Fungal infections in neutropenic patients: a 8-year prospective study

Abstract

In this paper we report a eight-year prospective study designed to further characterize incidence, epidemiology, specific syndromes, treatment and prognosis associated with fungal infections in neutropenic patients. During the study period 30 fungal infections were diagnosed in 30 patients among 313 episodes of fever and neutropenia (10%). There were 15 cases of candidiasis, 5 pulmonary aspergillosis, 3 sinusitis by Aspergillus fumigatus, 5 infections by Fusarium sp., one infection by Trichosporon sp., and one infection due to Rhodotorula rubra. Blood cultures were positive in 18 cases (60%). The predisposing factors for fungal infection in multivariate analysis were the presence of central venous catheter (p < 0.001), longer duration of profound (< 100/mm3) neutropenia (p < 0.001), the use of corticosteroids (p < 0.001), gram-positive bacteremia (p = 0.002) and younger age (p = 0.03). In multivariate analysis only recovery of the neutropenia (p < 0.001) was associated with good prognosis whereas the diagnosis of infection by Fusarium sp. (p = 0.006) was strongly associated with a poor outcome. The death rate was 43%. There was no statistically significant difference in the death rate between patients who did receive (52%) or did not receive (50%) antifungal treatment. Identifying patients at risk, specific syndromes and prognostic factors may help to reduce the high mortality associated with disseminated fungal infections in neutropenic patients.

The Anti- Candida Vaccine Based on the Recombinant N-Terminal Domain of Als1p Is Broadly Active against Disseminated Candidiasis

“…are the third most common nosocomial bloodstream isolates (15), exceeded in frequency only by coagulasenegative staphylococci and Staphylococcus aureus. Disseminated candidiasis has an attributable mortality of 40 to 50%, even with modern antifungal therapy (3,7,8,14). Clearly, new strategies to prevent Candida infections are needed.…”

Vaccination with Recombinant N-Terminal Domain of Als1p Improves Survival during Murine Disseminated Candidiasis by Enhancing Cell-Mediated, Not Humoral, Immunity

“…The mortality attributable to disseminated candidiasis is 40 to 50%, even with modern antifungal therapy (16,34,40,65). Furthermore, development of resistance to conventional antifungal therapies has created concern regarding the future ability to treat infections caused by Candida spp.…”

The Anti- Candida albicans Vaccine Composed of the Recombinant N Terminus of Als1p Reduces Fungal Burden and Improves Survival in Both Immunocompetent and Immunocompromised Mice

“…are the fourth most common nosocomial bloodstream isolates (14,20), causing an attributable mortality of 40 to 50% during hematogenously disseminated disease (5,10,11,19). The major clinical risk factors for disseminated candidiasis have been well described (17), allowing facile identification of at-risk patients.…”