PB2030 COMBINATION OF INVASIVE ASPERGILLOSIS AND INVASIVE CANDIDIASIS IN ONCOHEMATOLOGICAL PATIENTS

Abstract

Background:Candida spp. and Aspergillus spp. are the most common fungal pathogen an oncohematological patients. Publications about combination of invasive aspergillosis (IA) and invasive candidiasis (IC) are limited.Aims:To investigate the frequency, risk factors, treatment outcome in patients with combination of IA and IC.Methods:Retrospective analysis of 800 adult patients with proven and probable IA in 1998 ‐ 2017 yy. For the IA and IC diagnosis criteria EORTS/MSG, 2008 were used.Results:IC was detected in 10 patients, 1.25% of all IA patients. The patients’ age was from 18 to 59 years (median ‐ 37), men ‐ 60%. Among the underlying conditions acute leukemia prevailed ‐ 60%, lymphoma ‐ 10%, aplastic anemia ‐ 10%, and hemolytic uremic syndrome – 10%.Main risk factors were prolonged neutropenia – 90% (median – 10 days), lymphocytopenia ‐ 70% (median – 19 days), ICU stay – 50%, and glucocorticosteroid therapy – 40%.The main clinical variant of IC was candidemia (100%) with liver (10%) or spleen (10%) involvement. The main sites of IA were lungs (100%) and sinuses (20%).Diagnosis of IC was confirmed with blood culture in all patients: C. krusei – 40%, C. parapsilosis – 30%, Candida spp. – 30%. Positive galactomannan test in bronchoalveolar lavage (BAL) was in 80% patients. Microscopy of BAL revealed septated mycelium in 20% patients, BAL culture was positive (A.flavus) in 20% cases.All patients received antifungal therapy (voriconazole ‐ 60%, amphotericin B deoxycholate ‐ 60%, fluconazole – 30%, lipid amphotericin B – 20%, posaconazole – 20%). In patients with IA and IC 30‐days overall survival rate was 60%, 12‐weeks overall survival rate – 40%.Summary/Conclusion:Invasive candidiasis was detected in 1,25 % of patients with invasive aspergillosis. Main risk factors were prolonged neutropenia and lymphocytopenia, ICU stay, and glucocorticosteroid therapy. The main agents of invasive candidiasis were C. krusei ‐ 40% and C. parapsilosis – 30%. The main clinical variant of invasive candidiasis was candidemia (100%) with liver (10%) or spleen (10%) involvement. In patients with invasive aspergillosis and invasive candidiasis 30‐days overall survival rate was 60%, 12‐weeks overall survival rate – 40%.