Fatal Trichosporon fungemia in patients with hematologic malignancies
| Autor: | Naoyuki Katayama, Kei Suzuki, Yumiko Sugawara, Kouji Oka, Tadahiro Kohara, Kazunori Nakase, Tetsunori Shibazaki, Tetsuya Tsukada, Taiichi Kyo |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Antifungal Agents Adolescent Neutropenia Young Adult Trichosporon Internal medicine medicine Humans Blood culture Fungemia Aged Retrospective Studies Aged 80 and over Acute leukemia medicine.diagnostic_test biology business.industry Micafungin Breakthrough infection Hematology General Medicine Middle Aged medicine.disease biology.organism_classification Trichosporonosis Mycoses Hematologic Neoplasms Immunology Female business medicine.drug |
| Zdroj: | European journal of haematology. 84(5) |
| ISSN: | 1600-0609 |
| Popis: | Objective Invasive Trichosporon infection has been increasingly recognized in patients with hematologic malignancies. Our study aims to clarify the clinical characteristics of this disease and factors influencing patient prognosis. Patients and methods We retrospectively analyzed 33 cases of Trichosporon fungemia (TF) in patients with hematologic malignancies treated at our collaborating five hospitals in Japan between 1992 and 2007. Results The majority of these patients had acute leukemia (82%), neutropenia (85%), and a history of intensive chemotherapy (91%). TF occurred as a breakthrough infection during antifungal therapy in 30 patients (91%), 18 of whom were receiving micafungin. The surveillance cultures of most patients were negative for Trichosporon. Only a few patients exhibited elevated levels of 1,3-beta-d-glucan before positive blood culture. Twenty-five patients (76%) died of this infection. The resolution of infection was associated with neutrophil recovery (P = 0.0001), absence of hyperglycemia (P = 0.023), and azole inclusive therapy (P = 0.031). Survival was significantly longer in patients receiving antifungal therapies containing azole than in those who did not receive azole (P = 0.0034). Conclusions At present, the diagnosis of invasive trichosporonosis depends on blood culture studies, and the mortality of this disease is high; however, azole therapy and control of blood glucose level, together with hematopoietic recovery could help in improving the clinical outcome. When we use antifungals lacking anti-Trichosporon activity, sufficient care should be taken to prevent the development of breakthrough trichosporonosis. |
| Databáze: | OpenAIRE |
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