Fábio Silvestre Ataides
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical, Universidade Federal de Goiás, Goiânia, GO, Brasil
| | - Thaisa Cristina Silva
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical, Universidade Federal de Goiás, Goiânia, GO, Brasil
| | - Maysa de Paula Costa Dos Reis
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical, Universidade Federal de Goiás, Goiânia, GO, Brasil
| | - Maria do Rosário Rodrigues Silva
- Departamento de Microbiologia, Imunologia, Parasitologia e Patologia, Instituto de Patologia Tropical, Universidade Federal de Goiás, Goiânia, GO, Brasil
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12
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Sparham S, Charles PG. Controversies in diagnosis and management of community-acquired pneumonia. Med J Aust 2017; 206:316-319. [PMID: 28403766 DOI: 10.5694/mja16.01463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/10/2017] [Indexed: 12/23/2022]
Abstract
Community-acquired pneumonia (CAP) is a common condition; however, it appears to be overdiagnosed. Diagnosing CAP too frequently may be adding to the problems of overuse of antibiotics, such as bacterial resistance in the community and greater costs and complications in individuals. Data support that most patients with non-severe CAP can be treated for 3-5 days; however, most patients with CAP are receiving much longer courses of therapy. Macrolides such as azithromycin have the potential to prolong the QT interval, although large population studies show that this does not appear to result in excess cardiac mortality. CAP is associated with an increase in a variety of cardiac complications, most notably infarctions and worsening cardiac failure, so clinicians should be vigilant for signs and symptoms of these complications, particularly in patients with a history of ischaemic cardiac disease or the presence of cardiac risk factors. Cardiac risk factors should be assessed and managed in patients with CAP over 40 years of age, although there are yet to be data to show that this approach reduces deaths. Corticosteroids may have a slight effect on reducing deaths in patients with severe CAP, but this must be balanced against the significant potential for side effects.
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13
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Özdemir N, Tüysüz G, Çelik N, Yantri L, Erginöz E, Apak H, Özkan A, Yıldız İ, Celkan T. Febrile neutropenia in children with acute lymphoblastic leukemia: single center experience. Turk Arch Pediatr 2016; 51:79-86. [PMID: 27489464 DOI: 10.5152/turkpediatriars.2016.2757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 01/25/2016] [Indexed: 12/30/2022]
Abstract
AIM An important life-threatening complication of intensive chemotherapy administered in children with leukemia is febrile neutropenia. The objective of this study was to evaluate the clinical features and consequences of febrile neutropenia attacks in children who were treated for acute lymphoblastic leukemia. MATERIAL AND METHODS Nighty-six children who received chemotherapy for acute lymphoblastic leukemia in our center between January 1995 and December 2010 were included in the study. The data related to demographic characteristics, treatment features, relapse and febrile neutropenia incidences, risk factors, culture results and prognosis were retrospectively evaluated from the patients' files. RESULTS A total of two hundred-ninety nine febrile neutropenia attacks observed in the patients during initial treatment and relapse treatment were evaluated. When the incidence of febrile neutropenia was evaluated by years, it was observed that the patients treated after year 2000 had statistically significantly more febrile neutopenia attacks compared to the patients treated before year 2000. When the incidences of febrile neutropenia during initial treatment and during relapse treatment were compared, it was observed that more febrile neutropenia attacks occured during relapse treatment. Fifty-nine percent of all febrile neutropenia attacks were fever of unknown origin. Eighty microorganisms grew in cultures during febrile neutropenia throughout treatment in 75 patients; 86% were bacterial infections (50% gram positive and 50% gram negative), 8% were viral infections and 6% were fungal infections. Coagulase negative staphylococcus (n=17) was the most frequent gram positive pathogen; E. Coli (n=17) was the most commonly grown gram negative pathogen. CONCLUSIONS In this study, it was found that an increase in the incidence of febrile neutropenia occured in years. Increments in treatment intensities increase the incidence of febrile neutropenia while improving survival. Evaluation of febrile neutropenia results by hematology-oncology units in years will be directive in early and successful treatment.
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Affiliation(s)
- Nihal Özdemir
- Division of Hematology-Oncology, Department of Pediatrics, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Gülen Tüysüz
- Division of Hematology-Oncology, Department of Pediatrics, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Nigar Çelik
- Department of Microbiology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Leman Yantri
- Division of Hematology-Oncology, Department of Pediatrics, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ethem Erginöz
- Department of Public Health, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Hilmi Apak
- Division of Hematology-Oncology, Department of Pediatrics, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Alp Özkan
- Division of Hematology-Oncology, Department of Pediatrics, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - İnci Yıldız
- Division of Hematology-Oncology, Department of Pediatrics, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Tiraje Celkan
- Division of Hematology-Oncology, Department of Pediatrics, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
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14
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In Vivo Synergy of Amphotericin B plus Posaconazole in Murine Aspergillosis. Antimicrob Agents Chemother 2015; 60:296-300. [PMID: 26503653 DOI: 10.1128/aac.01462-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/18/2015] [Indexed: 11/20/2022] Open
Abstract
Aspergillus fumigatus is the main mold causing invasive fungal infection that shows high mortality rates. Therapeutic failure and the increase in drug resistance make it necessary to explore alternative treatments for this infection. We have evaluated the efficacy of amphotericin B at 0.8 mg/kg or 0.3 mg/kg of body weight combined with 40 mg/kg of posaconazole against three A. fumigatus isolates in a murine model of disseminated infection. The combination of the polyene and the azole led to a greater increase in survival and a significantly greater reduction in tissue burden than monotherapies.
