Ankara Etlik City Hospital, Chest Diseases Clinic, Ankara, Turkey.
Formerly Hacettepe University Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey.
Medicine (Baltimore). 2024 Oct 4;103(40):e39959. doi: 10.1097/MD.0000000000039959.
Invasive fungal infection (IFI) is an important cause of morbidity and mortality in acute leukemia patients. In the past few decades, the incidence of IFI has dramatically increased. Nevertheless, the management of IFI has become more complicated owing to changes in the epidemiology of fungal diseases and therapeutic regimens. Therefore, it is important to establish an appropriate strategy for centers that provide the diagnosis and treatment of acute leukemia patients based on scientific data and with available resources. In this study we investigated the incidence of IFI, pathogens, the use of diagnostic methods, and risk factors for IFI in acute leukemia patients over a 17-year period. A total of 502 acute leukemia patients (male/female: 57%/43%, mean age: 57.7 ± 15.5 years) hospitalized at adult and oncology hospitals between 2003 and 2020 were reviewed retrospectively. The incidence of proven and probable IFI was 13.2% (33.1%, when possible cases were included). The most common IFI was aspergillosis (49 patients, 9.7%), followed by candidemia, mucormycosis, and Pneumocystis jirovecii pneumonia. The galactomannan antigen test was positive in the serum of 39 (23.5%) patients and in bronchoalveolar lavage (BAL) fluid in 6 (3.6%) patients. Thirteen (7.8%) sputum cultures (11 Aspergillus spp. and 2 Candida spp.) and 4 (2.4%) BAL fluid (1 Aspergillus spp., 2 Candida spp., 1 P jirovecii) were positive for a fungal pathogen. Neutropenia, intensive care unit (ICU) follow-up and mechanical ventilation (MV) increased the risk of IFI by 3.5, 2.5, and 1.8 times, respectively. The median survival was 5 (range: 1.9-8) months. ICU follow-up shortened the survival by 12 months and increased the death risk by 2.49-fold. MV shortened survival by 57 months and increased the death risk by 3.82-fold. IFI remains a significant contributor to the morbidity and mortality in acute leukemia patients. Pulmonary involvement is the most common site. Neutropenia, ICU follow-up and MV are associated with an increased risk for IFI and mortality. We recommend in the IFI approach, to be aware of IFI in patients receiving intensive chemotherapy and/or recipients of hematopoietic stem cell transplantation, and to evaluate with microbiological, serological and radiological tests during the clinical follow-up.
侵袭性真菌感染（IFI）是急性白血病患者发病率和死亡率的重要原因。在过去的几十年中，IFI 的发病率显著增加。然而，由于真菌病的流行病学和治疗方案的变化，IFI 的治疗变得更加复杂。因此，根据科学数据并利用现有资源，为提供急性白血病患者诊断和治疗的中心制定适当的策略非常重要。在这项研究中，我们调查了 17 年来急性白血病患者 IFI 的发生率、病原体、诊断方法的使用以及 IFI 的危险因素。共回顾性分析了 2003 年至 2020 年期间在成人和肿瘤医院住院的 502 例急性白血病患者（男/女：57%/43%，平均年龄：57.7±15.5 岁）。确诊和可能 IFI 的发生率为 13.2%（包括可能病例时为 33.1%）。最常见的 IFI 是曲霉菌病（49 例，9.7%），其次是念珠菌血症、毛霉菌病和卡氏肺孢子虫肺炎。血清半乳甘露聚糖抗原试验阳性 39 例（23.5%），支气管肺泡灌洗液（BAL）阳性 6 例（3.6%）。13 例（7.8%）痰培养（11 例为曲霉菌属，2 例为念珠菌属）和 4 例（2.4%）BAL 液（1 例为曲霉菌属，2 例为念珠菌属，1 例为卡氏肺孢子虫）真菌病原体阳性。中性粒细胞减少症、重症监护病房（ICU）随访和机械通气（MV）使 IFI 的风险分别增加 3.5、2.5 和 1.8 倍。中位生存时间为 5（范围：1.9-8）个月。ICU 随访使生存时间缩短 12 个月，死亡风险增加 2.49 倍。MV 使生存时间缩短 57 个月，死亡风险增加 3.82 倍。IFI 仍然是急性白血病患者发病率和死亡率的重要原因。肺部受累是最常见的部位。中性粒细胞减少症、ICU 随访和 MV 与 IFI 和死亡率的增加相关。我们建议在 IFI 方法中，注意接受强化化疗和/或造血干细胞移植的患者的 IFI，并在临床随访期间进行微生物学、血清学和影像学检查。
