Abstract
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. 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. 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. 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.
Highlights
Invasive fungal infections (IFIs) are an important complication in immunocompromised individuals, neutropenic patients with hematological malignancies
This study is the first to verify the prevalence of IFIs in hematologic malignancy patients in Goias State (Midwest of Brazil)
Aspergillosis and candidemia were the major IFIs detected in patients with hematologic malignances, but other infections, such as fusariosis and A. kiliense fungemia with involvement of the lungs, were observed.This study focused on the epidemiology of fungal diseases, their considerable morbidity in patients with hematologic malignances, and low sensitivity of the culture methods for the detection of Aspergillus infections
Summary
Invasive fungal infections (IFIs) are an important complication in immunocompromised individuals, neutropenic patients with hematological malignancies. The collected data included diagnosis methods, demographics, clinical characteristics, and in vitro susceptibility to different antifungal agents. Invasive fungal infections (IFIs) are an important complication in immunocompromised individuals, in neutropenic patients with hematological malignancies[1]. Invasive aspergillosis (IA) and invasive candidiasis are the main invasive fungal diseases associated with bloodstream infections. Invasive yeasts, such as Candida spp., and molds, such as Aspergillus spp., are the predominant pathogens of IFIs, other uncommon and difficult-to-treat molds, such as Mucorales, Fusarium spp., and phaeohyphomycetes, have emerged in patients with hematological malignancies[4,5]. The clinical presentation of IFIs is nonspecific, and the diagnostic criteria are poorly defined in critically ill populations, rendering
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