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Clinical Spectrum, Diagnosis and Outcome of Rare Fungal Infections in Patients with Hematological Malignancies: Experience of 15-Year Period from a Single Tertiary Medical Center

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Abstract

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.

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Author notes

  1. Emilia Hardak and Eyal Fuchs have contributed equally.

Authors and Affiliations

  1. Division of Pulmonary Medicine, Rambam Health Care Campus, P.O. Box 9602, 31096, Haifa, Israel

    Emilia Hardak & Eyal Fuchs

  2. Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel

    Ilana Oren

  3. Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

    Tsila Zuckerman & Ilana Oren

  4. Clinical Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel

    Yuval Geffen

  5. Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel

    Emilia Hardak, Eyal Fuchs, Tsila Zuckerman & Ilana Oren

  6. Division of Pulmonology, Rambam Health Care Campus, 8, Ha’Aliya Street, 3525408, Haifa, Israel

    Eyal Fuchs

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  1. Emilia Hardak
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  2. Eyal Fuchs
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Correspondence to Emilia Hardak or Eyal Fuchs.

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Hardak, E., Fuchs, E., Geffen, Y. et al. Clinical Spectrum, Diagnosis and Outcome of Rare Fungal Infections in Patients with Hematological Malignancies: Experience of 15-Year Period from a Single Tertiary Medical Center. Mycopathologia 185, 347–355 (2020). https://doi.org/10.1007/s11046-020-00436-x

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  • DOI: https://doi.org/10.1007/s11046-020-00436-x

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