title: Infections caused by filamentous fungi in patients with hematologic malignancies. A report of 391 cases by GIMEMA Infection Program.
abstract: OBJECTIVE
  To evaluate the clinical characteristics of patients with hematologic malignancies developing a filamentous fungi infection (FFI) and to define the prognostic factors for their outcome.
  
  
  METHODS
  A retrospective study, conducted on patients admitted to 14 Hematology divisions of tertiary care or university hospitals, participating in the GIMEMA Infection Program, over a ten-year period (1988-1997). The study included patients with hematological malignancies and a histologically and/or microbiologically proven or probable FFI.
  
  
  RESULTS
  We included 391 patients (male/female: 262/129, median age 49 years) with hematologic malignancies (225 acute myeloid leukemia, 67 acute lymphocytic leukemia, 30 chronic myeloid leukemia, 22 non-Hodgkin's lymphoma, 12 myelodysplastic syndrome, 10 aplastic anemia, 7 Hodgkin's disease, 8 chronic lymphocytic leukemia, 5 multiple myeloma, and 5 hairy cell leukemia) who developed a proven FFI. Eighty percent of the patients had been neutropenic for an average of 14 days before the infection, and 71% had an absolute neutrophil count lower than 0.5 x 10(9)/L at the time of FFI diagnosis. The primary sites of infection were: lungs (85%), nose and paranasal sinus (10%), and other sites (5%). The diagnosis was made while still alive in 310 patients (79%), and at autopsy in the remaining 81 patients (21%). Chest X-ray was diagnostic in 77% of patients with pulmonary FFI, while computed tomography (CT) scan of the thorax was positive in 95% of cases. A significant diagnostic advantage for CT scan was observed in 145 patients who had both a chest X-ray and CT scan. Aspergillus was identified as the cause of FFI in 296 patients, Mucorales in 45 patients, Fusarium in 6 patients and other filamentous fungi species in 4 patients, while in a further 40 patients no agent was identifiable. The overall mortality rate three months after the diagnosis of FFI was 74%, and fungal infection had been the cause of death in 51% of patients.
  
  
  CONCLUSIONS
  Our retrospective study shows that FFI still remains a life-threatening complication in neutropenic patients. Despite appropriate treatment, half of the patients die due to this complication. The use of glucocorticoids and recovery from neutropenia are the most important prognostic factors. Mucorales infections are associated with a significantly poorer prognosis than those due to Aspergillus spp.
authors.affiliation: Istituto di Semeiotica Medica, Università Cattolica del Sacro Cuore, largo Francesco Vito 1, 00168 Rome, Italy. lpagano@rm.unicatt.it
authors.forename: L
authors.initials: L
authors.lastname: Pagano
authors.forename: C
authors.initials: C
authors.lastname: Girmenia
authors.forename: L
authors.initials: L
authors.lastname: Mele
authors.forename: P
authors.initials: P
authors.lastname: Ricci
authors.forename: M E
authors.initials: ME
authors.lastname: Tosti
authors.forename: A
authors.initials: A
authors.lastname: Nosari
authors.forename: M
authors.initials: M
authors.lastname: Buelli
authors.forename: M
authors.initials: M
authors.lastname: Picardi
authors.forename: B
authors.initials: B
authors.lastname: Allione
authors.forename: L
authors.initials: L
authors.lastname: Corvatta
authors.forename: D
authors.initials: D
authors.lastname: D'Antonio
authors.forename: M
authors.initials: M
authors.lastname: Montillo
authors.forename: L
authors.initials: L
authors.lastname: Melillo
authors.forename: A
authors.initials: A
authors.lastname: Chierichini
authors.forename: A
authors.initials: A
authors.lastname: Cenacchi
authors.forename: A
authors.initials: A
authors.lastname: Tonso
authors.forename: L
authors.initials: L
authors.lastname: Cudillo
authors.forename: A
authors.initials: A
authors.lastname: Candoni
authors.forename: C
authors.initials: C
authors.lastname: Savignano
authors.forename: A
authors.initials: A
authors.lastname: Bonini
authors.forename: P
authors.initials: P
authors.lastname: Martino
authors.forename: A
authors.initials: A
authors.lastname: Del Favero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005658:Fungi; D019337:Hematologic Neoplasms / Q000150:complications / Q000382:microbiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome