Invasive Pulmonary Fungal Infection Research Articles

Molecular Characterization and In Vitro Antifungal Susceptibility Profile of Schizophyllum commune, an Emerging Basidiomycete in Bronchopulmonary Mycoses

Schizophyllum commune (n = 30) showed lowest geometric mean MICs of isavuconazole (0.19 μg/ml), itraconazole (0.2 μg/ml), voriconazole (0.24 μg/ml), and amphotericin B (0.29 μg/ml) and high geometric mean MICs of fluconazole (19.39 μg/ml) and flucytosine (17.28 μg/ml). Five cases (of 8) of allergic bronchopulmonary mycosis that were treated with itraconazole had no recrudescence after 6 to 24 months of follow-up. One case each of invasive pulmonary mycosis and fungal ball were treated successfully with voriconazole and itraconazole.

Invasive Pulmonary Mycosis Due to Penicillium chrysogenum

Invasive Pulmonary Mycosis Due to Penicillium chrysogenum

Prospective trial finds nystatin mouthwash effective prophylaxis for pulmonary invasive fungal infections that originate in the throat of patients with hematologic malignancies

We investigated the source of fungi in the lungs of patients with hematological malignancies who had invasive pulmonary fungal infections (IPFI). We also conducted a prospective study to evaluate the efficacy of different mouthwash solutions in preventing IPFI in patients with hematologic malignancies. In order to determine the source of fungi in the lungs of 30 patients with hematologic malignancies who had IPFI, we collected samples from sites with suspected fungal infection and used PCR and sequencing for pathogen identification. For the prospective study, we enrolled 158 patients with hematological malignancies who had IPFI and randomly assigned them to one of three mouthwash groups: 1% nystatin, 2.5% sodium bicarbonate, or normal saline. Fungal staining and incidence of IPFI, oral fungal infection, and intestinal fungal infection were evaluated. We showed that 96.7% of the fungi isolated from the throats and the lungs were identical; 76.9% of the fungi from the lungs and digestive tracts were identical and, 84.6 % of the fungi from the throats and digestive tract were identical. Patients using 1% nystatin had lower incidence of IPFI (1.6%) and fungal enteritis (1.6%) than those using sodium bicarbonate (16.3% and 14.3%) or normal saline (27.7% and 12.8%). All treatments had low incidences of oral fungal infections (0 to 4.3%). Our data showed that fungi originating from mouth and throat cause IPFI. We also showed that use of a prophylactic mouthwash containing 1% nystatin was effective in preventing IPFI in patients with hematological malignancies.

Epidemiology and treatment outcome of invasive fungal infections in patients with hematological malignancies

Invasive fungal infection (IFI) causes morbidity and mortality among patients with hematological malignancies who receive cytotoxic chemotherapy or hematopoietic stem cell transplantation (HSCT). We evaluated the incidence and treatment outcomes of proven and probable IFI in 22 institutions between 2006 and 2008 following the recent European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) consensus criteria. We analyzed 2,821 patients with hematological malignancies, including 597 who had undergone HSCT; these included patients with acute leukemia (n = 697), myelodysplastic syndrome (n = 284), lymphoma (n = 1465), or multiple myeloma (n = 375). IFIs were diagnosed in 38 (1.3%) patients (18 proven and 20 probable), including 20 patients who underwent HSCT and 18 who received chemotherapy alone; these included patients with aspergillosis (n = 23), candidiasis (n = 6), mucormycosis (n = 6), trichosporonosis (n = 2), and geotrichosis (n = 1). The incidence of IFI was 5.4 % in allogeneic HSCT patients, 0.4 % in autologous HSCT patients, and 0.8 % in patients receiving chemotherapy alone. Eighteen patients with aspergillosis were diagnosed with probable pulmonary IFI as determined by computed tomography scan and positive galactomannan assay. Overall, antifungal targeted therapies resulted in successful outcomes in 60.0 % of patients. IFI-attributable mortality rate was higher in HSCT patients than in those receiving chemotherapy alone, but the difference was not statistically significant.

Fatal outcome after heart transplantation caused by Aspergillus lentulus

Opportunistic invasive fungal infections are a major cause of mortality in immunocompromised patients. Early diagnosis of invasive aspergillosis and proper identification of the causative agent is crucial for guidance of therapy. Accurate differentiation of Aspergillus lentulus, a filamentous fungus often misidentified as atypical Aspergillus fumigatus, is of concern as multiple antifungal drugs show a reduced susceptibility. This is the first report, to our knowledge, of a proven pulmonary invasive fungal infection caused by A. lentulus after heart transplantation.

