Risk factors for invasive pulmonary fungal infection in patients with hematological malignancies not receiving hematopoietic stem cell transplant

Abstract

We investigated the incidence, pathogens and risk factors of invasive pulmonary fungal infection (IPFI) in patients with hematological malignancies who did not receive hematopoietic stem cell transplantation (HSCT). Of the 323 patients included, 106 had IPFI with confirmed diagnosis or clinical diagnosis, 111 had pulmonary bacterial infections, and 106 did not have pulmonary infections. The risk factors for IPFI were explored through logistic univariate and multivariate analysis. The incidence of IPFI in patients with hematological malignancies but without HSCT was 3.5%. The leading pathogen was Candida albicans which accounted for 50.7% of the infections, and the second one was Aspergillus which accounted for 37.3% of the infections. The main risk factors for these patients were days of hospitalization, history of IPFI, agranulocytosis, concomitant hypoproteinemia, number of antibiotics being used, concomitant bacterial sepsis, and age. Furthermore, Nystatin mouthwash was protective against IPFI. Among patients with hematological malignancies, IPFI causes the highest proportion of deaths. We have identified two important pathogens and several risk factors as well as one factor protective against IPFI. Awareness of risk factors and reduction of pathogens can decrease the incidence of IPFI. Key words: fungemia, mycoses/prevention and control, epidemiology, Nystatin, hematologic neoplasms/complicationsInvasive pulmonary fungal infections (IPFI) have high morbidity, high mortality, and a low detection rate in laboratories and in clinical practice. Though patients with IPFI deteriorate rapidly, clinical manifestations are usually nonspecific and frequently masked by underlying diseases. This leads to misdiagnosis of IPFI and delayed treatment. Together, these problems, along with the influence of underlying diseases, significantly increase mortality. When IPFI patients do not receive timely treatment, their mortality is as high as 30% to 80% [1].Risk factors for IPFI include long-term broad-spectrum antibiotic use, long-term glucocorticoid use, agranulocytosis, invasive procedures, long-term stay in intensive care unit, hematopoietic stem cell transplantation (HSCT), total parenteral nutrition, concomitant hypoproteinemia, diabetes, chronic obstructive pulmonary disease, cancer, and AIDS [1][2][3][4][5][6][7]. However, risk factors for IPFI are seldom investigated for patients with hematological malignancies, and most investigations that do occur were focused on patients receiving HSCT [8][9][10]. Some patients with hematological malignancies who have not received HSCT still develop IPFI, even they were not identified as having any of the risk factors. Therefore, it is imperative to investigate the risk factors for IPFI in these patients. The present study examines the overall incidence of IPFI and the pathogens involved in patients with hematological malignancies who did not receive HSCT. Controls were patients from the same group who developed pulmonary bacterial infection and patients without pulmonary infection....

Prospective trial finds nystatin mouthwash effective prophylaxis for pulmonary invasive fungal infections that originate in the throat of patients with hematologic malignancies

“…Patients with hematological malignancies have compromised immune function, which is further impacted by radiotherapy and chemotherapy treatments. Our study patients showed no significant differences in the risk factors for IPFI which we previously identified [6]. It is also important to note that all the hospitalized patients in this study had a similar diet and performed regular brushing with similar toothbrushes.…”

“…These conditions allow fungi in the mouth to migrate to the lower respiratory tract, which results in fungal infection. We previously showed that risk factors for IPFI include number of days of hospitalization, history of IPFI, number of antibiotics used, sepsis and hypoalbuminemia [6]. Theoretically, the fungi from the lung and throat have sequence homology in IPFI patients, though this homology has not been confirmed in prior published reports.…”

MUCORMYCOSIS IN ONCOHEMATOLOGY PATIENTS (results of the prospective study)

“…В ряде зарубежных исследований продемонстри-ровано, что мукормикоз развивается преимуществен-но у больных острыми лейкозами [12][13][14][15][16]. Мы также показали, что острые лейкозы были фоновыми забо-леваниями у 64 % больных.…”

“…Результаты нашего исследования, а также данные литературы свидетельствуют, что у онкогематологиче-ских больных наиболее частой клинической формой мукормикоза является поражение легких (50-81 %) [2,[11][12][13]. В то же время у детей чаще развивается риноцеребральный мукормикоз (29 % vs 8 %).…”

Invasive candidiasis in critical care setting, updated recommendations from “Invasive Fungal Infections-Clinical Forum”, Iran

“…Currently, IFIs constitute a clinical issue on the rise in the ICUs both in the developing and developed world [19,20] . Predisposing factors such as patients' complicated medical or surgical status, invasive bedside procedure and wide administration of antibiotics have contributed to increased rate of IFIs, mainly IC and invasive aspergillosis (IA), in the ICU [21][22][23] . Candidemia is thus far known to be the most prevalent fungal infection afflicting ICU patients [23] .…”