[Clinical features of invasive pulmonary fungal infection secondary to malignant blood diseases].
OBJECTIVE
To summarize the clinical features of invasive pulmonary fungal infection (IPFI) secondary to malignant blood diseases (MBD).


METHODS
We retrospectively analyzed the clinical data of 52 patients with IPFI secondary to MBD admitted to Peking Union Medical College Hospital from January 1995 to December 2008.


RESULTS
The incidences of IPFI secondary to acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), non-Hodgkin's lymphoma (NHL), and aplastic anemia (AA) were 4.6%, 3.2%, 2.8%, and 2.5%, respectively. In patients with IPFI secondary to AML, 88.5% (23/26) of the patients suffered from the infections during the non-remission (NR) period (including relapse), and 11.5% (3/26) in the complete-remission (CR) period. In all the patients with IPFI secondary to malignant blood diseases, 86.5% (45/52) of MBD were neutropenic or agranulocytic, and 67.3% (35/52) had been treated with broad-spectrum antibiotics for more than 96 hours before anti-fungal therapy. The total mortality after anti-fungal therapy was 13.7% (7/51). More than half of patients with fluconazole or itraconazole as the first-line therapy had to switch to other medicines because of poor infection control.


CONCLUSIONS
IPFI secondary to MBD is most common in AML patients. Patients with NR of AML, neutropenia or agranulocytosis, and long-term broad-spectrum antibiotics usage are susceptible to IPFI. Fluconazole and itraconazole have low efficacy, and other more potent anti-fungal medicines should be considered.
Sun
Xue-Feng
XF
Department of Hematology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China.
Han
Bing
B
Feng
Jun
J
Zhou
Dao-Bin
DB
Wang
Shu-Jie
SJ
Xu
Ying
Y
Chen
Jia-Lin
JL
Jiao
Li
L
Zhang
Wei
W
Li
Jian
J
Duan
Ming-Hui
MH
Zhu
Tie-Nan
TN
Zou
Nong
N
Hua
Bao-Lai
BL
Cai
Hua-Cong
HC
Zhao
Yong-Qiang
YQ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult