title: Invasive fungal diseases in haematopoietic cell transplant recipients and in patients with acute myeloid leukaemia or myelodysplasia in Brazil.
abstract: Invasive fungal disease (IFD) shows distinct regional incidence patterns and epidemiological features depending on the geographic region. We conducted a prospective survey in eight centres in Brazil from May 2007 to July 2009. All haematopoietic cell transplant (HCT) recipients and patients with acute myeloid leukaemia (AML) or myelodysplasia (MDS) were followed from admission until 1 year (HCT) or end of consolidation therapy (AML/MDS). The 12-month cumulative incidence (CI) of proven or probable IFD was calculated, and curves were compared using the Grey test. Among 237 AML/MDS patients and 700 HCT recipients (378 allogeneic, 322 autologous), the 1-year CI of IFD in AML/MDS, allogeneic HCT and autologous HCT was 18.7%, 11.3% and 1.9% (p <0.001), respectively. Fusariosis (23 episodes), aspergillosis (20 episodes) and candidiasis (11 episodes) were the most frequent IFD. The 1-year CI of aspergillosis and fusariosis in AML/MDS, allogeneic HCT and autologous HCT were 13.4%, 2.3% and 0% (p <0.001), and 5.2%, 3.8% and 0.6% (p 0.01), respectively. The 6-week probability of survival was 53%, and was lower in cases of fusariosis (41%). We observed a high burden of IFD and a high incidence and mortality for fusariosis in this first multicentre epidemiological study of IFD in haematological patients in Brazil.
authors.affiliation: University Hospital, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. mnucci@hucff.ufrj.br
authors.forename: M
authors.initials: M
authors.lastname: Nucci
authors.forename: M
authors.initials: M
authors.lastname: Garnica
authors.forename: A B
authors.initials: AB
authors.lastname: Gloria
authors.forename: D S
authors.initials: DS
authors.lastname: Lehugeur
authors.forename: V C H
authors.initials: VC
authors.lastname: Dias
authors.forename: L C
authors.initials: LC
authors.lastname: Palma
authors.forename: P
authors.initials: P
authors.lastname: Cappellano
authors.forename: K Y
authors.initials: KY
authors.lastname: Fertrin
authors.forename: F
authors.initials: F
authors.lastname: Carlesse
authors.forename: B
authors.initials: B
authors.lastname: Simões
authors.forename: M D
authors.initials: MD
authors.lastname: Bergamasco
authors.forename: C A
authors.initials: CA
authors.lastname: Cunha
authors.forename: A
authors.initials: A
authors.lastname: Seber
authors.forename: M P D
authors.initials: MP
authors.lastname: Ribeiro
authors.forename: F
authors.initials: F
authors.lastname: Queiroz-Telles
authors.forename: M L M
authors.initials: ML
authors.lastname: Lee
authors.forename: M L
authors.initials: ML
authors.lastname: Chauffaille
authors.forename: L
authors.initials: L
authors.lastname: Silla
authors.forename: C A
authors.initials: CA
authors.lastname: de Souza
authors.forename: A L
authors.initials: AL
authors.lastname: Colombo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001230:Aspergillus / Q000302:isolation & purification; D001938:Brazil / Q000453:epidemiology; D002175:Candida / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005670:Fusarium / Q000302:isolation & purification; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000382:microbiology; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000628:therapy; D014180:Transplantation; D055815:Young Adult