Prevalence and description of invasive fungal infection in adults with hematological neoplasms

Background: Fungi have emerged as important causes of human infection, due primarily to the increased numbers of patients subjected to severe immunosuppression; therefore, the demand for information on the pathogenic role of these microorganisms and the diseases they cause is growing. This study aimed to evaluate invasive fungal infection (IFI) in adult patients with hematological neoplasms to identify common site of infection, type of causative fungi, the percentage of patients developing fungemia and determine high risk patients required early intervention.
Methods: A prospective study was conducted in South Egypt Cancer Institute, Assiut University. Diagnosis of fungal infection was made by conventional culture media (Sabaroudʹs agar), radiological finding and fungal DNA- PCR that performed on serum samples of patients to detect fungemia.
Results: Of 960 hematologic malignancy patients with high risk for infection, rate of fungal infection as documented both clinically and microbiologically was 8.3% (80 cases). Acute leukemia was the majority of the underlying hematological disease with fungal infection (58.8%). AML patients represented 33.8%, which was the highest percentage of cases followed by patients with ALL 25%, then NHL 23.8%. The most encountered hematological finding was Neutropenia which recorded in 71/80 (88.75%) patients, 35 out of 80 patients (43.75%)suffer from severe neutropenia. Lower respiratory tract infection (LRTI) was the most common presentation of fungal infection in patients (n 39, 48.75%), followed by fungemia and fungal oral mucositis grade ΙΙΙ or ΙѴ (n 30, 37.5%) for each. Isolated pathogens were yeasts in 25 patients (31.25%), molds in 19 patients (23.75%), mixed yeast and mold in 4 patients (5%) and polymicrobial pathogens (fungus and bacteria) in 32 patients (40%). Among isolated fungi, Candida species was the commonest, followed by Aspergillus species. .
Conclusion: Hematological malignancy especially acute leukemia patients were at high risk of invasive fungal infection. LRTI was the commonest detected clinical presentation specifically in patients with marked and prolonged neutropenia.