Management of invasive fungal infections in neutropenic patients

Abstract

The risk of infection in hematological disorders is high and changes according to the underlying disease or the type of treatment [1]. Fungal infections is a challenging field for physicians dealing with hematological patients because the underlying disease itself causes a substantial increase in the risk of infections, and the presentation and the course of infections, can be puzzling. This brings out the importance of experience and evidence in this area. Classically, fungal infections can be defined as infections occuring in patients with prolonged neutropenia but special procedures such as stem cell transplantation (SCT) can change this. The changing pattern of transplant approaches such as nonmyeloablative (NMA) transplantation, new drugs, and new indications caused some major changes in the timing of fungal infections [2/4]. The risk of having a fungal infection is around 5/8% in acute leukemias and 7/20% in allogeneic stem cell transplant recipients. The risk in autologous transplants is similar to acute leukemia patients. Although the numbers represent a small proportion of infections in SCT patients, there are a lot of problems facing the physician; the mortality of fungal infections in SCT is very high (over 80%) in SCT patients, the fungal infection is sometimes very difficult to diagnose, very difficult and expensive to treat, and prolongs the hospital stay [5/7].