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15
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Monocyte recovery at day 100 is associated with improved survival in multiple myeloma patients who undergo allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2015; 51:297-9. [PMID: 26457907 DOI: 10.1038/bmt.2015.244] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Bernardeschi C, Foulet F, Ingen-Housz-Oro S, Ortonne N, Sitbon K, Quereux G, Lortholary O, Chosidow O, Bretagne S. Cutaneous Invasive Aspergillosis: Retrospective Multicenter Study of the French Invasive-Aspergillosis Registry and Literature Review. Medicine (Baltimore) 2015; 94:e1018. [PMID: 26131805 PMCID: PMC4504535 DOI: 10.1097/md.0000000000001018] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Invasive aspergillosis (IA) has poor prognosis in immunocompromised patients. Skin manifestations, when present, should contribute to an early diagnosis. The authors aimed to provide prevalence data and a clinical and histologic description of cutaneous manifestations of primary cutaneous IA (PCIA) and secondary CIA (SCIA) in a unique clinical series of IA and present the results of an exhaustive literature review of CIA. Cases of proven and probable IA with cutaneous manifestations were retrospectively extracted from those registered between 2005 and 2010 in a prospective multicenter aspergillosis database held by the National Reference Center for Invasive Mycoses and Antifungals, Pasteur Institute, France. Patients were classified as having PCIA (i.e., CIA without extracutaneous manifestations) or SCIA (i.e., disseminated IA). Among the 1,410 patients with proven or probable IA, 15 had CIA (1.06%), 5 PCIA, and 10 SCIA. Hematological malignancies were the main underlying condition (12/15). Patients with PCIA presented infiltrated and/or suppurative lesions of various localizations not related to a catheter site (4/5), whereas SCIA was mainly characterized by disseminated papules and nodules but sometimes isolated nodules or cellulitis. Histologic data were available for 11 patients, and for 9, similar for PCIA and SCIA, showed a dense dermal polymorphic inflammatory infiltrate, with the epidermis altered in PCIA only. Periodic acid Schiff and Gomori-Grocott methenamine silver nitrate staining for all but 2 biopsies revealed hyphae compatible with Aspergillus. Aspergillus flavus was isolated in all cases of PCIA, with Aspergillus fumigatus being the most frequent species (6/10) in SCIA. Two out 5 PCIA cases were treated surgically. The 3-month survival rate was 100% and 30% for PCIA and SCIA, respectively. Our study is the largest adult series of CIA and provides complete clinical and histologic data for the disease. Primary cutaneous IA should be recognized early, and cases of extensive necrosis should be treated surgically; its prognosis markedly differs from that for SCIA. Any suppurative, necrotic, papulonodular, or infiltrated skin lesion in an immunocompromised patient should lead to immediate biopsy for histologic analysis and mycological skin direct examination and culture.
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Affiliation(s)
- Céline Bernardeschi
- Dermatology Department, UPEC (CB, SI-H-O, OC); Mycology and Parasitology Department (FF); Pathology Department, AP-HP, Henri Mondor Hospital, Créteil (NO); Pasteur Institute, National Reference Center for Invasive Mycoses and Antifungals, Paris (KS, OL, SB); Skin Cancer Unit, Nantes University Hospital (GQ); Infectious Diseases and Tropical Medicine Department, AP-HP, Necker-Enfants malades Hospital, Necker-Pasteur Infectious Diseases Center, IHU Imagine, Paris (OL); Université Paris Descartes (NO, OL); Université Paris-Est-Créteil UPEC, Créteil (OC); Mycology and Parasitology Department, AP-HP, Saint Louis Hospital, Paris (SB); Université Paris Diderot (SB); INSERM Centre d'Investigation Clinique, Créteil, (OC); and EA EpidermE, UPEC, Créteil, France (SI-H-O, OC)
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17
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Hsu LY, Lee DG, Yeh SP, Bhurani D, Khanh BQ, Low CY, Norasetthada L, Chan T, Kwong YL, Vaid AK, Alejandria I, Mendoza M, Chen CY, Johnson A, Tan TY. Epidemiology of invasive fungal diseases among patients with haematological disorders in the Asia-Pacific: a prospective observational study. Clin Microbiol Infect 2015; 21:594.e7-11. [PMID: 25749561 DOI: 10.1016/j.cmi.2015.02.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 01/12/2015] [Accepted: 02/22/2015] [Indexed: 12/15/2022]
Abstract
We conducted a 2-year multicentre prospective observational study to determine the epidemiology of and mortality associated with invasive fungal diseases (IFDs) among patients with haematological disorders in Asia. Eleven institutions from 8 countries/regions participated, with 412 subjects (28.2% possible, 38.3% probable and 33.5% proven IFDs) recruited. The epidemiology of IFDs in participating institutions was similar to Western centres, with Aspergillus spp. (65.9%) or Candida spp. (26.7%) causing the majority of probable and proven IFDs. The overall 30-day mortality was 22.1%. Progressive haematological disorder (odds ratio [OR] 5.192), invasive candidiasis (OR 3.679), and chronic renal disease (OR 6.677) were independently associated with mortality.
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Affiliation(s)
- L Y Hsu
- National University Hospital, National University Health System, Singapore.
| | - D G Lee
- Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - S P Yeh
- China Medical University Hospital, Taiwan
| | - D Bhurani
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - B Q Khanh
- National Institute of Hematology and Blood Transfusion, Hanoi, Viet Nam
| | - C Y Low
- Singapore General Hospital, Singapore
| | | | - T Chan
- Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Y L Kwong
- Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - A K Vaid
- Maedanta Medicity, Gurgaon, India
| | - I Alejandria
- National Kidney and Transplant Institute, Quezon City, Philippines
| | - M Mendoza
- National Kidney and Transplant Institute, Quezon City, Philippines
| | - C Y Chen
- National Taiwan University Hospital, Taiwan
| | - A Johnson
- International Health Management Associates, Inc., Schaumburg, IL, USA
| | - T Y Tan
- Changi General Hospital, Singapore
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18
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Raad II, Zakhem AE, Helou GE, Jiang Y, Kontoyiannis DP, Hachem R. Clinical experience of the use of voriconazole, caspofungin or the combination in primary and salvage therapy of invasive aspergillosis in haematological malignancies. Int J Antimicrob Agents 2014; 45:283-8. [PMID: 25455847 DOI: 10.1016/j.ijantimicag.2014.08.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 07/09/2014] [Accepted: 08/14/2014] [Indexed: 12/30/2022]
Abstract
Invasive aspergillosis (IA) is a life-threatening infection in severely immunocompromised haematological malignancy patients. In this study, the efficacy and safety of caspofungin, voriconazole or the combination as primary and salvage therapy in patients with IA were compared. The study included 181 patients with haematological malignancies and IA who received primary or salvage therapy with caspofungin, voriconazole or the combination. In total, 138 patients who received treatment for ≥7 days were analysed; 86 underwent primary antifungal therapy (15 with caspofungin, 38 with voriconazole and 33 with both). Among the salvage therapy patients, 17 received caspofungin, 24 received voriconazole and 35 received both. In the primary therapy group, no difference in therapy response was found, but caspofungin was associated with higher IA mortality rates. A multivariate competing risk analysis of primary antifungal therapy revealed that voriconazole was independently associated with lower IA-associated mortality rates than caspofungin (hazard ratio=0.2, 95% confidence interval 0.06-0.96; P=0.04). In the salvage therapy group, the three treatment groups had similar responses and IA-associated mortality rates. The combination of voriconazole and caspofungin did not result in better outcomes compared with voriconazole alone, as primary or salvage therapy, in haematological malignancy patients. However, voriconazole was associated with a lower Aspergillus-associated mortality rate compared with caspofungin monotherapy.
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Affiliation(s)
- Issam I Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Aline El Zakhem
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Gilbert El Helou
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Ray Hachem
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
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Danylo A, Courtemanche C, Pelletier R, Boudreault AA. Performance of MycAssay Aspergillus DNA real-time PCR assay compared with the galactomannan detection assay for the diagnosis of invasive aspergillosis from serum samples. Med Mycol 2014; 52:577-83. [DOI: 10.1093/mmy/myu025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Robinet P, Baychelier F, Fontaine T, Picard C, Debré P, Vieillard V, Latgé JP, Elbim C. A polysaccharide virulence factor of a human fungal pathogen induces neutrophil apoptosis via NK cells. THE JOURNAL OF IMMUNOLOGY 2014; 192:5332-42. [PMID: 24790151 DOI: 10.4049/jimmunol.1303180] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aspergillus fumigatus is an opportunistic human fungal pathogen that sheds galactosaminogalactan (GG) into the environment. Polymorphonuclear neutrophils (PMNs) and NK cells are both part of the first line of defense against pathogens. We recently reported that GG induces PMN apoptosis. In this study, we show that PMN apoptosis occurs via a new NK cell-dependent mechanism. Reactive oxygen species, induced by the presence of GG, play an indispensable role in this apoptotic effect by increasing MHC class I chain-related molecule A expression at the PMN surface. This increased expression enables interaction between MHC class I chain-related molecule A and NKG2D, leading to NK cell activation, which in turn generates a Fas-dependent apoptosis-promoting signal in PMNs. Taken together, our results demonstrate that the crosstalk between PMNs and NK cells is essential to GG-induced PMN apoptosis. NK cells might thus play a role in the induction of PMN apoptosis in situations such as unexplained neutropenia or autoimmune diseases.
