Epidemiology and risk factors for invasive fungal infections during induction chemotherapy for newly diagnosed acute myeloid leukemia: A retrospective cohort study

Abstract

This study investigated the epidemiology and risk factors associated with invasive fungal infections (IFIs) during induction chemotherapy in a cohort of Taiwanese patients with newly-diagnosed acute myeloid leukemia (AML). IFIs are a significant complication in the management of immunocompromised cancer patients; such infections are associated with a high incidence of morbidity and mortality, particularly in many South-Asian countries, where IFI rates are increasing. We retrospectively analyzed IFI incidence data from 105 patients with newly diagnosed AML at a single center undergoing their first course of induction chemotherapy without primary antifungal prophylaxis between November 2008 and December 2014. Of 21 cases documented as proven/provable IFIs 16 (76%) were invasive aspergillosis, 2 (10%) were mucormycosis infections, and 3 (14%) were proven yeast infections. The lung was the most commonly affected site (n = 16; 76%); 2 patients (10%) developed fungal sinusitis. IFI cases were more often males (P = 0.020). In multivariate analysis, patients with neutropenia lasting>30 days were more than twice as likely to develop IFI (OR, 2.24 [95% CI, 2.81–31.11], P<0.001). We also confirmed patients with smoker and receiving parenteral nutrition during chemotherapy were significant associated with IFIs. Our findings suggest that antifungal prophylaxis should be considered for patients with AML during induction chemotherapy, particularly in patients from Southeastern Asia, an area of potentially high IFI rates. We recommend that clinicians determine which patients receiving induction chemotherapy for AML are at high risk of developing IFI, to allow for targeted therapeutic prophylaxis.

Analysis of risk factors and clinical indicators in bloodstream infections among patients with hematological malignancy : a retrospective study

“…The positive rate of 25.2% was higher than other reports from different studies, which may be due to our objects were hematological patients who were more likely to have infection because of their lower immunity [10,11]. AML, lymphoma and ALL were the most common basic diseases in the two groups, which are consistent with other studies [1,[12][13][14]. In the blood culture positive group, more Gram-negative bacteria (51.9%) were isolated than Gram-positive bacteria (32.1%) and fungi (7.4%), indicating that clinicians should attach great importance to infection by Gram-negative bacteria.…”

Interactions between immune response to fungal infection and microRNAs: The pioneer tuners

“…The incidence of IFIs has risen substantially in the past decades . Today, risk factors are extensive and growing, including human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) pandemic, antibiotic and steroid therapy, immunosuppressive therapies, autoimmunity and transplantation . Statistics are considerable and have made IFIs as a main clinical problem that annually imposes hefty costs, involving 2,000,000 people per year worldwide .…”

“…Considerable outbreak of IFIs is due to the increase of at‐risk individuals, that is in patients infected with human immunodeficiency virus (HIV), patients prolongedly use broad‐spectrum antibiotics, patients undergoing hematopoietic stem cell transplantation (HSCT) and those receiving intensive chemotherapy or radiotherapy. Moreover, lack of controlling strategies for the use of antibiotics, especially in developing countries, is another reason for growing at‐risk hosts . The immune system has pivotal roles in the severity of fungal infections.…”

O Perfil Clínico - Epidemiológico Da Malária Em Um Município Da Amazônia Brasileira

“…candidemia, por se tratar de uma infecção fúngica invasiva, pode apresentar rápida progressão e atingir diversos órgãos como olhos, rins, coração, cérebro entre outros. Desta forma, a presença de lesão ocular denominada endolftalmite por Candida, associada à corioretinite, tem sido utilizada como marcador importante na avaliação clínica dos pacientes(TISSOT et al, 2017;LIEN et al, 2018)..A presença de lesões cutâneas e abscessos musculares podem ser indicadores clínicos desta infecção. As lesões cutâneas variam entre aparecimento de pústulas não dolorosas de base eritematosa até lesões que podem evoluir com necrose, em pacientes com clínica sugestiva para candidemia.…”

“…As lesões cutâneas variam entre aparecimento de pústulas não dolorosas de base eritematosa até lesões que podem evoluir com necrose, em pacientes com clínica sugestiva para candidemia. Nos casos nos quais não houve desenvolvimento de leveduras nas hemoculturas, a biópsia de lesões de pele pode contribuir para o desfecho do diagnóstico microbiológico(TISSOT et al, 2017;LIEN et al, 2018).Nas condições predisponentes dos pacientes com leucemia, a recuperação e melhora clínica é fortemente dependente da ausência de neutropenia, havendo associação significativa com terapia imunossupressora (incluindo esteroides), com baixas taxas de sobrevivência(ANDES et al, 2012). Importantes variações epidemiológicas mundiais têm ocorrido na incidência de infecções fúngicas(NUCCI et al, 2013).…”