Fungal infections in acute leukemia patients during selective decontamination of the digestive tract--a clinical, laboratory and pathological study.

Selective decontamination (SD) is used for prevention of bacterial as well as fungal infection in acute leukemia patients during remission induction therapy. We analyzed 138 treatment periods of 108 patients. The intensified chemotherapy resulted in severe granulocytopenia below 0.1 X 10(9) l for over 25.2 days. In 19 patients there was a suspect of major fungal infection, for which they were given antimycotics (in 15 cases amphotericin B and 5-fluocytosin). Fourteen of them died. Major fungal infections were documented in 5 cases. In 18% of the deceased we found major fungal infection (7 cases of Candida sp., 5 cases of Aspergillus, one case of Candida as well as mucor). There was a correlation between fungal infection, the late stages of the haematological malignancy and the lesions appearing on the oropharyngeal mucosa. However, no correlation appeared to exist in the serological and culture findings between the groups with and without fungal infection. The SD-regime is meant to suppress the Candida cell concentration in the digestive tract but has no influence on Aspergillus in the respiratory tract. The clinical occurrence of major fungal infections published in the E.O.R.T.C.--Gnotobiotic Project Group was 8.2%. According to the literature there is in the eighties a tendency for an increased incidence of aspergillosis. The use of the SD-regime as prophylaxis as well as early antifungal therapy appear to be of great advantage in reducing the frequency of fungal infections in immunocompromised patients.