Fungal Pneumonia in Patients with Hematologic Malignancy and Hematopoietic Stem Cell Transplantation

Young, Alisha Y; Juarez, Miguel M. Leiva; Evans, Scott E.

doi:10.1016/j.ccm.2017.04.009

Cited by 29 publications

(22 citation statements)

References 121 publications

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“…The treatment also leads to a longer risk of neutropenia and a higher risk of fungal pneumonia. Neutropenia, which is usually caused by chemotherapy or radiotherapy, is a major risk factor for bacterial and fungal lung infections [ 5 ]. Similarly, in this study, the Incidence of neutropenia was found to be higher in patients with fungal pneumonia than in non-fungal pneumonia patients (80% vs. 53%).…”

Section: Discussionmentioning

confidence: 99%

“…Both innate and adaptive immune functions are suppressed by the cancer itself and chemotherapeutic agents. Fungal pneumonia is common in patients with hematological cancer due to mucosal damage caused by cytotoxic chemotherapies and steroids, neutropenia and leukocyte defects, hematopoietic stem cell transplantation (HSCT) and subsequent immunosuppressive agents used for the treatment of graft versus host disease (GVHD) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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The Outcome of Fungal Pneumonia with Hematological Cancer

et al. 2020

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Background: Fungal pneumonia is a common infectious complication of hematological cancer (HC) patients. In this retrospective study, the objective was set to identify the risk factors and outcome of fungal pneumonia in adult HC patients. Materials and Methods: This retrospective study was conducted with adult (>16 years) HC patients from January 2017 and December 2018. Results: During the study period, of 181 patients included 76 were diagnosed with fungal pneumonia. The most common HC was identified as acute myeloid leukaemia (40%). Of the participating patients, 52 (29%) were hematopoietic stem cell transplant (HSCT) recipients. The median age of patients with fungal pneumonia was significantly greater: 57 vs. 48 (odds ratio [OR]: 1.08) and they had longer hospitalization durations (OR: 1.14). Overall, 37 patients (20%) died, and 28-day mortality was significantly greater among patients with fungal pneumonia than without fungal pneumonia (33% vs. 11%). The most significant risk factors for mortality in fungal pneumonia were identified as need of intensive care unit (ICU) (OR: 191.2, P <0.001) and the need of vasopressor support (OR:81.6, P <0.012). ICU-mortality was (88%). Conclusion: Fungal pneumonia is a lethal complication in HC patients. Intensive care need is the most important predictive factor for mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Outcome of Fungal Pneumonia with Hematological Cancer

et al. 2020

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“…Bacterial pneumonias are also common and may occur as a co-infection or secondary infection with a respiratory virus. Fungal and other opportunistic infections such as Pneumocystis jirovecii must also be considered [42]. As in immunocompetent patients, treatment of ARDS centers on treatment of the underlying cause while providing supportive care with low tidal volume mechanical ventilation.…”

Section: Respiratory Viral Infection Is Common Aftermentioning

confidence: 99%

“…IPS is thought to affect up to 15% of patients after myeloablative allogeneic HSCT, and only ~ 2% of patients after non-myeloablative HSCT. Median time of onset of IPS [35,42] is 19 days after HSCT and mortality ranges from 60-80% in all patients, with nearly 100% mortality if mechanical ventilation is required [58]. Though the pathophysiology of IPS is incompletely understood, research indicating a pathogenic role for TNF-α has led to the use of the anti-TNF-α antibody etanercept to treat IPS, with mixed clinical results [59][60][61][62].…”

Section: Respiratory Viral Infection Is Common Aftermentioning

confidence: 99%

ICU Complications of Hematopoietic Stem Cell Transplant, Including Graft vs Host Disease

Stephens

2020

Evidence-Based Critical Care

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A 44 year-old woman with a history of acute myeloid leukemia (AML) underwent a non-myeloablative haploidentical peripheral blood hematopoietic stem cell transplant (HSCT) 10 days ago. She was admitted to the hospital with fevers to 39 °C. On examination, she is anxious-appearing, with a temperature of 38.9 °C, a heart rate of 120 beats/min, a respiratory rate of 28 breaths/min, a blood pressure of 98/64 mmHg, and an oxygen saturation of 94% on 4 L/min oxygen via nasal cannula. A tunneled central venous catheter is in situ in her right internal jugular vein. Her total white blood cell (WBC) count is <0.5 cells/mm 3 and platelet count is 8000 cells/mm 3 . A chest CT scan shows diffuse patchy bilateral infiltrates (Figure). She is started on empiric antibiotic coverage with piperacillin/tazobactam, and 3 L of crystalloid are administered. Several hours later, she is more hypotensive, with nadir systolic pressures of 80-88 mmHg, and is more hypoxic, now saturating 85% on 6 L/min nasal cannula oxygen. QuestionHow should this patient be managed?Answer Broad spectrum antibiotics and lung-protective respiratory support.All patients after HSCT are immunosuppressed, profoundly so in the early post-transplant period before engraftment has occurred. This patient is likely to have a pneumonia with secondary septic shock, but a central line-associated infection from her tunneled central line is possible, as are non-infectious complications of HSCT. Respiratory failure is the most frequent cause of intensive care unit (ICU) admission after HSCT, most frequently from an infectious cause. The patient was placed on high-flow nasal cannula (HFNC) for oxygenation support and started on a norepinephrine infusion for hemodynamic support. Antibacterial coverage was changed to meropenem, levofloxacin, and vancomycin, and voriconazole was added for antifungal coverage. Her central line was removed. Her respiratory status continued to decline, and endotracheal intubation and mechanical ventilation were required 24 h after admission. She was placed on volume assist-control with a tidal volume of 6 mL/kg predicted body weight, and bronchoscopy with bronchoalveolar lavage (BAL) was performed. The BAL fluid was initially bloody, but cleared with sequential aliquots. Microbiologic studies of the BAL fluid were positive for respiratory syncytial virus and Pseudomonas aeruginosa. She was maintained on low tidal-volume ventilation and vasopressors were weaned off. Her white blood cell count slowly began to recover, and her respiratory status began to improve. She was extubated on hospital day 12 and was discharged from the ICU on hospital day 14. Principles of ManagementHematopoietic stem cell transplant (HSCT) has become an essential therapeutic modality in the treatment of malignant and non-malignant hematologic disease. In 2016, more than 23,000 HSCTs were performed in the United States, including approximately 15,000 autologous HSCTs and more than 8500 allogeneic transplants [1]. Allogeneic transplants are associated with more morbidity and m...

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“…In patients with profound (ANC < 500) and/or prolonged duration of neutropenia (>10 days), in addition to the above mentioned etiologies, fungal pathogens should be strongly considered [12]. Aspergillus fumigatus is the most common fungal pathogen causing pneumonia in this patient population.…”

Section: Fungal Pathogensmentioning

confidence: 99%

Respiratory Infections

Klinkova¹

2019

Infections in Neutropenic Cancer Patients

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Pneumonia is defined as the presence of a new pulmonary infiltrate on radiologic imaging in the patient with appropriate clinical symptoms such as fever, cough, production of purulent sputum, shortness of breath and/or hypoxia, in the absence of pulmonary edema [1, 2]. Keywords Pneumonia in neutropenic cancer patients • Community acquired viruses • Invasive fungal infection • Diffuse alveolar hemorrhage (DAH) • Cryptogenic organizing pneumonia (COP) • Consolidation pneumonia • Nodular and/or cavitary infiltrates • "Halo" sign • Reverse "halo" sign • Scattered nodules • Viral pneumonia • Rhinosinusitis

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Fungal Pneumonia in Patients with Hematologic Malignancy and Hematopoietic Stem Cell Transplantation

Cited by 29 publications

References 121 publications

The Outcome of Fungal Pneumonia with Hematological Cancer

The Outcome of Fungal Pneumonia with Hematological Cancer

ICU Complications of Hematopoietic Stem Cell Transplant, Including Graft vs Host Disease

Respiratory Infections

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