Invasive fungal diseases in haematopoietic cell transplant recipients and in patients with acute myeloid leukaemia or myelodysplasia in Brazil

Abstract

Invasive fungal disease (IFD) shows distinct regional incidence patterns and epidemiological features depending on the geographic region. We conducted a prospective survey in eight centres in Brazil from May 2007 to July 2009. All haematopoietic cell transplant (HCT) recipients and patients with acute myeloid leukaemia (AML) or myelodysplasia (MDS) were followed from admission until 1 year (HCT) or end of consolidation therapy (AML/MDS). The 12-month cumulative incidence (CI) of proven or probable IFD was calculated, and curves were compared using the Grey test. Among 237 AML/MDS patients and 700 HCT recipients (378 allogeneic, 322 autologous), the 1-year CI of IFD in AML/MDS, allogeneic HCT and autologous HCT was 18.7%, 11.3% and 1.9% (p <0.001), respectively. Fusariosis (23 episodes), aspergillosis (20 episodes) and candidiasis (11 episodes) were the most frequent IFD. The 1-year CI of aspergillosis and fusariosis in AML/MDS, allogeneic HCT and autologous HCT were 13.4%, 2.3% and 0% (p <0.001), and 5.2%, 3.8% and 0.6% (p 0.01), respectively. The 6-week probability of survival was 53%, and was lower in cases of fusariosis (41%). We observed a high burden of IFD and a high incidence and mortality for fusariosis in this first multicentre epidemiological study of IFD in haematological patients in Brazil.

An overview of infectious complications after allogeneic hematopoietic stem cell transplantation

“…A multi-center prospective study from Brasil reported that invasive fungal infections detected at a rate of 9.2% after allo-HSCT [32]. While the incidences of aspergillosis and invasive candidiasis were similar, the incidence of Fusarium infections was found as high as 5.2%.…”

The Global Burden of Fungal Diseases

“…A multicenter Brazilian study of patients with HSCT and hematologic malignancy reported invasive aspergillosis to be the most common IFI, with 6.5% of patients developing the disease. 30 Published data on prevalence from most of Asia or Africa are lacking. 16 Although the current burden is not known, aspergillosis is likely to increase as resource-limited countries increase organ and bone marrow transplantation.…”

“…34 One prospective study of several transplant centers in the United States noted a cumulative incidence of rare molds, including Fusarium, of 0.25%, 27,28 which was significantly lower than the incidence of 2.5% among patients with HSCT and hematologic malignancy reported from eight centers in Brazil. 30 The global burden of fusariosis is unknown.…”

Haematopoietic cell transplants in Latin America

“…Additional virus infections in transplant recipients requiring unavailable and/or expensive drugs in Latin America include adenovirus and BK virus. Fungal infections are also more frequent in immune compromised persons in Latin American countries 6 . For example, Fusarium spp .…”