Togano Tomiteru, Suzuki Yuhko, Nakamura Fumihiko, Tse William, Kume Hikaru
Department of Hematology, National Center for Global Health and Medicine, Tokyo, Japan.
Division of Blood and Bone Marrow Transplantation, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
Med Mycol. 2021 Jan 4;59(1):50-57. doi: 10.1093/mmy/myaa029.
Visceral mycoses (VM) are a deadly common infection in patients with acute leukemia and myelodysplastic syndrome (MDS). We retrospectively analyzed the data from the centralized "Annual Report of Autopsy Cases in Japan" that archives the national autopsy cases since 1989. Among the total of 175,615 archived autopsy cases, 7183 cases (4.1%) were acute leukemia and MDS patients. While VM was only found in 7756 cases (4.4% in total cases), we found VM had a disproportionally high prevalence among acute leukemia and MDS patients: 1562 VM cases (21.7%) and nearly sixfold higher in prevalence. Aspergillus spp. was the most predominant causative agent (45.0%), and Candida spp. was the second (22.7%) among confirmed single pathogen involved cases. The prevalence of Candida spp. infection decreased about 50% due to the widely use of fluconazole prophylaxis, which may skew toward doubling of the Mucormycetes incidence compared to 30 years ago. Complicated fungal infection (> one pathogen) was 11.0% in acute leukemia and MDS in 2015. It was 14.7 times higher than in other populations. Among 937 patients who received allogeneic hematopoietic cell transplantation (HCT), the prevalence of VM was 28.3% and 23.3% with GVHD. Aspergillus spp. was less prevalent, but Candida spp. was more associated with GVHD. Its prevalence remains stable. Although Aspergillus spp. was the primary causative agent, non-albicans Candida spp. was increasing as a breakthrough infection especially in GVHD cases. Complicated pathogen cases were more common in acute leukemia and MDS.
内脏真菌病（VM）是急性白血病和骨髓增生异常综合征（MDS）患者中一种常见的致命感染。我们回顾性分析了自1989年起存档全国尸检病例的集中式《日本尸检病例年度报告》中的数据。在总共175615例存档尸检病例中，7183例（4.1%）为急性白血病和MDS患者。虽然VM仅在7756例病例中被发现（占总病例的4.4%），但我们发现VM在急性白血病和MDS患者中的患病率极高：1562例VM病例（21.7%），患病率几乎高出六倍。在确诊的单一病原体感染病例中，曲霉属是最主要的病原体（45.0%），念珠菌属位居第二（22.7%）。由于氟康唑预防措施的广泛使用，念珠菌属感染的患病率下降了约50%，这可能导致毛霉菌病的发病率相较于30年前增加了一倍。2015年，急性白血病和MDS患者中复杂真菌感染（>一种病原体）的发生率为11.0%。这比其他人群高出14.7倍。在937例接受异基因造血细胞移植（HCT）的患者中，VM的患病率在有移植物抗宿主病（GVHD）时为28.3%，无GVHD时为23.3%。曲霉属的患病率较低，但念珠菌属与GVHD的相关性更高。其患病率保持稳定。虽然曲霉属是主要病原体，但非白色念珠菌属作为突破性感染尤其是在GVHD病例中呈上升趋势。复杂病原体病例在急性白血病和MDS中更为常见。