Concurrent Pulmonary Aspergillus fumigatus and Mucor Infection in a Cardiac Transplant Recipient: A Case Report

Invasive fungal infections are a significant complication of solid organ transplantation. Here we report the first case of concurrent invasive pulmonary fungal infection caused by Aspergillus fumigatus and Mucor species in a heart transplant recipient. Polymicrobial mold infection is rare but should be considered in solid organ transplant recipients who fail to respond to initial antifungal therapy targeting a single organism. It is also of interest that in addition to potent immunosuppression and prolonged voriconazole therapy, possible airway fungal colonization following hurricane Katrina cleaning efforts might have contributed to this dual invasive mold infection.

Interleukin‐12 and interleukin‐2 alone or in combination against the infection in invasive pulmonary aspergillosis mouse model

Aspergillus fumigatus is an intracellular opportunistic fungus causing invasive pulmonary mycosis, characterised by hyphal invasion and destruction of pulmonary tissue. Th1 cytokines could enhance fungicidal activity. The effects from the combination of interleukin-12 (IL-12) and IL-2 are rarely known in invasive pulmonary aspergillosis infection. To assess the cleaning of A. fumigatus infection in the pulmonary tissues by IL-12 and IL-2, interferon-γ (IFN-γ) was detected in the sera using ELISA, quantification of IFN-γ mRNA using real-time RT-PCR and lung Colony-forming unit was assayed by cultivation. Morphology was analysed by histopathological examination. Our results showed that IL-12 and/or IL-2 could enhance the IFN-γ expression in the pulmonary tissue, reduce the colony load in the pulmonary tissue and increase the survival rate of mouse. The combination of IL-12 and IL-2 could assist in increasing the IFN-γ expression in the pulmonary tissue, but neither reduce colony load in the pulmonary tissue nor increase the survival rate of mouse significantly. It was demonstrated that IL-12 and IL-2 were strong immunomodulatory cytokines as a prerequisite for protecting the host from infectious agents.

The reversed halo sign: update and differential diagnosis

The reversed halo sign is characterised by a central ground-glass opacity surrounded by denser air-space consolidation in the shape of a crescent or a ring. It was first described on high-resolution CT as being specific for cryptogenic organising pneumonia. Since then, the reversed halo sign has been reported in association with a wide range of pulmonary diseases, including invasive pulmonary fungal infections, paracoccidioidomycosis, pneumocystis pneumonia, tuberculosis, community-acquired pneumonia, lymphomatoid granulomatosis, Wegener granulomatosis, lipoid pneumonia and sarcoidosis. It is also seen in pulmonary neoplasms and infarction, and following radiation therapy and radiofrequency ablation of pulmonary malignancies. In this article, we present the spectrum of neoplastic and non-neoplastic diseases that may show the reversed halo sign and offer helpful clues for assisting in the differential diagnosis. By integrating the patient's clinical history with the presence of the reversed halo sign and other accompanying radiological findings, the radiologist should be able to narrow the differential diagnosis substantially, and may be able to provide a presumptive final diagnosis, which may obviate the need for biopsy in selected cases, especially in the immunosuppressed population.

Dry powder insufflation of crystalline and amorphous voriconazole formulations produced by thin film freezing to mice

Attention has begun to focus on the pulmonary delivery of antifungal agents for invasive fungal infections as inhalation of the fungal spores is often the initial step in the pathogenesis of many of these infections, including invasive pulmonary aspergillosis (IPA). IPA in immunocompromised patients has high mortality rates despite current systemic (oral or intravenous) therapies. In this study, particulate voriconazole (VRC) formulations were designed with suitable properties for inhalation using thin film freezing (TFF), a particle engineering process capable of producing low-density porous aggregate particles. Nanostructured amorphous morphology of VRC was less favorable in vitro and in vivo than microstructured crystalline morphology, despite being a poorly water-soluble compound. Using a Handihaler® dry powder inhaler (DPI), microstructured crystalline TFF-VRC and nanostructured amorphous TFF-VRC-PVP K25 (1:3) had fine particle fractions of 37.8% and 32.4% and mass median aerodynamic diameters of 4.2 and 5.2μm, respectively. Single dose 24-h pharmacokinetic studies were conducted in ICR mice. AUC0–24h in the lung tissue and plasma was 452.6μgh/g wet lung weight and 38.4μgh/mL, respectively, following a 10mg/kg insufflated dose of TFF-VRC directly into the lungs of the mice, while AUC0–24h in the lung tissue and plasma was 232.1μgh/g wet lung weight and 18.6μgh/mL, respectively, following a 10mg/kg insufflated dose of TFF-VRC-PVP K25 (1:3). High concentrations of VRC in lung tissue coupled with clinically relevant plasma concentrations suggest that pulmonary delivery of microstructured crystalline VRC could potentially be a beneficial strategy for administration of VRC to patients with invasive pulmonary fungal infections.

