Zygomycosis Presenting as Acute Myocardial Infarction during Hematological Malignancies

Joshita, Satoru; Kitano, Kiyoshi; Nagaya, Tadanobu; Nakazawa, Koh; Ishida, Fumihiro

doi:10.2169/internalmedicine.47.0832

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…85,87 In some cases, the clinical presentation was atypical, 139 with unusual features like spinal cord 131,135,140 or coronary artery obstruction. 141 In a recent, large European series of zygomycosis infections occurring between 2005 and 2007, MDS was the underlying disorder in only 6 of the 230 (2.6%) cases and in 6 of the 102 (6%) hematologic malignancies. 139 Other unusual IFI have been reported, such as fusariosis, 142 Trichosporon beigelii infection.…”

Section: Invasive Fungal Infectionsmentioning

confidence: 99%

Infections in myelodysplastic syndromes

et al. 2012

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Myelodysplastic syndromes are associated with a risk of severe infections. While neutropenia is likely to be the main predisposing factor, several other immune defects have been reported, including impaired neutrophil function, B-, T-and NK-cell defects and the possible consequences of iron overload due to red blood cell transfusions. The advanced age of most patients, their frequent comorbidities, and the fact that drugs such as hypomethylating agents and lenalidomide, which are effective in myelodysplastic syndromes but can transiently worsen neutropenia, may increase the risk of infection and their severity in this context. The majority of infections in myelodysplastic syndromes are bacterial, while the incidence of fungal infections is not well known and viral infections seem to be rare. No prophylactic measures against infections have demonstrated efficacy in myelodysplastic syndromes. However, pending more data, we propose here some recommendations for the management of patients with myelodysplastic syndromes. In the future, an important contribution can be made by prospective trials testing the efficacy of prophylactic and therapeutic approaches to infection in these patients, especially in the context of the new drugs available for myelodysplastic syndromes. ABSTRACTand respective bacterial, fungal, and viral causes of infection in MDS. Most of these data are retrospective. Some are compromised by inconsistencies in the definition of the infectious events or, although taken from therapeutic trials, may be biased by patient eligibility criteria. In a recent US retrospective series of 273 untreated low-or intermediate-1 risk MDS patients who died in the period from 1980 to 2004, infection was the primary cause of death, accounting for 38% of the total, followed by AML transformation (15%) and hemorrhage (13%).9 Pneumonia was the most common infection, responsible for 40% of infectious deaths. Infection, mostly of a bacterial origin, was microbiologically documented in 30% of the cases of pneumonia in these MDS patients. As this study covered three decades, it was possible to show a significant decrease in the incidence of infectious deaths over time, likely attributable to improved supportive care. Another US survey of the Medicare population (an insurance covering more than 97% of all US citizens aged 65 years or over) indicated that, in a population of 1.3 million people over the age of 65 years followed between the years 2003 and 2005, patients with MDS had a higher prevalence of infections than the non-MDS Medicare population (22.5% vs. 6.

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