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Invasive Fungal Infections in Patients with Hematologic Malignancies

  • Yaşar Barış Turgut
  • Gökhan Sargın
  • Gökhan Pektaş
Chapter

Abstract

Invasive fungal infections (IFI) are among the most important causes of mortality and morbidity in patients with severe immunodeficiency. Hematological malignancy and allogeneic stem cell transplantation patients are among the leading risk groups. The most important determining factor in the treatment of IFI is the initiation of early treatment. Despite all the developments in recent years, the lack of fast and reliable diagnostic tests in the diagnosis of IFI diagnosis increases the importance of better risk stratification of groups in terms of IFI. An effective antifungal prophylaxis in high-risk patients is important in reducing mortality, morbidity, and cost. Today, better defined risk factors, diagnostic tests, and newly developed antifungal drugs reduce IFI-related risks. The prognosis improved with use of appropriate antifungal therapy protocol.

Keywords

Invasive fungal infection Aspergillus Hematopoietic stem cell transplantation Antifungal therapy 

Abbreviations

AHSCT

Allogeneic hematopoietic stem cell transplantation

AML

Acute myeloid leukemia

CNS

Central nervous system

IFI

Invasive fungal infection

MRI

Magnetic resonance imaging

References

  1. Caggiano G, Iatta R, Laneve A, Manca F, Montagna MT. Observational study on candidaemia at a university hospital in southern Italy from 1998 to 2004. Mycoses. 2008;51:123–8.CrossRefGoogle Scholar
  2. Chamilos G, Luna M, Lewis RE, Bodey GP, Chemaly R, Tarrand JJ, Safdar A, Raad II, Kontoyiannis DP. Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: an autopsy study over a 15-year period (1989–2003). Haematologica. 2006;91:986–9.PubMedGoogle Scholar
  3. Chen K, Wang Q, Pleasants RA, Ge L, Liu W, Peng K, Zhai S. Empiric treatment against invasive fungal diseases in febrile neutropenic patients: a systematic review and network meta-analysis. BMC Infect Dis. 2017;17:159.CrossRefGoogle Scholar
  4. Cordonnier C, Pautas C, Maury S, Vekhoff A, Farhat H, Suarez F, Dhédin N, Isnard F, Ades L, Kuhnowski F, Foulet F, Kuentz M, Maison P, Bretagne S, Schwarzinger M. Empirical versus preemptive antifungal therapy for high-risk, febrile, neutropenic patients: a randomized, controlled trial. Clin Infect Dis. 2009;15(48):1042–51.CrossRefGoogle Scholar
  5. Franquet T, Müller NL, Giménez A, Guembe P, de La Torre J, Bagué S. Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics. 2001;21:825–37.CrossRefGoogle Scholar
  6. Girmenia C, Pizzarelli G, Cristini F, Barchiesi F, Spreghini E, Scalise G, Martino P. Candida guilliermondii fungemia in patients with hematologic malignancies. J Clin Microbiol. 2006;44:2458–64.CrossRefGoogle Scholar
  7. Görük M, Dal MS, Dal T, Karakus A, Tekin R, Özcan N, Ayyildiz O. Evaluation of febrile neutropenic patients hospitalized in a hematology clinic. Asian Pac J Trop Biomed. 2015;5(12):1051–4.CrossRefGoogle Scholar
  8. Haßler A, Porto L, Lehrnbecher T. Cerebral fungal infection in pediatric cancer patients. Curr Fungal Infect Rep. 2015;9:6–14.CrossRefGoogle Scholar
  9. de Hoog GS, Guarro J, Gené J, Figueras MJ. Atlas of clinical fungi. 3rd ed. Utrecht: Centraalbureau voor Schimmelcultures (CBS); 2009.Google Scholar
  10. Hou X, Zhang H, Kou L, Lv W, Lu J, Li J. Clinical features and diagnosis of chronic pulmonary aspergillosis in Chinese patients. Medicine (Baltimore). 2017;96:e8315.CrossRefGoogle Scholar
  11. Hsiao HH, Tsai HJ, Liu YC, Tseng YT, Lu PL, Yang WC, Liu TC, Lin SF. Invasive fungal infections in patients with acute leukemia. Kaohsiung J Med Sci. 2006;22:217–22.CrossRefGoogle Scholar
  12. Jahagirdar BN, Morrison VA. Emerging fungal pathogens in patients with hematologic malignancies and marrow/stem-cell transplant recipients. Semin Respir Infect. 2002;17:113–20.CrossRefGoogle Scholar
  13. Lass-Flörl C. The changing face of epidemiology of invasive fungal disease in Europe. Mycoses. 2009;52:197–205.CrossRefGoogle Scholar
  14. Maertens JA, Frere P, Lass-Florl C, Heinz W, Cornely OA. Primary antifungal prophylaxis in leukaemia patients. Eur J Cancer. 2007;5:43–8.CrossRefGoogle Scholar
  15. Marr KA. Invasive Candida infections: the changing epidemiology. Oncology. 2004;18:9–14.PubMedGoogle Scholar
  16. Martino P, Girmenia C. Mycoses and their treatment in malignant hemopathies (in Italian). Recenti Prog Med. 1999;90:160–8.PubMedGoogle Scholar
