title: Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: an autopsy study over a 15-year period (1989-2003).
abstract: We evaluated autopsy-proven invasive fungal infections (IFI) in patients with hematologic malignancies over three periods (1989-1993, 1994-1998, and 1999-2003). The autopsy rate declined significantly (67%-34%-26%, respectively p<0.0001). IFI were identified in 314 (31%) of 1017 autopsies. Most IFI (75%) were not diagnosed antemortem. The prevalence of invasive mold infections increased significantly (19%-24%-25% p=0.05) in parallel with the emergence of Zygomycetes (0.9%-4%-3%; p=0.03). The prevalence of all other IFI remained relatively constant. Among patients with invasive pulmonary aspergillosis, those with graft-versus-host disease had a histopathological pattern distinct from those with neutropenia. The complex and evolving epidemiology of IFI in severely immunocompromised patients is not well captured by current diagnostic methods.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, Unit 402, Laboratory Medicine, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
authors.forename: Georgios
authors.initials: G
authors.lastname: Chamilos
authors.forename: Mario
authors.initials: M
authors.lastname: Luna
authors.forename: Russell E
authors.initials: RE
authors.lastname: Lewis
authors.forename: Gerald P
authors.initials: GP
authors.lastname: Bodey
authors.forename: Roy
authors.initials: R
authors.lastname: Chemaly
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Tarrand
authors.forename: Amar
authors.initials: A
authors.lastname: Safdar
authors.forename: Issam I
authors.initials: II
authors.lastname: Raad
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications / Q000382:microbiology; D019337:Hematologic Neoplasms / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology / Q000209:etiology*; D009503:Neutropenia / Q000150:complications; D009894:Opportunistic Infections; D015995:Prevalence
chemical_list: D007166:Immunosuppressive Agents