The value of assay of (1, 3)-β-D-glucan in bronchoalveolar lavage fluid for detection of invasive pulmonary fungal infection in critically ill patients in intensive care unit

To evaluate the value of (1, 3)-β-D-glucan (G test) in bronchoalveolar lavage fluid (BALF) in diagnosing and determining the therapeutic effects among the critically ill patients suspected with invasive pulmonary fungal infection (IPFI). Study was conducted between February 2010 and August 2011 in medical intensive care unit (MICU) of the Affiliated Hospital of Guiyang Medical College. Patients suspected of suffering from IPFI were enrolled. G tests of BALF and serum, and culture and microscopic examination of BALF were performed twice weekly.Clinical feature, mycological evidence and the results of G test were recorded. The results of IPFI were defined as "proven", "probable", "possible" and "non-IPFI". G test in BALF and serum was done with tachypleus amebocyte lysate. Positive G test was defined as cut-off index ≥20 ng/L in two consecutive measurements. Furthermore, the patients with positive G test received preemptive antifungal therapy with fluconazole or itraconazole. G tests of BALF and serum were respectively done on 7th day and 14th day of treatment. Ninety-eight patients were included. Among them, 10 patients were "proven" in whom the positive rate of BALF G test was 90.0%; 29 patients the results were considered as "probable" in whom the positive rate of BALF G test was 82.8%; in 32 patients the results were "possible" IPFI in whom the positive rate of BALF G test was 71.9%, 27 patients were "non-IPFI" in whom the positive rate of BALF G test was 7.4%. The positive rate of BALF G test was 84.6% (33/39), the positive rate of serum G test was 59.0% (23/39), the positive rate of culture of BALF was 41.0% (16/39), the positive rate of microscopic examination of BALF was 38.5% (15/39) in "proven" cases and "probable" cases. G test (cut-off ≥20 ng/L) of BALF had shown to have sensitivity, specificity, positive predictive value (PPV) of 84.6% (33/39), 92.6% (25/27), 94.3% (33/35), respectively, and negative predictive value (NPV) of 80.7% (25/31). The G test detection (cut-off ≥20 ng/L) in serum had shown to have sensitivity, specificity, PPV of 58.9% (23/39), 88.9% (24/27), 88.5%(23/26), respectively, and NPV of 60.0% (24/40), and the differences in sensitivity were statistically significant (P < 0.05). BALF G test assay tended to become positive earlier than the culture for 2-8 days with mean of (5.35 ± 2.26) days.Forty out of 56 G test positive patients were given preemptive antifungal therapy for 2 weeks, and there was a good response in 31 patients, but no response in 9 cases with 22.5% mortality. After treatment, the result of G test (ng/L) was lowered in patients with a good response in treatment group (BALF: 245.13 ± 43.84, 174.00 ± 13.01, 28.52 ± 7.38; serum: 93.26 ± 18.75, 72.15 ± 12.90, 37.37 ± 10.45, all P < 0.05). On the other hand, an elevated value suggested an unsatisfactory result in ineffective group (BALF: 267.58 ± 54.63, 309.71 ± 82.47, 486.72 ± 98.21; serum: 101.58 ± 12.75, 98.07 ± 27.45, 112.07 ± 19.21, all P < 0.05). There were significantly differences in the results of G tests on 7th day and 14th day between BALF G test and serum G test in both groups (all P < 0.05). It is suggested that BALF G test may be an useful test for early diagnosis of IPFI. Moreover, the dynamic change in G test values could be useful for assessing therapeutic response.