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Affiliation(s)
- Pauline Robinet
- Université Pierre et Marie Curie Paris 06, Unité Mixte de Recherche-S CR7, Sorbonne Université, F-75005 Paris, France; INSERM, Centre d'Immunologie et des Maladies Infectieuses, Unité Mixte de Recherche-S CR7, INSERM U1135, F-75013 Paris, France
| | - Florence Baychelier
- INSERM, Centre d'Immunologie et des Maladies Infectieuses, Unité Mixte de Recherche-S CR7, INSERM U1135, F-75013 Paris, France
| | | | - Capucine Picard
- Centre D'étude des Déficits Immunitaires, Assistance Publique-Hôpitaux de Paris, L'hôpital Necker - Enfants Malades, 75743 Paris, France; Paris Descartes University, Sorbonne Paris Cité, 75006 Paris, France; Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U980, Necker Medical School, 75015 Paris, France; and
| | - Patrice Debré
- Université Pierre et Marie Curie Paris 06, Unité Mixte de Recherche-S CR7, Sorbonne Université, F-75005 Paris, France; INSERM, Centre d'Immunologie et des Maladies Infectieuses, Unité Mixte de Recherche-S CR7, INSERM U1135, F-75013 Paris, France; Département d'Immunologie, Assistance Publique - Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Vincent Vieillard
- INSERM, Centre d'Immunologie et des Maladies Infectieuses, Unité Mixte de Recherche-S CR7, INSERM U1135, F-75013 Paris, France
| | - Jean-Paul Latgé
- Institut Pasteur, Unité des Aspergillus, 75015 Paris, France
| | - Carole Elbim
- Université Pierre et Marie Curie Paris 06, Unité Mixte de Recherche-S CR7, Sorbonne Université, F-75005 Paris, France; INSERM, Centre d'Immunologie et des Maladies Infectieuses, Unité Mixte de Recherche-S CR7, INSERM U1135, F-75013 Paris, France;
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Role of management strategies in reducing mortality from invasive fungal disease in children with cancer or receiving hemopoietic stem cell transplant: a single center 30-year experience. Pediatr Infect Dis J 2014; 33:233-7. [PMID: 24136371 DOI: 10.1097/inf.0000000000000101] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the last decades, several diagnostic and therapeutic strategies have been implemented for management of invasive fungal diseases (IFD) in patients with cancer or receiving allogeneic hemopoietic stem cell transplant. Few data are available on their impact on mortality in children. METHODS All IFD episodes diagnosed at tertiary care center during a 30-year period between 1983 and 2012 were analyzed for 90-day mortality and risk factors. Diagnoses were coded according to international (European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group) criteria. Four treatment eras (1983-1990, 1991-1999, 2000-2005 and 2006-2012) were defined according to availability of diagnostic technologies, new antifungal drugs and use of a diagnostic-driven approach without empiric antifungal therapy. RESULTS A total of 198 IFD were diagnosed in 191 patients; 71.2% were proven/probable infections; 39.9% were caused by yeasts and 31.3% by molds. Within 90 days from IFD diagnosis, 58 (30.4%) patients died for a 28.3% cumulative probability of death. A multivariable analysis showed that the highest risk of death was associated with alternative donor-hemopoietic stem cell transplant [hazard ratio (HR): 3.96] and mold etiology (HR: 1.34). The risk of death significantly decreased across the treatment eras, with almost a 3-fold reduced risk for patients diagnosed during the 2006-2012 period (HR: 0.24). Also if the variable year of diagnosis was considered as continuous, the hazard of death significantly decreased by 5% per year (HR: 0.95). CONCLUSIONS New management strategies resulted in a better prognosis of IFD in children with cancer or hemopoietic stem cell transplant. A diagnostic-driven approach was not associated with an increase in mortality.
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Successful Allogeneic Bone Marrow Transplantation Using Reduced Doses of Cyclophosphamide and Fludarabine Associated to Granulocyte Transfusions in a Patient With Severe Aplastic Anemia Complicated by an Invasive Aspergillosis of Sinuses and a Rhizopus Gingivitis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2013. [DOI: 10.1097/ipc.0b013e31826e7f48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Multicenter comparison of serum and whole-blood specimens for detection of Aspergillus DNA in high-risk hematological patients. J Clin Microbiol 2013; 51:1445-50. [PMID: 23426930 DOI: 10.1128/jcm.03322-12] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Samples from patients at high risk for invasive aspergillosis (IA) were prospectively collected and analyzed for the presence of molecular markers of fungal infection. Serum specimens were screened for galactomannan and Aspergillus DNA, and whole-blood specimens were screened only for Aspergillus DNA. Fungal infections were categorized according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group, National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. Forty-seven cases (proven and probable IA) and 31 controls (no evidence of IA) were selected retrospectively for this case-control study, comprising 803 samples, in order to determine the performance of whole-blood PCR, serum PCR, and serum galactomannan testing. Although no single assay was able to detect every case of IA, a combination of different assays provided the best performance. There was no significant difference between the use of whole-blood and serum specimens for PCR-based diagnosis of IA, but there was a trend for whole blood to be more sensitive (85% versus 79%) and to yield an earlier positive result (36 days versus 15 days) than for serum. However, DNA extraction from serum specimens is easier and faster than that from whole-blood specimens, and it allows the same specimen to be used for both galactomannan and PCR assays. In conclusion, the appropriate sample type for DNA extraction should be determined by the local requirements and the technical platforms available at each individual center. A combination of biomarker tests offered the best diagnostic utility for detecting IA.
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Georgiadou SP, Pongas G, Fitzgerald NE, Lewis RE, Rytting M, Marom EM, Kontoyiannis DP. Invasive Mold Infections in Pediatric Cancer Patients Reflect Heterogeneity in Etiology, Presentation, and Outcome: A 10-Year, Single-Institution, Retrospective Study. J Pediatric Infect Dis Soc 2012; 1:125-35. [PMID: 26619165 DOI: 10.1093/jpids/pis042] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 02/13/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is scarcity of data regarding invasive mold infections (IMIs) in children with cancer. METHODS We retrospectively identified patients (18 years old or younger) with malignant disease who developed proven or probable IMIs (European Organization for Research on the Treatment of Cancer/Mycoses Study Group criteria) during a 10-year period (1998-2008). We reviewed their risk factors and clinical characteristics and assessed their crude mortality rates and treatment outcomes 12 weeks after IMI diagnosis. RESULTS Forty-eight patients (30 males) were identified, 30 (63%) of whom had a proven IMI. The most prevalent mold were Aspergillus species (40%), followed by Mucorales (20%) and Fusarium species (11%). Acute leukemia was the most common underlying malignancy (39 patients, [81%]). Twenty-three (59%) of them had refractory leukemia. Neutropenia was present at the day of IMI diagnosis in 67% of the patients. Sixty-two percent of the patients received prior corticosteroids. The dominant site of infection was the lungs (79%), followed by skin (29%) and sinuses (10%). Seventy-one percent of patients had radiological findings suggestive of fungal pneumonia (either nodules or masses). The mainstay of antifungal therapy was a lipid formulation of amphotericin B. Antifungal therapy resulted in 54% response rate (33% complete) at 12 weeks. The crude 12-week mortality rate was 31%. Logistic regression analysis demonstrated that monocytopenia (P = .013), malnutrition (P = .012), and intensive care admission in the month prior to IMI diagnosis (P = .027) were risk factors for death within 12 weeks. CONCLUSIONS Although Aspergillus spp. was the most common mold in our pediatric cancer population, the epidemiology of the IMIs was diverse. Adults and children share similar risk factors for and epidemiology of IMIs.
