SIMIFF study: Italian fungal registry of mold infections in hematological and non-hematological patients

Abstract

PurposeWe compared the risk factors, the diagnostic tools and the outcome of filamentous fungal infections (FFIs) in hematological patients (HAEs) and non-hematological patients (non-HAEs).MethodsProspective surveillance (2009–2011) of proven and probable FFIs was implemented in 23 Italian hospitals.ResultsOut of 232 FFIs, 113 occurred in HAEs and 119 in non-HAEs. The most frequent infection was invasive aspergillosis (76.1 % for HAEs, 56.3 % for non-HAEs), and the localization was principally pulmonary (83.2 % for HAEs, 74.8 % for non-HAEs). Neutropenia was a risk factor for 89.4 % HAEs; the main underlying condition was corticosteroid treatment (52.9 %) for non-HAEs. The distribution of proven and probable FFIs was different in the two groups: proven FFIs occurred more frequently in non-HAEs, whereas probable FFIs were correlated with the HAEs. The sensitivity of the galactomannan assay was higher for HAEs than for non-HAEs (95.3 vs. 48.1 %). The overall mortality rate was 44.2 % among the HAEs and 35.3 % among the non-HAEs. The etiology influenced the patient outcomes: mucormycosis was associated with a high mortality rate (57.1 % for HAEs, 77.8 % for non-HAEs).ConclusionsThe epidemiological and clinical data for FFIs were not identical in the HAEs and non-HAEs. The differences should be considered to improve the management of FFIs according to the patients’ setting.

Diagnosis of invasive mold diseases in patients with hematological malignancies using Aspergillus, Mucorales, and panfungal PCR in BAL

“…In our cohort, the specificity of Aspergillus and panfungal PCR was similar or better to previous reports with 36%‐94% and 67%‐86% in BAL‐fluid, respectively, while their sensitivities were much lower . There are several potential explanations for the poor sensitivities of our PCR in the BAL‐fluid.…”

“…Most of these assays, however, fail to identify different mold species (spp. ), particularly Mucorales , Scedosporium, and Fusarium spp . These molds are increasing and have important implications regarding treatment and mortality .…”

Pulmonary Fungal Diseases in Immunocompetent Hosts: A Single-Center Retrospective Analysis of 35 Subjects

“…For all populations of the study, hypoalbuminemia, cancer, and positive culture were risk factors for mortality, whereas hypoalbuminemia was the only independent risk factor for mortality. Factors significantly associated with mortality in pulmonary aspergillosis were hypoalbuminemia, cancer, and therapy combining with surgery or not, compared with reported risk factors as corticosteroid therapy, organ failure, lung cancer, liver cirrhosis, disseminated infection, mechanical ventilation and coinfection with bacterial pneumonia and cytomegalovirus [16,[30][31][32][33][34]. Despite a variety of treatment therapy, all cases with pulmonary cryptococcosis showed favorable outcomes (cure or improvement).…”

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

“…These issues are amplified in HM/HSCT patients, as the above described immune defects frequently result in atypical presentations. Fever, fatigue, or exertional dyspnea may be the only presenting symptoms, while sputum and radiographic consolidations may be absent 43,57 . Many of the cardinal clinical features of pneumonia depend on robust immune responses that may be impaired in HM/HSCT patients, thus a high clinical suspicion is key to making the correct diagnosis.…”