Department of Internal Medicine, University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Mycoses. 2019 May;62(5):413-417. doi: 10.1111/myc.12901.
Patients treated for invasive aspergillosis may relapse during subsequent periods of immunosuppression and should receive secondary prophylaxis. Little is known about the frequency of relapse and practices of secondary prophylaxis for invasive fusariosis (IF).
Evaluate practices of secondary prophylaxis and the frequency of relapse in patients who survived IF and were exposed to subsequent periods of immunosuppression.
Multicentre retrospective study of patients with haematological malignancies who developed IF, survived the initial fungal disease period, and were exposed to subsequent periods of immunosuppression.
Among 40 patients, 35 received additional chemotherapy and developed neutropenia (median, 24 days; range, 4-104), and five received glucocorticoids for the treatment of graft-vs-host disease. Overall, 32 patients received secondary prophylaxis (voriconazole in 24) for a median of 112 days (range, 12-468). IF relapsed in five patients (12.5%): 2/8 (25%) not on prophylaxis and 3/32 (9.4%) receiving prophylaxis. Among 28 patients with disseminated IF, relapse occurred in 2/2 (100%) not on prophylaxis and in 3/26 (11.5%) on prophylaxis (P = 0.03). All patients who relapsed IF died.
Patients with IF who survive the initial disease may relapse if exposed to subsequent episodes of immunosuppressive therapies. Secondary prophylaxis should be considered, especially if IF was disseminated.
接受侵袭性曲霉菌病治疗的患者在随后的免疫抑制期间可能会复发，应接受二级预防。对于侵袭性镰刀菌病（IF），我们知之甚少，包括复发的频率和二级预防的实践。
评估存活 IF 并暴露于随后免疫抑制期的患者的二级预防实践和复发频率。
对患有血液系统恶性肿瘤且发生 IF、存活初始真菌感染期并暴露于随后免疫抑制期的患者进行多中心回顾性研究。
在 40 名患者中，有 35 名接受了额外的化疗并出现中性粒细胞减少症（中位数，24 天；范围，4-104 天），5 名因移植物抗宿主病而接受糖皮质激素治疗。总体而言，有 32 名患者（24 名接受伏立康唑）接受了二级预防（中位数为 112 天；范围，12-468 天）。有 5 名患者（12.5%）发生 IF 复发：8 名未接受预防治疗的患者中有 2 例（25%），32 名接受预防治疗的患者中有 3 例（9.4%）。在 28 名播散性 IF 患者中，2 名（100%）未接受预防治疗的患者和 3 名（11.5%）接受预防治疗的患者复发（P=0.03）。所有复发 IF 的患者均死亡。
如果存活 IF 的患者暴露于随后的免疫抑制治疗，可能会复发 IF。应考虑二级预防，特别是 IF 播散。