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Affiliation(s)
- Sarah P Georgiadou
- Departments of Infectious Diseases, Infection Control and Employee Health
| | - Georgios Pongas
- Departments of Infectious Diseases, Infection Control and Employee Health
| | | | - Russell E Lewis
- Departments of Infectious Diseases, Infection Control and Employee Health
| | - Michael Rytting
- Pediatric Hematology, The University of Texas M. D. Anderson Cancer Center, Houston
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Kwon JC, Kim SH, Park SH, Choi SM, Lee DG, Choi JH, Yoo JH, Kim YJ, Lee S, Kim HJ, Lee JW, Min WS. Prognosis of invasive pulmonary aspergillosis in patients with hematologic diseases in Korea. Tuberc Respir Dis (Seoul) 2012; 72:284-92. [PMID: 23227068 PMCID: PMC3510278 DOI: 10.4046/trd.2012.72.3.284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 09/21/2011] [Accepted: 10/31/2011] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to investigate therapeutic outcomes and assess factors associated with therapeutic outcomes in hematologic patients with invasive pulmonary aspergillosis (IPA). Methods We analyzed all consecutive cases of IPA in adults with hematologic diseases from January 2008 to January 2009 at a Catholic Hematopoietic Stem Cell Transplantation (HSCT) Center in Seoul, Korea. Results A total of 54 patients were identified. Underlying diseases were acute myelogenous leukemia (n=25), acute lymphoblastic leukemia (n=10), myelodysplastic syndrome (n=7), chronic myelogenous leukemia (n=3), multiple myeloma (n=3), severe aplastic anemia (n=2) and other hematologic diseases (n=4). Twenty six patients (48.2%) were assessed as having a favorable response, of which 16 patients (29.6%) showed complete response. Overall 12-week mortality and IPA attributable mortality were 38.9% (n=21) and 33.3% (n=18), respectively. In multivariate analysis, uncontrolled underlying disease (odds ratio [OR], 7.31; 95% confidence interval [CI], 1.49~35.94; p=0.014) was associated with an unfavorable response, and for 12-week mortality, uncontrolled underlying disease (OR, 11.79; 95% CI, 1.49~93.46; p=0.020) and hypoalbuminemia (OR, 9.89; 95% CI, 1.42~68.99; p=0.021) were significantly poor prognostic factors. Conclusion IPA still remains as a poor therapeutic outcome, especially in patients with refractory hematologic diseases.
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Affiliation(s)
- Jae-Cheol Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Ilsan Hospital, Goyang, Korea
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Nouér SA, Nucci M, Kumar NS, Grazziutti M, Restrepo A, Anaissie E. Baseline platelet count and creatinine clearance rate predict the outcome of neutropenia-related invasive aspergillosis. Clin Infect Dis 2012; 54:e173-83. [PMID: 22423136 DOI: 10.1093/cid/cis298] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Invasive aspergillosis (IA) is a life-threatening infection for immunocompromised patients. Improvement in IA outcome has been hampered by lack of early prognostic factors, namely, those available before starting chemotherapy (baseline) or early in the course of IA (nonbaseline). We hypothesized that prognostic factors can be identified before chemotherapy, ≤7 days from the first positive serum Aspergillus galactomannan index (s-GMI). METHODS We analyzed 98 patients with multiple myeloma who developed neutropenia-related IA and had a positive s-GMI. Three response criteria were used: kinetics of s-GMI, European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) definitions, and 6-week survival. Baseline and nonbaseline variables were analyzed separately. RESULTS Independent response predictors at baseline were a platelet count ≥65,000 platelets/mm(3) (odds ratio [OR], 1.009; 95% confidence interval [CI], 1.001-1.017; P = .03) by s-GMI kinetics, and a platelet count ≥65,000 platelets/mm(3) (OR, 1.009; 95% CI, 1.002-1.017; P = .01) and a creatinine clearance rate ≥53 mL/min (OR, 1.024; 95% CI, 1.006-1.042; P = .009) by EORTC/MSG criteria, with response rates of 83% and 28% when both variables were above or below these cutoffs, respectively (P < .001). Only baseline creatinine clearance rate ≥53 mL/min predicted 6-week survival (P = .003). Normalization of the s-GMI ≤7 days after the first positive s-GMI and neutrophil recovery were the nonbaseline factors associated with positive outcomes. CONCLUSIONS Two simple, inexpensive to measure, widely available, and routinely collected prechemotherapy values, platelet count and creatinine clearance rate, predict IA outcome and stratify patients into low-, intermediate-, and high-risk categories, while early evaluation of s-GMI allows timely treatment modification. These findings may improve patient outcomes by optimizing management strategies for this serious infection and may prove valuable in designing clinical trials of interventions to improve IA outcomes.
