Changing Epidemiology of Invasive Mold Infections in Patients Receiving Azole Prophylaxis

Cho

et al. 2019

Mycoses

Summary Since mould‐active azole prophylaxis has become a standard approach for patients with high‐risk haematologic diseases, the epidemiology of invasive fungal infections (IFIs) has shifted towards non‐Aspergillus moulds. It was aimed to identify the epidemiology and characteristics of non‐Aspergillus invasive mould infections (NAIMIs). Proven/probable NAIMIs developed in patients with haematologic diseases were reviewed from January 2011 to August 2018 at Catholic Hematology hospital, Seoul, Korea. There were 689 patients with proven/probable invasive mould infections; of them, 46 (47 isolates) were diagnosed with NAIMIs. Fungi of the Mucorales order (n = 27, 57.4%) were the most common causative fungi, followed by Fusarium (n = 9, 19.1%). Thirty‐four patients (73.9%) had neutropenia upon diagnosis of NAIMIs, and 13 (28.3%) were allogeneic stem cell transplantation recipients. The most common site of NAIMIs was the lung (n = 27, 58.7%), followed by disseminated infections (n = 8, 17.4%). There were 23.9% (n = 11) breakthrough IFIs, and 73.9% (n = 34) had co‐existing bacterial or viral infections. The overall mortality at 6 and 12 weeks was 30.4% and 39.1%, respectively. Breakthrough IFIs (adjusted hazards ratio [aHR] = 1.99, 95% CI: 1.3‐4.41, P = .031) and surgical treatment (aHR = 0.09, 95% CI: 0.02‐0.45, P = .003) were independently associated with 6‐week overall mortality. NAIMIs were not rare and occur as a complex form of infection often accompanied by breakthrough/mixed/concurrent IFIs and bacterial or viral infections. More active diagnostic efforts for NAIMIs are needed.

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Characteristics and risk factors for mortality of invasive non‐Aspergillus mould infections in patients with haematologic diseases: A single‐centre 7‐year cohort study

Cho

et al. 2019

Mycoses

“…Twenty‐three cases with confirmed invasive Rasamsonia spp. infection from the FungiScope ® registry (n = 6, 26.1%), and the literature (n = 18, 73.9%) were enrolled . One of the FungiScope ® cases (4.3%) was published previously (Figure ).…”

Section: Resultsmentioning

confidence: 99%

Risk factors and mortality in invasive Rasamsonia spp. infection: Analysis of cases in the FungiScope^® registry and from the literature

Stemler

Salmanton‐García

Seidel

et al. 2019

Mycoses

Self Cite

Summary Background The new Rasamsonia spp. complex can develop invasive infection in immunosuppression or chronic pulmonary disease. It has potential to be misidentified as other genera due to morphological similarities. Nowadays, there is a gap of knowledge on this fungi. Objectives To provide knowledge base of risk factors and therapeutic decisions in invasive Rasamsonia spp. complex infection. Patients/Methods Cases of invasive infection due to Rasamsonia spp. (formerly Geosmithia/Penicillium spp.) from FungiScope® registry and all reported cases from a literature were included. Results We identified 23 invasive infections due to Rasamsonia spp., six (26.1%) in the FungiScope® registry. Main risk factors were chronic granulomatous disease (n = 12, 52.2%), immunosuppressive treatment (n = 10, 43.5%), haematopoietic stem cell transplantation (n = 7, 30.4%), graft‐versus‐host disease and major surgery (n = 4, 17.4%, each). Predominantly affected organs were the lungs (n = 21, 91.3%), disease disseminated in seven cases (30.4%). Fungal misidentification occurred in 47.8% (n = 11), and sequencing was used in 69.6% of the patients (n = 16) to diagnose. Breakthrough infection occurred in 13 patients (56.5%). All patients received antifungal treatment, mostly posaconazole (n = 11), caspofungin (n = 10) or voriconazole (n = 9). Combination therapy was administered in 13 patients (56.5%). Susceptibility testing showed high minimum inhibitory concentrations for azoles and amphotericin B, but not for echinocandins. No preferable treatment influencing favourable outcome was identified. Overall mortality was 39% (n = 9). Conclusion Rasamsonia spp. are emerging fungi causing life‐threatening infections, especially in immunocompromised and critically ill patients. Mortality is high. Treatment is challenging and clinicians dealing with this patient population should become aware of this infection constituting a medical emergency.

Pediatric Blood & Cancer

“…The epidemiology of invasive fungal infections (IFI) in immunocompromised children continues to evolve alongside cancer treatment regimens and hematopoietic stem cell transplant (HSCT) protocols in conjunction with selective pressure from antifungal prophylaxis strategies and environmental influences . As such, the morbidity and mortality associated with IFIs in immunocompromised children remains a major concern …”

Section: Introductionmentioning

confidence: 99%

Epidemiology of invasive fungal infections in immunocompromised children; an Australian national 10‐year review

Bartlett

Cann

Yeoh

et al. 2018

Background A thorough understanding of local and contemporary invasive fungal infection (IFI) epidemiology in immunocompromised children is required to provide a rationale for targeted prevention and treatment strategies. Methods Retrospective data over 10 years from four tertiary pediatric oncology and hematopoietic stem cell transplant (HSCT) units across Australia were analyzed to report demographic, clinical, and mycological characteristics of IFI episodes, and crude IFI prevalence in select oncology/HSCT groups. Kaplan–Meier survival analyses were used to calculate 180‐day overall survival. Results A total of 337 IFI episodes occurred in 320 children, of which 149 (44.2%), 51 (15.1%), and 110 (32.6%) met a modified European Organization for Research and Treatment of Cancer (mEORTC) criteria for proven, probable, and possible IFI, respectively. There were a further 27 (8.0%) that met a “modified possible IFI” criteria. Median age at IFI diagnosis was 8.4 years. Crude mEORTC IFI prevalence in acute lymphoblastic leukemia, acute myeloid leukemia, solid tumor, and allogeneic HSCT cohorts was 10.6%, 28.2%, 4.4%, and 11.7%, respectively. Non‐Aspergillus species represented 48/102 (47.1%) molds identified, and non‐albicans Candida represented 66/93 (71.0%) yeasts identified. There were 56 deaths among 297 children who met mEORTC criteria, with 180‐day overall survival for proven, probable, and possible IFIs of 79.7%, 76.2%, and 84.4%, respectively. Conclusion Non‐Aspergillus molds and non‐albicans Candida contributed substantially to pediatric IFI in our study, with high IFI prevalence in leukemia and allogeneic HSCT cohorts. Inclusion of IFIs outside of European Organization for Research and Treatment of Cancer criteria revealed an IFI burden that would go otherwise unrecognized in published reports.