title: Invasive aspergillosis in patients with hematological malignancies in the Czech and Slovak republics: Fungal InfectioN Database (FIND) analysis, 2005-2009.
abstract: OBJECTIVE
  To evaluate risk factors, diagnostic procedures, and treatment outcomes of invasive aspergillosis (IA) in patients with hematological malignancies.
  
  
  METHODS
  A retrospective analysis of data from proven/probable IA cases that occurred from 2005 to 2009 at 10 hematology centers was performed.
  
  
  RESULTS
  We identified 176 IA cases that mainly occurred in patients with acute leukemias (58.5%), mostly those on induction/re-induction treatments (39.8%). Prolonged neutropenia was the most frequent risk factor for IA (61.4%). The lungs were the most frequently affected site (93.8%) and computed tomography detected abnormalities in all episodes; however, only 53.7% of patients had findings suggestive of IA. Galactomannan (GM) detection in serum or bronchoalveolar lavage fluid (positive in 79.1% and 78.8% of episodes, respectively) played a crucial role in IA diagnosis. Neutrophil count and antifungal prophylaxis did not influence the GM positivity rate, but empirical therapy decreased this rate (in serum). Of the IA cases, 53.2% responded to initial antifungal therapy. The combination of voriconazole and echinocandin, even as initial or salvage therapy, did not perform better than voriconazole monotherapy (p=0.924 for initial therapy and p=0.205 for salvage therapy). Neutrophil recovery had a significant role in the response to initial (but not salvage) antifungal therapy.
  
  
  CONCLUSIONS
  Our retrospective analysis identified key diagnostic and treatment characteristics, and this understanding could improve the management of hematological malignancy patients with IA.
authors.affiliation: Department of Internal Medicine - Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic. zracil@fnbrno.cz
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Racil
authors.forename: Barbora
authors.initials: B
authors.lastname: Weinbergerova
authors.forename: Iva
authors.initials: I
authors.lastname: Kocmanova
authors.forename: Jan
authors.initials: J
authors.lastname: Muzik
authors.forename: Michal
authors.initials: M
authors.lastname: Kouba
authors.forename: Lubos
authors.initials: L
authors.lastname: Drgona
authors.forename: Lucia
authors.initials: L
authors.lastname: Masarova
authors.forename: Tomas
authors.initials: T
authors.lastname: Guman
authors.forename: Elena
authors.initials: E
authors.lastname: Tothova
authors.forename: Kristina
authors.initials: K
authors.lastname: Forsterova
authors.forename: Jan
authors.initials: J
authors.lastname: Haber
authors.forename: Barbora
authors.initials: B
authors.lastname: Ziakova
authors.forename: Eva
authors.initials: E
authors.lastname: Bojtarova
authors.forename: Jan
authors.initials: J
authors.lastname: Vydra
authors.forename: Peter
authors.initials: P
authors.lastname: Mudry
authors.forename: Renata
authors.initials: R
authors.lastname: Foralova
authors.forename: Daniela
authors.initials: D
authors.lastname: Sejnova
authors.forename: Nada
authors.initials: N
authors.lastname: Mallatova
authors.forename: Vit
authors.initials: V
authors.lastname: Kandrnal
authors.forename: Petr
authors.initials: P
authors.lastname: Cetkovsky
authors.forename: Jiri
authors.initials: J
authors.lastname: Mayer
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000276:immunology / Q000627:therapeutic use*; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D001992:Bronchoalveolar Lavage Fluid; D002648:Child; D002675:Child, Preschool; D018153:Czech Republic / Q000453:epidemiology; D016208:Databases, Factual; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D007938:Leukemia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008351:Mannans / Q000097:blood; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D011743:Pyrimidines / Q000627:therapeutic use; D012189:Retrospective Studies; D018154:Slovakia / Q000453:epidemiology; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D008351:Mannans; D011743:Pyrimidines; D014230:Triazoles; C012990:galactomannan; D065819:Voriconazole; D005690:Galactose