Abstract
The aim of this multicenter prospective study was to evaluate the incidence of invasive fungal infections (IFIs) in adult and pediatric patients with hematologic malignancies, involving nine nosocomial facilities in Southern Italy over a period of 18 months. Furthermore, results of an environmental microbial surveillance routinely carried out in some of the enrolled hospitals are reported. A total of 589 onco-hematological patients were enrolled and 27 IFIs were documented. The main infections were caused by yeasts, more than filamentous fungi (overall incidence of 2.7% and 1.9%, respectively). The yeasts were mainly represented by Candida spp. (87.5%), all isolated by blood cultures; C. parapsilosis was the most common species. Among mould infections, the most frequent site was the lung, with regard to aspergillosis (81.8%). In six of the 10 patients with suspected aspergillosis, the diagnosis was made by the detection of galactomannan and (1,3)-β-d-glucan antigens. The microbiological surveillance carried out on 156 air, 312 water and 312 surface samples revealed low environmental contamination: Alternaria alternata was the only fungus isolated from two surface samples. Our data, especially the low occurrence of filamentous fungi, suggest a particular local epidemiology. Further studies are needed to confirm this microbiological trend in onco-hematological patients in Southern Italy, the results of which might be helpful to improve the management of these patients.
Highlights
IntroductionThe epidemiology of invasive fungal infections (IFIs) in onco-hematological patients has changed substantially in recent years and its incidence varies considerably among different nations [1,2,3].A special vulnerability to these infections is introduced by risk factors related to the underlying disease (e.g., neutropenia especially for acute myeloid leukemia patients, steroids usage, high dose cytarabine, invasive medical devices) [4,5], genetic profile [6,7], pre-hospital and hospital exposure [8], age, and comorbidities.Among IFIs caused by yeasts, Candida albicans remains an important pathogen, but a rising rate of infections is caused by non-albicans Candida species (i.e., C. glabrata, C. guilliermondii, C. parapsilosis, C. tropicalis and C. krusei) [9,10,11].Over the last 20 years, an increasing number of infections caused by moulds has been reported: Aspergillus spp. seems to be the main fatal complication in patients with hematological malignancies, but other opportunistic moulds, such as Fusarium spp. and Zygomycetes, have been described [12], whereas infections caused by other filamentous fungi are still rare [13,14]. the actual incidence of the IFIs has increased, its real frequency is often underestimated because of the difficulty in diagnosis [15]
Among IFIs caused by yeasts, Candida albicans remains an important pathogen, but a rising rate of infections is caused by non-albicans Candida species (i.e., C. glabrata, C. guilliermondii, C. parapsilosis, C. tropicalis and C. krusei) [9,10,11]
The present study reports the incidence of IFIs in onco-hematological patients, the characteristics of enrolled patients, and the role of the additional biomarkers-diagnostic tests
Summary
The epidemiology of invasive fungal infections (IFIs) in onco-hematological patients has changed substantially in recent years and its incidence varies considerably among different nations [1,2,3].A special vulnerability to these infections is introduced by risk factors related to the underlying disease (e.g., neutropenia especially for acute myeloid leukemia patients, steroids usage, high dose cytarabine, invasive medical devices) [4,5], genetic profile [6,7], pre-hospital and hospital exposure [8], age, and comorbidities.Among IFIs caused by yeasts, Candida albicans remains an important pathogen, but a rising rate of infections is caused by non-albicans Candida species (i.e., C. glabrata, C. guilliermondii, C. parapsilosis, C. tropicalis and C. krusei) [9,10,11].Over the last 20 years, an increasing number of infections caused by moulds has been reported: Aspergillus spp. seems to be the main fatal complication in patients with hematological malignancies, but other opportunistic moulds, such as Fusarium spp. and Zygomycetes, have been described [12], whereas infections caused by other filamentous fungi are still rare [13,14]. the actual incidence of the IFIs has increased, its real frequency is often underestimated because of the difficulty in diagnosis [15]. The epidemiology of invasive fungal infections (IFIs) in onco-hematological patients has changed substantially in recent years and its incidence varies considerably among different nations [1,2,3]. The use of laboratory tests has expanded in recent years, IFIs diagnosis continue to be hampered by non-specific clinical manifestations and difficulties in obtaining appropriate biological samples for mycological investigations. Such investigations usually require invasive procedures (e.g., histological samples, bronchoalveolar lavage) often precluded by cytopenia or by the critical condition of these patients. The newer diagnostic approaches, focusing on the detection of surrogate markers such us circulating fungal antigens or metabolites (e.g., galactomannan and (1,3)-β-D-glucan), need serum samples repeated over time because of their occasional presence in the blood [15]
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