BACKGROUND Patients with hematological malignancies and allogeneic hematopoietic stem-cell transplant recipients carry a high risk of rare (non-Aspergillus molds and non-Candida yeasts) invasive fungal infections (IFI). METHODS We retrospectively evaluated and described the patient profile, clinical manifestations, isolated species, treatment and outcome of patients with hematological malignancies diagnosed with these rare IFIs during 15 years in a large single hemato-oncology center. RESULTS Eighty-seven patients with hematological malignancies treated in our center had at least one positive culture or molecular identification of a rare fungus. Ninety-three isolates were considered the etiological agents of the infection. The most common underlying hematological malignancy was acute myeloid leukemia, 36 patients (41.4%). Eighty patients (91%) received chemotherapy less than 30 days prior to IFI diagnosis. The most frequent site of infection was the respiratory tract: 34 patients (39%) had pulmonary and 19 patients (22%) had a sinusal or nasopharyngeal infections. Disseminated infection, defined as positive blood cultures or parallel infection in multiple organ systems, was documented in 20 patients (23%). The most common fungal species were Fusarium (35%) and Zygomycetes (25%). Coinfection with more than one fungus was noted in 20 patients (23%). Forty-seven of 87 patients (54%) in this study died within 90 days of IFI diagnosis. CONCLUSIONS Rare IFIs in patients with hematological malignancy become increasingly frequent. Early identification with traditional and molecular methods is important in management of these patients.

中文翻译：

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血液系统恶性肿瘤患者的罕见真菌感染的临床频谱，诊断和结果：从一家三级医疗中心获得15年的经验。

背景技术具有血液系统恶性肿瘤和同种异体造血干细胞移植接受者的患者具有罕见的（非曲霉菌和非念珠菌）侵袭性真菌感染（IFI）的高风险。方法我们回顾性评估并描述了在大型单一血液肿瘤中心15年内诊断为这些罕见IFI的血液系统恶性肿瘤患者的病历，临床表现，分离的物种，治疗和结果。结果在我们中心接受治疗的87例血液系统恶性肿瘤患者至少具有一种阳性培养物或罕见真菌的分子鉴定。九十三株分离物被认为是感染的病原体。血液中最常见的恶性肿瘤是急性髓细胞性白血病，共有36例患者（占41.4％）。在IFI诊断之前不到30天，有80名患者（91％）接受了化疗。感染最常见的部位是呼吸道：肺部感染34例（39％），鼻窦或鼻咽感染19例（22％）。已有20名患者（23％）记录到弥散性感染，定义为阳性血液培养或多器官系统平行感染。最常见的真菌种类是镰刀菌（35​​％）和合子菌（25％）。在20例患者中（23％）发现与一种以上真菌共感染。在这项研究中，有87位患者中有47位（54％）在IFI诊断后90天内死亡。结论血液系统恶性肿瘤患者中罕见的IFI变得越来越频繁。传统和分子方法的早期识别对于这些患者的治疗很重要。