Epidemiology of invasive fungal disease in haematologic patients

Abstract

Invasive fungal disease (IFD) is frequent in patients with haematologic malignancies and in recipients of haematopoietic cell transplantation (HCT). An epidemiologic study conducted in Brazil reported a high incidence of IFD in haematologic patients, and invasive fusariosis was the leading IFD. A limitation of that study was that galactomannan was not available for at least half of the study period. In order to characterise the epidemiology and burden of IFD in three cohorts, HCT, acute myeloid leukaemia (AML) or myelodysplasia (MDS), and acute lymphoid leukaemia (ALL), we conducted a prospective multicentre cohort study in four haematologic Brazilian centres. From August 2015 to July 2016, all patients receiving induction chemotherapy for newly diagnosed or relapsed AML, MDS or ALL, and all HCT recipients receiving conditioning regimen were followed during the period of neutropenia following chemotherapy or the conditioning regimen. During a 1‐year period, 192 patients were enrolled: 122 HCT recipients (71 allogeneic, 51 autologous), 46 with AML, and 24 with ALL. The global incidence of IFD was 13.0% (25 cases, 11 proven and 14 probable). Invasive aspergillosis (14 cases) was the leading IFD, followed by candidemia (6 cases) and fusariosis (3 cases). The incidence of IFD was 26.1% in AML/MDS, 16.7% in ALL, 11.3% in allogeneic HCT, and 2.0% in autologous HCT. The burden of IFD in haematologic patients in Brazil is high, with a higher frequency in AML and ALL. Invasive aspergillosis is the leading IFD, followed by invasive candidiasis and fusariosis.

Epidemiology of Invasive Fungal Diseases in Patients with Hematologic Malignancies and Hematopoietic Cell Transplantation Recipients Managed with an Antifungal Diagnostic Driven Approach

“…In agreement with other studies evaluating the epidemiology of IFD in hematology [3][4][5][6]8,24,33], aspergillosis was the most frequent IFD in our study. In addition, similar to other studies conducted in Brazil [6,8], fusariosis was the second most frequent IFD.…”

“…In the present study, we observed a high incidence of IFD in ALL (13.0%), similar to that observed in the study by Souza et al [8]. The incidence of IFD in ALL may vary widely, and is higher in patients receiving more intensive chemotherapeutic regimens, given to treat high-risk groups and relapsed ALL [31].…”

“…As already reported in other epidemiologic studies of IFD in patients with hematologic malignancies [5,6,8,24,25], in our study, AML was the underlying condition associated with the highest frequency of IFD. The 20.9% rate observed is in the top range of 10-17% described in other studies [5,6,26,27], and similar to the incidence reported in a recent study from Brazil, in which patients also received fluconazole prophylaxis and were monitored with serial serum galactomannan and chest CT scan [8]. The high burden of IFD in Brazilian centers when compared to other countries may reflect suboptimal environmental protection, as most patients with AML receive induction remission in rooms without an HEPA filter and positive pressure.…”

“…The highest incidences have been reported in allogeneic hematopoietic cell transplant (HCT) recipients and in patients with acute myeloid leukemia (AML) receiving induction remission chemotherapy [1][2][3][4][5][6]. In addition, recent studies have shown a high incidence of IFD in patients with acute lymphoid leukemia (ALL) [7,8], and the emergence of a new group at risk: patients with chronic lymphoproliferative diseases receiving ibrutinib [9][10][11].…”

The Emerging Role of Mast Cells in Response to Fungal Infection

“…Currently, more than 300 million people suffer from severe fungal infections, and an estimated over 1.5 million people die from deep fungal infections each year (1). With broad-spectrum antibiotics used and the increase of immunodeficiency disease such as acquired immune deficiency syndrome, pathogenic fungi opportunistic infections showed a trend of rising sharply (2)(3)(4). Although early diagnosis and the use of antifungal drugs have a certain positive effect on the prevention and control of fungal infection, there are still some unsolved problems in clinical practice, such as insufficient evidence of some etiology and drug resistance.…”