Rate, Risk Factors, and Outcomes of Invasive Fungal Infections in Patients with Hematologic Malignancies

Shirin Afhami; Alireza Adibimehr; Seyed Asadollah Mousavi; Mohammad  Vaezi; Mahnaz Montazeri; Mohammadreza Salehi; Mohsen Meidani; Mahshid Saleh; Kazem Ahmadikia; Emmanuel Roilides; Johan Maertens; Neda Alijani

doi:10.18502/ijhoscr.v18i1.14746

Shirin Afhami Department of Infectious Diseases, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
Alireza Adibimehr Department of Infectious Diseases, Kamkar Arbnia Hospital, Qom University of Medical Sciences (QUMS), Qom, Iran
Seyed Asadollah Mousavi Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
Mohammad Vaezi Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences (TUMS), Tehran, Iran
Mahnaz Montazeri Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
Mohammadreza Salehi Department of Infectious Diseases, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
Mohsen Meidani Department of Infectious Diseases, Imam Khomeini Hospital Complex, School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
Mahshid Saleh Wisconsin National Primate Research Center, University of Wisconsin Graduate School, Madison, Wisconsin, USA
Kazem Ahmadikia Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
Emmanuel Roilides Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Medicine, Hippokration General Hospital, Thessaloniki, Greece
Johan Maertens Department of Microbiology, Immunology, and Transplantation, K.U. Leuven, Leuven, Belgium
Neda Alijani Department of Infectious Diseases, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran

DOI: https://doi.org/10.18502/ijhoscr.v18i1.14746

Keywords: Hematologic malignancy; Invasive fungal infection; Aspergillosis; AML; Risk factors

Abstract

Background: Invasive fungal infections (IFIs) are a significant cause of mortality and morbidity in patients with hematological malignancies. Given the considerable prevalence and consequences of IFIs, hence revealing the exact cause of fungal infections, their rate, associated risk factors, and complications could contribute to reducing both financial and life costs, choosing targeted antifungal treatment, and avoiding unnecessary toxic treatments in individuals who are not suffering from mycoses.

Materials and Methods: This prospective cross-sectional study was conducted in the first semester of 2019. All patients with hematologic malignancies (HM) admitted to Dr. Shariati Hospital were studied. Only those with probable/proven IFIs defined according to the last update of EORTC/MSG criteria were included in the study. The demographic and clinical data were recorded from the hospital information registration system using a questionnaire. Statistical analysis was performed using SPSS software version 24.

Results: Out of 1109 HM patients hospitalized during the study period, 67 (6.04%) IFIs were diagnosed. Of these, 57 (85.04%) were aspergillosis, 7 (10.4%) were mucormycosis, and 3 patients developed other fungal infections. Males constituted 67.2% of the entire IFI population. The mean±SD age of the samples was 43.16 ± 13.8 years. The most common type of malignancy was AML. Lung imaging showed lesions associated with fungal infections in 52 cases (77.6%), with multiple nodules as the most prevalent pattern being observed in 64.2% of cases. Sinus involvement was evidenced in the PNS CT scan of 46 (68.6%) patients. The attributable mortality rate for IFIs was 62.7%. Both the types of IFI and malignancies had no significant relationship with the outcome of patients. Central venous catheter, mucositis, and antibiotic use were the most frequent risk factors.

Conclusion: IFI represents a frequent complication for HM patients with high mortality. Aspergillus species are the predominant etiology in these settings. Considering our results, in high-risk patients, manifestations of warning signs in the sinus and lungs, which would not be cleared despite receiving antibiotics, should raise the possibility of IFIs.