Pulmonary aspergillosis in hematologic malignancies: lights and shadows

Pagano, Livio; Fianchi, Luana; Caira, Morena

doi:10.3324/haematol.12939

Cited by 47 publications

(72 citation statements)

References 50 publications

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“…Regardless of infection site, patients with mucormycosis present with fever in at least 80% of cases . Imaging studies show focal areas of consolidation with fungal infiltrates.…”

Section: Discussionsupporting

confidence: 81%

“…In immunocompetent hosts, spores are quickly phagocytosed whereas in immunocompromised individuals, they can lead to rapidly spreading, invasive infections with high mortality . This occurs most commonly in the setting of hematologic malignant diseases, estimated at 4.29 cases per 100 000 patients with a 60% mortality rate in these patients . Mucormycosis has also been reported in patients with poorly controlled diabetes, chronic corticosteroid use, solid organ transplant, and, as in this case, malnourishment .…”

Section: Discussionmentioning

confidence: 90%

“…Control is closely linked to management of the precipitating condition . Posaconazole and others are considered if amphotericin treatment fails or if patients relapse . Successful treatment of mucormycosis requires early detection, diagnosis, and initiation of appropriate therapy.…”

Section: Discussionmentioning

confidence: 99%

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Palatal Swelling in a Patient With Refractory Leukemia

Stoopler

Tanaka

2019

JAMA Dermatol

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A man in his 20s presented with rapidly growing, severely painful oral lesions on the left hard palate of 2 months' duration. His medical history was significant for Philadelphia chromosome-negative B-cell acute lymphocytic leukemia refractory to multiple treatments, including chimeric antigen receptor T-cell therapy, with transformation to acute myeloid leukemia (AML) status posttreatment. At the time of evaluation, he had been hospitalized for 5 months with severe protein-calorie malnutrition, pancytopenia, and recurrent neutropenic fevers. The patient was febrile (38.3°C), with a white blood cell count of 0.5/μL (absolute neutrophil count 0.00; to convert to ×10 9 /L, multiply by 0.001), hemoglobin levels of 7.6g/dL (to convert to g/L, multiply by 10.0), hematocrit 21%, and platelet count 9/μL (to convert to ×10 9 /L, multiply by 1.0). He was not receiving active cancer treatment. He appeared cachectic and pale. Intraoral examination revealed poor oral hygiene. The left hard palate exhibited a large swelling with a 5×3-cm indurated area of ulceration, central necrosis, and desquamation (Figure , A). The patient was treated palliatively with dexamethasone solution and nystatin rinse. A biopsy was not recommended owing to medical instability. However, the patient retained a sloughed fragment of the affected tissue, which was submitted for histologic evaluation. A maxillofacial computed tomography (CT) scan completed the etiological investigation. WHAT IS YOUR DIAGNOSIS?Clinical Review & Education

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“…Regardless of infection site, patients with mucormycosis present with fever in at least 80% of cases . Imaging studies show focal areas of consolidation with fungal infiltrates.…”

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 90%

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Palatal Swelling in a Patient With Refractory Leukemia

Stoopler

Tanaka

2019

JAMA Dermatol

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“…These myeloid defects likely underlie the indolently progressive nature of reported cases, which can span years (presuming that these reports represent a single fungal clone that relapses). This presentation is in gross distinction from the acute forms of candidiasis seen in classical at-risk groups, which can be fulminant and is more reminiscent of the chronic, disseminated (hepatosplenic) candidiasis accompanying myeloid reconstitution following intensive cytoreductive chemotherapy [ 111 , 112 ]. Antifungal therapy may be effective in controlling sCNSc disease, although not invariably so.…”

Section: Candidiasismentioning

confidence: 99%

Of Mycelium and Men: Inherent Human Susceptibility to Fungal Diseases

Vinh

2023

Pathogens

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In medical mycology, the main context of disease is iatrogenic-based disease. However, historically, and occasionally, even today, fungal diseases affect humans with no obvious risk factors, sometimes in a spectacular fashion. The field of “inborn errors of immunity” (IEI) has deduced at least some of these previously enigmatic cases; accordingly, the discovery of single-gene disorders with penetrant clinical effects and their immunologic dissection have provided a framework with which to understand some of the key pathways mediating human susceptibility to mycoses. By extension, they have also enabled the identification of naturally occurring auto-antibodies to cytokines that phenocopy such susceptibility. This review provides a comprehensive update of IEI and autoantibodies that inherently predispose humans to various fungal diseases.

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“…As a result, interest in prevention continues, with efficacy demonstrated for posaconazole in patients receiving induction-remission chemotherapy for AML/ myelodysplastic syndromes (MDSs) and high-risk allogeneic HSCT (allo-HSCT) recipients (7,32). However, given incidence rates of invasive fungal diseases (IFDs) of 10 to 15% among patients with AML and HSCT recipients (5,17,23), nonselective prophylaxis has raised concerns regarding overtreatment and expenditure (9,25) because the numbers of eligible patients are high and the duration of prophylaxis is potentially lengthy.…”

mentioning

confidence: 99%

Attributable Hospital Cost and Antifungal Treatment of Invasive Fungal Diseases in High-Risk Hematology Patients: an Economic Modeling Approach

Ananda‐Rajah

Cheng

Morrissey

et al. 2011

Antimicrob Agents Chemother

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Improvement in the short-term survival of patients with invasive aspergillosis (IA) (22, 24) is encouraging, but crude mortality rates remain high at Ͼ30% in patients with acute myeloid leukemia (AML) (24) and 57% in hematopoietic stem cell (HSCT) recipients (1). As a result, interest in prevention continues, with efficacy demonstrated for posaconazole in patients receiving induction-remission chemotherapy for AML/ myelodysplastic syndromes (MDSs) and high-risk allogeneic HSCT (allo-HSCT) recipients (7, 32). However, given incidence rates of invasive fungal diseases (IFDs) of 10 to 15% among patients with AML and HSCT recipients (5,17,23), nonselective prophylaxis has raised concerns regarding overtreatment and expenditure (9, 25) because the numbers of eligible patients are high and the duration of prophylaxis is potentially lengthy.Increasingly, the economic impact of IFDs has been considered in the clinical debate. One center, after determining the attributable mean IA-associated medical cost in AML/MDS patients to be €15,280 in association with a 30% institutional incidence, concluded that antimold prophylaxis was likely costbeneficial from the patient and hospital perspectives (29). Cost determination methods for IFDs have included gross costs (16,

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Pulmonary aspergillosis in hematologic malignancies: lights and shadows

Cited by 47 publications

References 50 publications

Palatal Swelling in a Patient With Refractory Leukemia

Palatal Swelling in a Patient With Refractory Leukemia

Of Mycelium and Men: Inherent Human Susceptibility to Fungal Diseases

Attributable Hospital Cost and Antifungal Treatment of Invasive Fungal Diseases in High-Risk Hematology Patients: an Economic Modeling Approach

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