Risk factors for invasive pulmonary fungal infection in patients with hematological malignancies not receiving hematopoietic stem cell transplant

We investigated the incidence, pathogens and risk factors of invasive pulmonary fungal infection (IPFI) in patients with hematological malignancies who did not receive hematopoietic stem cell transplantation (HSCT). Of the 323 patients included, 106 had confirmed IPFI, 111 had pulmonary bacterial infections, and 106 did not have pulmonary infections. The risk factors for IPFI were explored through logistic univariate and multivariate analysis. The incidence of IPFI in patients with hematological malignancies but without HSCT was 3.5%. The leading pathogen was Candida albicans which accounted for 50.7% of the infections, and the second one was Aspergillus which accounted for 37.3% of the infections. The main risk factors for these patients were days of hospitalization, history of IPFI, agranulocytosis, concomitant hypoproteinemia, number of antibiotics being used, concomitant bacterial sepsis, and age. Furthermore, Nystatin mouthwash was protective against IPFI. Among patients with hematological malignancies, IPFI causes the highest proportion of deaths. We have identified two important pathogens and several risk factors as well as one factor protective against IPFI. Awareness of risk factors and reduction of pathogens can decrease the incidence of IPFI.

Reversed Halo Sign After Radiofrequency Ablation of a Lung Nodule

We report a case of the "reversed halo sign" 6 weeks after radiofrequency ablation (RFA) of a lung neoplasm in an 80-year-old man. The "reversed halo sign," first described on computed tomography in cryptogenic organizing pneumonia, has later been described as being associated with a wide range of pulmonary pathologies, including paracoccidiodomycosis, tuberculosis, lymphomatoid granulomatosis, Wegener granulomatosis, invasive pulmonary fungal infections, and sarcoidosis. Although a number of computed tomography findings have been reported after RFA of both primary lung tumors and pulmonary metastases, this case demonstrates that the reversed halo sign may also occur after RFA.

In vivo Hypoxia and a Fungal Alcohol Dehydrogenase Influence the Pathogenesis of Invasive Pulmonary Aspergillosis

Currently, our knowledge of how pathogenic fungi grow in mammalian host environments is limited. Using a chemotherapeutic murine model of invasive pulmonary aspergillosis (IPA) and 1H-NMR metabolomics, we detected ethanol in the lungs of mice infected with Aspergillus fumigatus. This result suggests that A. fumigatus is exposed to oxygen depleted microenvironments during infection. To test this hypothesis, we utilized a chemical hypoxia detection agent, pimonidazole hydrochloride, in three immunologically distinct murine models of IPA (chemotherapeutic, X-CGD, and corticosteroid). In all three IPA murine models, hypoxia was observed during the course of infection. We next tested the hypothesis that production of ethanol in vivo by the fungus is involved in hypoxia adaptation and fungal pathogenesis. Ethanol deficient A. fumigatus strains showed no growth defects in hypoxia and were able to cause wild type levels of mortality in all 3 murine models. However, lung immunohistopathology and flow cytometry analyses revealed an increase in the inflammatory response in mice infected with an alcohol dehydrogenase null mutant strain that corresponded with a reduction in fungal burden. Consequently, in this study we present the first in vivo observations that hypoxic microenvironments occur during a pulmonary invasive fungal infection and observe that a fungal alcohol dehydrogenase influences fungal pathogenesis in the lung. Thus, environmental conditions encountered by invading pathogenic fungi may result in substantial fungal metabolism changes that influence subsequent host immune responses.

Diagnostic value of serum (1-3)-β-D-glucan for invasive fungal infection in neonates

Objective To evaluate the diagnostic value of serum (1-3)-β-D-glucan detection for invasive fungal infection (IFI) in neonates. Methods Eighty-seven neonates who were suspected to be IFI cases in neonatal intensive care unit from May 2008 to January 2010 were enrolled into this study. All subjects had infection symptoms, while did no react to the antibiotics treatment. The diagnosis of IFI was made according to Invasive pulmonary fungal infection diagnostic criteria of children set by Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association and Invasive fungal infection diagnostic criteria for critical patients set by the Society of Critical Care Medicine, Chinese Medical Association. Circulating (1-3)-β-D-glucan levels were determined with GKT-5M set kinetic fungus detection kit. Levels of (1-3)-Β-D-glucan in IFI group and that in the control group were compared; optimal cut-off value was established with receiver operating characteristic (ROC) curve; and the sensitivity and specificity at the cut-off value of 20.0 pg/ml and optimal cut-off value were calculated and compared. Results Among the 87 suspected cases, 59 cases were not diagnosed as IFI and 28 cases were diagnosed as IFI finally. Five patients were confirmed to be IFI; seven cases were clinically diagnosed and 16 cases were still suspected IFI. Among the five confirmed cases, four cases were blood culture positive for Candida parapsilosis, one case Candida albicans positive and two cases both cerebrospinal fluid culture and blood culture positive for Candida albicans. The median levels of (1-3)-β-D-glucan of patients diagnosed as IFI (n=28) was 131.6 pg/ml(18.6-9999.0 pg/ml), which was higher than that of the patients without IFI (8.5 pg/ml, 5.0-34.6 pg/ml)(Z=-5.064, P<0.05). Area under ROC curve was 0.806 (95% CI: 0.725-0.886, P<0.05). The sensitivity (96.43% vs 69.49%) and specificity (72.22% vs 84.21%) for (1-3)-β-D-glucan were different as 20.0 pg/ml and 53.7 pg/ml were used as the cut-off values for diagnosing IFI. Conclusions (1-3)-β-D-glucan level could be used to diagnose IFI of neonates, but further studies are needed to evaluate false-positive rates and its cut-off value in IFI diagnosis. Key words: Mycoses; Infant, newborn; beta-Glucan

Prophylactic Application of Nebulized Liposomal Amphotericin B in Hematologic Patients with Neutropenia

Background: Pulmonary invasive fungal infections (IFI) are well-recognized complications with high morbiditiy and mortality in patients with hematologic malignancies. Patients and Methods: Aerosolized liposomal amphotericin B (lipAmB) was evaluated as an antifungal prophylaxis in patients with an expected neutropenia of more than 10 days due to intensive chemotherapy or stem cell transplantation, in a prospective phase II trial. Results: 98 treatment episodes were included in the study and compared to 105 historical control patients. Inhalation was performed between 0 and 103 days. No severe side effects of therapy occurred. 40 patients considered inhalations as unpleasant, 2 as very unpleasant, mostly due to bad taste or cough. Few cases of definite or probable IFI were recorded, whereas a large number of patients were treated with systemic antifungal therapy for pneumonia or fever of unknown origin without a significant difference between study patients and controls. In a predefined subgroup analysis of 48 patients with newly diagnosed acute myeloid leukemia (AML), significantly more patients survived for 1 year in the AmB prophylaxis than in the control group (80% vs. 54%, p < 0.01). Conclusions: Inhalations of lipAmB are feasible and safe. Results in the subgroup of patients with AML together with data from other trials suggest further evaluation of effectiveness.

Diagnostic value of computed tomography in invasive pulmonary fungal infections

To analyze the computed tomographic (CT) features of invasive pulmonary fungal infections (IPFI) and evaluate the value of CT-guided percutaneous biopsy. Seventeen IPFI cases diagnosed by CT-guided percutaneous biopsy were recruited. The distribution, extent, density and size of IPFI were analyzed in correlation with the final diagnosis retrospectively. And the relationship with the causative factor of mycosis was also assessed. (1) Candida albicans (n = 7) and cryptococcosis & aspergillus (n = 5) were identified. (2) It showed segmental on lobar consolidation within lung field (n = 6), mixture of patterns and nodule (n = 4) and mass (n = 7). (3) The overall diagnostic accuracy of fiberoptic bronchoscopy examination was 35.3%. (4) The incidence of complicated pneumothorax was 11.8% (2/17). These cases were self-limited without any special treatment. The CT findings of PFI are too complex to be easily distinguished from other diseases. And the CT-guided percutaneous is a safe and effective procedure.

Invasive pulmonary fungal infections in children

The incidence of invasive pulmonary fungal infections in children has been increasing in recent years. Early diagnosis and treatment is importan to the survival of patients. Risk factors,clinical and radiological manifestations, microbiological examination, diagnosis procedure and treatment are summarized to improve pediatricians' awareness and knowledge of invasive pulmonary fungal infections in children. Key words: Invasive pulmonary fungal infections; Diagnosis; Treatment; Children

Invasive pulmonary and central nervous system aspergillosis following slops aspiration in a trauma patient

Cerebral aspergillosis is a rare complication of multiple trauma. In this report, we present a remarkable case of multiple lung and brain lesions caused by aspergillosis after a falling incident. A 54-year-old male was admitted with multiple trauma (brain contusion, aspiration pneumonitis with pulmonary contusion, right humerus fracture and right scapular fracture) due to a 6-m fall and aspiration of slops. In view of aspiration pneumonitis (Figure ​(Figure1,1, day 1), intravenous antibiotic treatment (tazocin, moxifloxacin hydrochloride and metronidazole) was started. Brain computerized tomography (CT) on day 12 indicated a focus of encephalomalacia in the left frontal lobe, which was thought to be the progress of brain contusion (Figure ​(Figure1,1, day 12). On the same day, chest CT showed a pulmonary halo sign on the left upper lung (Figure ​(Figure1,1, day 12), and voriconazole therapy was used because of high suspicion of invasive pulmonary fungal infection. Voriconazole treatment had to be stopped, however, due to severe rash 5 days later. Anti-fungus therapy was continued with caspofungin. On day 19, the brain CT showed signs of fungus infection (Figure ​(Figure1,1, day 19). Twenty-two days after injury, the central venous catheter culture grew aspergillus species and established the diagnosis of invasive aspergillosis in this patient; liposomal amphotericin B was then also added to the patient's treatment. On day 34, enhanced CT imaging of the brain showed progression of multiple lesions of fungus infection (Figure ​(Figure1,1, day 34). Unfortunately, the patient died 40 days after injury. Figure 1 Chest and brain computerized tomography on days 1, 12, 19, 28, and 34. Aspiration pneumonitis with pulmonary contusion was shown on day 1. Black arrows, multiple lesions of fungus infection in both the lung and the brain. White arrows, progression of ... We have described invasive aspergillosis with a rapidly progressive and fatal pulmonary and cerebral course in a previously healthy man. Neuroaspergillosis is an uncommon infection associated with an exceedingly high mortality. The diagnosis of neuroaspergillosis is difficult, often made at the terminal stage of disease or on autopsy [1]. Perhaps due to the greater penetration into the central nervous system (CNS), voriconazole treatment greatly improved clinical outcomes with a survival rate of 30% in high-risk patients [2,3]. According to the guidelines for treating invasive pulmonary aspergillosis, voriconazole is recommended for primary treatment [4]. Unfortunately, this patient was refractory to voriconazole because of severe rash, and then caspofungin was selected for salvage therapy. Owing to the large molecular mass, high protein binding and water solubility of caspofungin, its penetration into the CNS was limited [5]; this invasive pulmonary aspergillosis was then further complicated by dissemination to the CNS on day 19. In conclusion, we report a rare trauma case accompanied with invasive pulmonary and CNS aspergillosis following slops aspiration. This case highlights the diagnostic challenge presented by invasive aspergillosis in non-neutropenic patients and underscores its poor prognosis.

Mold colonization of fiberglass insulation of the air distribution system: effects on patients with hematological malignancies

We investigated mold colonization of air handling units (AHUs) of heating, ventilating, and air conditioning (HVAC) systems and its effects, including invasive pulmonary mycoses and febrile neutropenia, in patients with hematological malignancies. Sample collection with transparent adhesive tape and culture swabs revealed that AHUs were heavily colonized with molds, including thermotolerant, variously distributed Penicillium spp. Cases of nosocomial invasive pulmonary mycosis were not clustered in specific patient rooms but did occur frequently when the HVAC systems were not in use, prior to intervention (i.e., sealing and disuse of AHUs in private room), and during construction of a new hospital building. Multivariate logistic regression analysis of initial episodes of febrile neutropenia showed that the rate of febrile neutropenia was significantly associated with the duration of neutropenia (odds ratio [OR]: 1.16; 95% confidence interval [CI]: 1.07-1.27) and with sex (OR: 0.469; CI: 0.239-0.902). An evaluation of private rooms showed that female patients also had a lower rate of fever after intervention (OR: 0.0016; 95% CI: 0.000-0.209). The reduced rate of febrile neutropenia after intervention suggests that mold colonization of AHUs had adverse effects on patients with hematological malignancies.

The efficacy of voriconazole therapy for invasive pulmonary fungal infection in 92 patients

Objective To explore the efficacy and side effects of voriconazole therapy of invasive pulmonary fungal infection.Methods 92 patients received therapy with voriconazole.The symptoms and signs,laboratory test results,and bacteriological indexes were determined.The efficacy and side effects of voriconazole were assessed.Results The curative rate was 58.33% and total effective rate was 80.56%.Mycological clearance rate was 76.67%.Adverse reactions were mainly mental and psychic,including 49 (53.26%) cases of hallucination,26 (28.26%) visual disturbance,and 22 (23.91%) insomnia.2 patients had to discontinue voriconazole because of its severe reactions.The adverse reactions disappeared automatically in other patients after the completion of treatment.18 pateints died of worsening of the primary disorders.Conclusions Voriconazole is a novel antifungal agent.As a first-line medication for invasive pulmonary fungal infection,it is effective and safe. Key words: Voriconazole; Invasive pulmonary fungal infection