Abstract

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.

中文翻译：

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急性白血病和骨髓增生异常综合症患者内脏真菌病的流行病学：分析日本的国家尸检数据库。

摘要

内脏真菌病（VM）是急性白血病和骨髓增生异常综合症（MDS）患者的致命性常见感染。我们回顾性分析了自1989年以来对全国尸检病例进行存档的集中式“日本尸检病例年度报告”中的数据。在总共175615例尸检病例中，有7183例（4.1％）是急性白血病和MDS患者。尽管仅在7756例病例中发现了VM（占总病例的4.4％），但我们发现在急性白血病和MDS患者中VM的患病率异常高：1562个VM病例（21.7％），患病率高出近六倍。曲霉属 是最主要的病原体（45.0％），念珠菌属。在已确认的单一病原体感染病例中是第二（22.7％）。念珠菌的流行spp。由于广泛使用氟康唑预防，感染减少了约50％，与30年前相比，它可能使毛霉菌的发病率翻倍。2015年，急性白血病和MDS中的复杂真菌感染（>一种病原体）为11.0％，是其他人群的14.7倍。在937位接受同种异体造血细胞移植（HCT）的患者中，GVHD的VM患病率为28.3％和23.3％。曲霉属 较少流行，但念珠菌属。与GVHD更相关。其流行率保持稳定。虽然曲霉属。是主要的病原体，非白色念珠菌spp。作为突破性感染正在增加，尤其是在GVHD病例中。在急性白血病和MDS中，复杂的病原体病例更为常见。