Invasive Fungal Infection in Febrile Patients with Hematologic Malignancies Undergoing Chemotherapy in Iran

Abstract

Background: Patients with hematological malignancies undergoing cytotoxic chemotherapy are susceptible to develop invasive fungal infections particularly Aspergillus and Candida spp. Early detection of these infections is required to start immediate antifungal therapy and increase the survival of these patients. Method: Our study included consecutive patients of any age with hematologic malignancies who were hospitalized to receive chemotherapy and suffer from persistent fever (rectal temperature >38.5°C) for more than 5 days despite receiving broad-spectrum antibiotics. A whole blood sample was taken and sent for blood culture. PCR was also conducted for Aspergillus and Candida species. Results: One hundred and two patients were investigated according to the inclusion criteria. The most common hematologic malignancy was AML affecting 38 patients (37.2%). Six patients were diagnosed with invasive fungal infections (A. fumigatus n=3, C. albicans n=2, A. flavus n=1) by PCR (5.8%) while blood culture showed fungus only in 1 patient. Three more cases were known as probable IFI since they responded to antifungal therapy but the PCR result was negative for them. AML was the most prevalent malignancy in IFI patients (83.3%) and odds ratio for severing neutropenia was 21.5. Odds for each of the baseline characteristics of patients including gender, age>60, diabetes mellitus, previous IFI, history of using more than 3 antibiotics, antifungal prophylaxis, episodes of chemotherapy> 8 and chemotherapy regimen of daunarubicin+cytarabine were calculated. Conclusion: We found that multiplex real-time PCR assay is more accurate than blood culture in detecting fungal species and the results are prepared sooner. Among all factors, the only type of cancer (AML) and severe neutropenia, were found to be risk factors for the development of fungal infections in all hematologic cancer patients and previous IFI was a risk factor only AML patients.

Rate, Risk Factors, and Outcomes of Invasive Fungal Infections in Patients with Hematologic Malignancies

“…In the study of Fracchiolla et al, the mean age of patients was higher, and there was no significant relationship with the type of fungus 18 . AML was the most common malignancy, consistent with findings by Sheikh Baha'i et al and Mishra et al 13 who showed that AML was the most frequent risk factor for IFIs 24 . Another study in Japan also reported AML as the most common type of malignancy complicated by IFIs 12 .…”

“…Candidemia and IA are associated with poor prognosis and a mortality rate of 33% and 42%, respectively. Mucormycosis has the worst prognosis among IFIs, with a mortality rate of 64% 11 - 13 .…”

Invasive Fungal Infections Among Patients with Hematological Malignancies: A Two-Year Multicentric Study from Tehran, Iran

“…This condition commonly results from chemotherapy, and many studies have confirmed its critical role as a risk factor for IFI. Additionally, various other risk factors for IFI have been identified (18)(19)(20). A study involving 102 patients with hematological malignancies in Iran found that being over 60 years old, having diabetes mellitus, a previous history of IFI, receiving more than three types of antibiotics, and undergoing more than eight chemotherapy courses were significant risk factors for IFI (19).…”

“…Additionally, various other risk factors for IFI have been identified (18)(19)(20). A study involving 102 patients with hematological malignancies in Iran found that being over 60 years old, having diabetes mellitus, a previous history of IFI, receiving more than three types of antibiotics, and undergoing more than eight chemotherapy courses were significant risk factors for IFI (19). Another study from Spain identified corticosteroid treatment and recent viral infection as risk factors in patients with hematological malignancies, with only 12% of these patients being neutropenic (20).…”

Invasive fungal infections in hematologic malignancies: Incidence, management, and antifungal therapy

“…[ 44 ] In a recent study conducted by Sheikhbahaei et al ., it was shown that fungal culture established only 17% of samples as positive, while all of the surveyed samples (with clinical presentation related to IFIs) showed positive results when analyzed using reverse transcription-PCR. [ 56 ]…”