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Affiliation(s)
- Simone Aranha Nouér
- Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Brazil
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Neutrophils mediate maturation and efflux of lung dendritic cells in response to Aspergillus fumigatus germ tubes. Infect Immun 2012; 80:1759-65. [PMID: 22392929 DOI: 10.1128/iai.00097-12] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Invasive aspergillosis is a life-threatening complication of neutrophil deficiency or dysfunction. Neutropenia has previously been associated with enhanced influx of CD11b-expressing conventional dendritic cells to the lungs in response to Aspergillus species, but whether neutrophils directly modulate the function of dendritic cells in this infection is not known. We hypothesized that, in the setting of intrapulmonary challenge with Aspergillus, neutrophils promote the maturation and traffic of lung conventional dendritic cells to draining mediastinal lymph nodes. We report that neutropenia results in a marked accumulation of dendritic cells in the lungs of mice challenged with Aspergillus but greatly diminishes their egress to mediastinal lymph nodes independent of neutrophil microbicidal functions. Furthermore, the phenotype of lung dendritic cells was more immature in neutropenic animals than in nonneutropenic mice exposed to the microorganism. Consistent with this, coincubation with neutrophils greatly enhanced the upregulation of costimulatory molecules on dendritic cells exposed to Aspergillus in vitro, a process that was dependent on cell contact and the dendritic cell receptor DC-SIGN. Taken together, our data support an immunomodulatory cross talk between neutrophils and dendritic cells in the context of host response to Aspergillus that promotes the maturation and efflux of lung dendritic cells.
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Wintenberger C. [Update on the management of fungal infections]. Med Mal Infect 2011; 41:633-7. [PMID: 22056378 DOI: 10.1016/j.medmal.2011.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C Wintenberger
- Service de maladies infectieuses et tropicales, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
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Thoma MD, Huneke TJ, DeCook LJ, Johnson ND, Wiegand RA, Litzow MR, Hogan WJ, Porrata LF, Holtan SG. Peripheral blood lymphocyte and monocyte recovery and survival in acute leukemia postmyeloablative allogeneic hematopoietic stem cell transplant. Biol Blood Marrow Transplant 2011; 18:600-7. [PMID: 21843495 DOI: 10.1016/j.bbmt.2011.08.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 08/05/2011] [Indexed: 12/16/2022]
Abstract
Many previous studies of immune reconstitution (IR) postallogeneic hematopoietic stem cell transplantation (HSCT) have focused on lymphocyte recovery. Recognizing that IR involves complex interactions between innate and adaptive immune networks, we hypothesized that patterns of both monocyte and lymphocyte recovery could provide additional prognostic information. To test our hypothesis, we analyzed data from 135 consecutive patients undergoing myeloablative allogeneic HSCT for acute myeloid (AML) and lymphoblastic leukemia (ALL) from 2001 to 2010. The absolute lymphocyte and monocyte counts (ALC and AMC, respectively) were determined longitudinally at days +15, +30, +60, and +100, and correlated with clinical outcomes. At the day +30 time point, both ALC and AMC >0.3 × 10(9) cells/L were strongly associated with improved survival (overall survival [OS] 29.6 months versus 5.4 months, P = .006 and 25.3 months versus 5.1 months, P = .01 respectively), a pattern that generally continued through the day +100 evaluation. Multivariate analysis revealed the following independent prognostic factors: early disease status at transplantation, the development of chronic GVHD, the day +30 AMC, day +100 AMC, and day +100 ALC. To further explore whether any inherent patterns in the timing of lymphocyte and monocyte recovery had prognostic value post-HSCT, we performed unsupervised hierarchical clustering on the longitudinal hematopoietic parameters studied in this cohort. Four clusters of patients were identified: clusters A-D. Patient clusters B and D both demonstrated improved ALC and AMC recovery at the day +60 and day +100 time points and had significantly improved OS compared with clusters A and C (57.8 months versus 19.7 and 4.4 months, respectively, P < .001). Our data suggest that patients with poor lymphocyte and monocyte recovery beyond the day +60 time points may be at risk for poorer outcomes, and that further investigation into lymphoid/myeloid interactions in developing individualized immunotherapy is warranted.