  17. Montagna MT, De Giglio O, Napoli C, Lovero G, Caggiano G, Delia M, Pastore D, Santoro N, Specchia G. Invasive fungal infections in patients with hematologic malignancies (Aurora project): lights and shadows during 18-months surveillance. Int J Mol Sci. 2012;13:774–87.CrossRefGoogle Scholar
  18. Neofytos D, Horn D, Anaissie E, Steinbach W, Olyaei A, Fishman J, Pfaller M, Chang C, Webster K, Marr K. Epidemiology and outcome of invasive fungal infection in adult hematopoietic stem cell transplant recipients: analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance registry. Clin Infect Dis. 2009;48:265–73.CrossRefGoogle Scholar
  19. Pagano L, Caira M, Candoni A, Offidani M, Fianchi L, Martino B, Pastore D, Picardi M, Bonini A, Chierichini A, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica. 2006;91:1068–75.PubMedGoogle Scholar
  20. Pagano L, Caira M, Nosari A, Van Lint MT, Candoni A, Offidani M, Aloisi T, Irrera G, Bonini A, Picardi M, Caramatti C, Invernizzi R, Mattei D, Melillo L, de Waure C, Reddiconto G, Fianchi L, Valentini CG, Girmenia C, Leone G, Aversa F. Fungal infections in recipients of hematopoietic stem cell transplants: results of the SEIFEM B-2004 study—Sorveglianza Epidemiologica Infezioni Fungine Nelle Emopatie Maligne. Clin Infect Dis. 2007;45:1161–70.CrossRefGoogle Scholar
  21. Pagano L, Caira M, Candoni A, Offidani M, Martino B, Specchia G, Pastore D, Stanzani M, Cattaneo C, Fanci R, Caramatti C, Rossini F, Luppi M, Potenza L, Ferrara F, Mitra ME, Fadda RM, Invernizzi R, Aloisi T, Picardi M, Bonini A, Vacca A, Chierichini A, Melillo L, de Waure C, Fianchi L, Riva M, Leone G, Aversa F, Nosari A. Invasive aspergillosis in patients with acute myeloid leukemia: a SEIFEM-2008 registry study. Haematologica. 2010a;95:644–50.CrossRefGoogle Scholar
  22. Pagano L, Caira M, Valentini CG, Posteraro B, Fianchi L. Current therapeutic approaches to fungal infections in immunocompromised hematological patients. Blood Rev. 2010b;24:51–61.CrossRefGoogle Scholar
  23. Rambaldi B, Russo D, Pagano L. Defining invasive fungal infection risk in hematological malignancies: a new tool for clinical practice. Mediterr J Hematol Infect Dis. 2017;9(1):e2017012.CrossRefGoogle Scholar
  24. Ruhnke M, Maschmeyer G. Management of mycoses in patients with hematologic disease and cancer- review of the literature. Eur J Med Res. 2002;7:227–35.PubMedGoogle Scholar
  25. Sainz J, Pérez E, Hassan L, Moratalla A, Romero A, Collado MD, Jurado M. Variable number of tandem repeats of TNF receptor type 2 promoter as genetic biomarker of susceptibility to develop invasive pulmonary aspergillosis. Hum Immunol. 2007;68:41–50.CrossRefGoogle Scholar
  26. Segal BH, Bow EJ, Menichetti F. Fungal infections in nontransplant patients with hematologic malignancies. Infect Dis Clin N Am. 2002;16:935–64.CrossRefGoogle Scholar
  27. Sinkó J, Csomor J, Nikolova R, Lueff S, Kriván G, Reményi P, Bátai A, Masszi T. Invasive fungal disease in allogeneic hematopoietic stem cell transplant recipients: an autopsy-driven survey. Transpl Infect Dis. 2008;10:106–9.CrossRefGoogle Scholar
  28. Somboonwit C, Greene JN. Diagnostic methodologies for invasive fungal infections in hematopoietic stem-cell transplant recipients. Semin Respir Infect. 2002;17:151–7.CrossRefGoogle Scholar
  29. Starkey J, Moritani T, Kirby P. MRI of CNS fungal infections: review of aspergillosis to histoplasmosis and everything in between. Clin Neuroradiol. 2014;24:217–30.CrossRefGoogle Scholar
  30. Viscoli C, Varnier O, Machetti M. Infections in patients with febrile neutropenia: epidemiology, microbiology, and risk stratification. Clin Infect Dis. 2005;40:240–5.CrossRefGoogle Scholar
  31. Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Segal BH, Steinbach WJ, Stevens DA, et al. Treatment of aspergillosis: clinical practice guidelines of the infectious diseases society of America. Clin Infect Dis. 2008;46:327–60.CrossRefGoogle Scholar
  32. Zumla A, James G. Granulomatous infections: etiology and classification. Clin Infect Dis. 1996;23:146–58.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Yaşar Barış Turgut
    • 1
  • Gökhan Sargın
    • 2
  • Gökhan Pektaş
    • 3
  1. 1.Department of Internal MedicineMuğla Sıtkı Koçman University School of MedicineMuğlaTurkey
  2. 2.Department of Internal MedicineAydın Adnan Menderes University School of MedicineAydınTurkey
  3. 3.Division of HematologyMuğla Sıtkı Koçman University HospitalMuğlaTurkey

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