title: Improved survival from fungaemia in patients with haematological malignancies: analysis of risk factors for death and usefulness of early antifungal therapy.
abstract: Fourty-three episodes of fungaemia encountered from 1978 to 1991 in 43 patients with haematological malignancies are reviewed here to analyse the risk factors for death and to evaluate the efficacy of early antifungal therapy. Low serum cholinesterase and elevated serum blood urea nitrogen were significantly associated with fungaemic death, defined as death occurring within 2 weeks after documentation of fungaemia. Overall death rate from fungaemia was 62.8%. Before the introduction of early antifungal therapy in 1986, however, fungaemic mortality was 85.7%; it was reduced to 51.7% thereafter (p = 0.01). Determination of plasma (1-->3)-beta-D-glucan was helpful in detecting deep fungal infections and initiating antifungal therapy early.
authors.affiliation: Department of Medicine, Jichi Medical School, Tochigi-ken, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Iwama
authors.forename: M
authors.initials: M
authors.lastname: Yoshida
authors.forename: A
authors.initials: A
authors.lastname: Miwa
authors.forename: T
authors.initials: T
authors.lastname: Obayashi
authors.forename: S
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Y
authors.initials: Y
authors.lastname: Miura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000380:Agranulocytosis; D000935:Antifungal Agents / Q000627:therapeutic use*; D001806:Blood Urea Nitrogen; D002177:Candidiasis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D002648:Child; D002802:Cholinesterases / Q000097:blood; D005260:Female; D016469:Fungemia / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D006402:Hematologic Diseases / Q000150:complications*; D006801:Humans; D007938:Leukemia / Q000150:complications*; D008223:Lymphoma / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D015996:Survival Rate; D013921:Thrombocytopenia
chemical_list: D000935:Antifungal Agents; D012709:Serum Albumin; D002802:Cholinesterases