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Affiliation(s)
- Mary D Thoma
- Division of Hematology, Department of Medicine, Mayo Clinic Graduate School of Medicine, Rochester, Minnesota 55905, USA
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Lortholary O, Gangneux JP, Sitbon K, Lebeau B, de Monbrison F, Le Strat Y, Coignard B, Dromer F, Bretagne S. Epidemiological trends in invasive aspergillosis in France: the SAIF network (2005-2007). Clin Microbiol Infect 2011; 17:1882-9. [PMID: 21668573 DOI: 10.1111/j.1469-0691.2011.03548.x] [Citation(s) in RCA: 250] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A prospective (2005-2007) hospital-based multicentre surveillance of EORTC/MSG-proven or probable invasive aspergillosis (IA) cases whatever the underlying diseases was implemented in 12 French academic hospitals. Admissions per hospital and transplantation procedures were obtained. Cox regression models were used to determine risk factors associated with the 12-week overall mortality. With 424 case-patients included, the median incidence/hospital was 0.271/10(3) admissions (range 0.072-0.910) without significant alteration of incidence and seasonality over time. Among the 393 adults (62% men, 56 years (16-84 years)), 15% had proven IA, 78% haematological conditions, and 92.9% had lung involvement. Acute leukaemia (34.6%) and allogeneic stem cell transplantation (21.4%) were major host factors, together with chronic lymphoproliferative disorders (21.6%), which emerged as a new high-risk group. The other risk host factors consisted of solid organ transplantation (8.7%), solid tumours (4.3%), systemic inflammatory diseases (4.6%) and chronic respiratory diseases (2.3%). Serum galactomannan tests were more often positive (≥69%) for acute leukaemia and allogeneic stem cell transplantation than for the others (<42%; p <10(-3)). When positive (n = 245), cultures mainly yielded Aspergillus fumigatus (79.7%). First-line antifungal therapy consisted of voriconazole, caspofungin, lipid formulations of amphotericin, or any combination therapy (52%, 14%, 8% and 19.9%, respectively). Twelve-week overall mortality was 44.8% (95% CI, 39.8-50.0); it was 41% when first-line therapy included voriconazole and 60% otherwise (p <0.001). Independent factors for 12-week mortality were older age, positivity for both culture and galactomannan and central nervous system or pleural involvement, while any strategy containing voriconazole was protective.
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Affiliation(s)
- O Lortholary
- Institut Pasteur, Centre National de Référence Mycologie et Antifongiques, Unité de Mycologie Moléculaire, Paris CNRS URA3012, Paris, France
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Michallet M, Sobh M, Morisset S, Kraghel S, Nicolini FE, Thomas X, Bienvenu AL, Picot S, Nicolle MC, Vanhems P. Risk factors for invasive aspergillosis in acute myeloid leukemia patients prophylactically treated with posaconazole. Med Mycol 2011; 49:681-7. [PMID: 21314250 DOI: 10.3109/13693786.2011.557668] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Invasive aspergillosis (IA) is an important cause of morbidity and mortality in neutropenic patients with hematological malignancies. To investigate the immediate and mid-term benefits of posaconazole prophylaxis in AML patients undergoing first induction chemotherapy and to study the infection risk factors, we prospectively studied the IA incidence in these patients at our hospital between years 2007 and 2008; then we compared them to a matched control group without prophylaxis. There were 55 and 66 patients in each group respectively. At day 32 post-induction, two probable cases (3.6%) were scored in the prophylaxis group compared to 8 cases (12.1%) in the control group (4 possible and 4 probable). At day 100, it reached 7.27% and 15.5% respectively. Kaplan-Meier analysis at day 100 showed lower mortality rate in the prophylaxis group compared to the control group [3.64% (n = 2, none due to IA) and 10.61% (n = 7, four due to IA) respectively, P = 0.002]. Multivariate analysis showed age and lack of response to induction as independent infection risk factors. Posaconazole prophylaxis resulted in lower incidence of IA and significantly improved survival. Patient's age and response to induction treatment are two independent infection risk factors, and need more attention during future clinical trials linked to antifungal prophylaxis.
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Affiliation(s)
- Mauricette Michallet
- Department of Hematology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
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Pagano L, Akova M, Dimopoulos G, Herbrecht R, Drgona L, Blijlevens N. Risk assessment and prognostic factors for mould-related diseases in immunocompromised patients. J Antimicrob Chemother 2010; 66 Suppl 1:i5-14. [DOI: 10.1093/jac/dkq437] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Herbrecht R, Rajagopalan S, Danna R, Papadopoulos G. Comparative survival and cost of antifungal therapy: posaconazole versus standard antifungals in the treatment of refractory invasive aspergillosis. Curr Med Res Opin 2010; 26:2457-64. [PMID: 20822354 DOI: 10.1185/03007995.2010.516110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Refractory invasive aspergillosis (IA) is a life-threatening condition. Cost of treatment, although secondary, is important if newer drugs are to be widely accepted. Posaconazole has been shown to have activity against aspergillosis. METHODS Analyses were conducted to compare the effectiveness and cost of posaconazole 800 mg/day with those of standard antifungal therapy, using Walsh et al. 2007 data. All-cause mortality and total drug costs were analyzed for three patient groups: All Refractory, Refractory Non-neutropenic, and Refractory Neutropenic IA Patients. Comparative survival analysis using Kaplan-Meier estimates after censoring data at 28, 42, 84, 182, and 365 days and Cox proportional hazard method was used to estimate hazard rates after controlling for difference in baseline neutropenia. For cost analysis, only antifungal drug acquisition cost was used. RESULTS Significantly more of the 94 patients treated with posaconazole remained alive at every time point compared with the 68 external control patients within the All Refractory group (p = 0.0001). Similar results were obtained for the other two groups. For the posaconazole-treated patients mean total drug costs were $11846 (±$12406), $12642 (±$11811), and $8903 (±$14345), and for the external controls total drug costs were $35537 (±$73059), $48097 (±$88702), and $13556 (±$16324) for the All Refractory, Refractory Non-neutropenic, and Neutropenic IA groups, respectively. Key limitations of the study included noninclusion of hospitalization or other drug costs, low patient numbers beyond 84 days, and the fact that the Walsh et al. 2007 study was completed before other newer antifungal agents (such as voriconazole and caspofungin) were available. CONCLUSIONS Posaconazole appears to confer a survival benefit and reduced total drug cost compared with standard antifungal therapy, such as amphotericin B (lipid and nonlipid formulations), itraconazole, or both, to treat patients with probable or proven refractory IA.
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Trends in the postmortem epidemiology of invasive fungal infections at a university hospital. J Infect 2010; 61:259-65. [DOI: 10.1016/j.jinf.2010.06.018] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 06/11/2010] [Accepted: 06/14/2010] [Indexed: 01/02/2023]
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Hiemenz JW, Raad II, Maertens JA, Hachem RY, Saah AJ, Sable CA, Chodakewitz JA, Severino ME, Saddier P, Berman RS, Ryan DM, DiNubile MJ, Patterson TF, Denning DW, Walsh TJ. Efficacy of caspofungin as salvage therapy for invasive aspergillosis compared to standard therapy in a historical cohort. Eur J Clin Microbiol Infect Dis 2010; 29:1387-94. [DOI: 10.1007/s10096-010-1013-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 06/26/2010] [Indexed: 10/19/2022]
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Baddley JW, Andes DR, Marr KA, Kontoyiannis DP, Alexander BD, Kauffman CA, Oster RA, Anaissie EJ, Walsh TJ, Schuster MG, Wingard JR, Patterson TF, Ito JI, Williams OD, Chiller T, Pappas PG. Factors associated with mortality in transplant patients with invasive aspergillosis. Clin Infect Dis 2010; 50:1559-67. [PMID: 20450350 DOI: 10.1086/652768] [Citation(s) in RCA: 227] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Invasive aspergillosis (IA) is an important cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients. The purpose of this study was to evaluate factors associated with mortality in transplant patients with IA. METHODS Transplant patients from 23 US centers were enrolled from March 2001 to October 2005 as part of the Transplant Associated Infection Surveillance Network. IA cases were identified prospectively in this cohort through March 2006, and data were collected. Factors associated with 12-week all-cause mortality were determined by logistic regression analysis and Cox proportional hazards regression. RESULTS Six-hundred forty-two cases of proven or probable IA were evaluated, of which 317 (49.4%) died by the study endpoint. All-cause mortality was greater in HSCT patients (239 [57.5%] of 415) than in SOT patients (78 [34.4%] of 227; P<.001). Independent poor prognostic factors in HSCT patients were neutropenia, renal insufficiency, hepatic insufficiency, early-onset IA, proven IA, and methylprednisolone use. In contrast, white race was associated with decreased risk of death. Among SOT patients, hepatic insufficiency, malnutrition, and central nervous system disease were poor prognostic indicators, whereas prednisone use was associated with decreased risk of death. Among HSCT or SOT patients who received antifungal therapy, use of an amphotericin B preparation as part of initial therapy was associated with increased risk of death. CONCLUSIONS There are multiple variables associated with survival in transplant patients with IA. Understanding these prognostic factors may assist in the development of treatment algorithms and clinical trials.
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Affiliation(s)
- John W Baddley
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, AL 35294-0006, USA.
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Fungal infections in oncology patients: update on epidemiology, prevention, and treatment. Curr Opin Oncol 2010; 22:138-42. [PMID: 20019613 DOI: 10.1097/cco.0b013e328335a755] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Fungal infections that occur after hematopoietic stem cell transplant and therapies for hematologic malignancies contribute to poor outcomes. In the recent year, studies have focused on updating epidemiologic data, providing an understanding of immunogenetic risks for infection, and optimizing prevention and treatment strategies; these studies will be reviewed. RECENT FINDINGS Contributions to our understanding of epidemiology have come from multicenter studies. Results demonstrate variability in the numbers of diagnosed invasive aspergillosis cases in oncology centers, and a persistent, although relatively low rate of invasive candidiasis. Both multiple and single-center studies are demonstrating improved outcomes of treating invasive aspergillosis. Several important studies have outlined the importance of immunogenetics in conferring risks for invasive fungal infections. There have been numerous studies recently published that assist with our understanding of preventive strategies, questioning the utility of pretherapy screening computed tomography scans and masks. Several important randomized trials compared alternative strategies to standard 'empirical' therapies. Finally, several studies were performed that outline complexity in administering new azole antifungals, assisting in optimizing outcomes. SUMMARY Studies published in the most recent year outline several important advances in our understanding of epidemiology, prevention and treatment of invasive fungal infections.
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Vickers AJ, Cronin AM. Traditional statistical methods for evaluating prediction models are uninformative as to clinical value: towards a decision analytic framework. Semin Oncol 2010; 37:31-8. [PMID: 20172362 DOI: 10.1053/j.seminoncol.2009.12.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cancer prediction models are becoming ubiquitous, yet we generally have no idea whether they do more good than harm. This is because current statistical methods for evaluating prediction models are uninformative as to their clinical value. Prediction models are typically evaluated in terms of discrimination or calibration. However, it is generally unclear how high discrimination needs to be before it is considered "high enough"; similarly, there are no rational guidelines as to the degree of miscalibration that would discount clinical use of a model. Classification tables do present the results of models in more clinically relevant terms, but it is not always clear which of two models is preferable on the basis of a particular classification table, or even whether either model should be used at all. Recent years have seen the development of straightforward decision analytic techniques that evaluate prediction models in terms of their consequences. This depends on the simple approach of weighting true and false positives differently, to reflect that, for example, delaying the diagnosis of a cancer is more harmful than an unnecessary biopsy. Such decision analytic techniques hold the promise of determining whether clinical implementation of prediction models would do more good than harm.
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Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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