title: Epidemiology and sites of involvement of invasive fungal infections in patients with haematological malignancies: a 20-year autopsy study.
abstract: Autopsy studies remain an essential tool for understanding the patterns of fungal disease not detected ante mortem with current diagnostic approaches. We collected data concerning the microbiological trends, patient clinical characteristics and sites of involvement for invasive fungal infections (IFIs) identified at autopsy in a single large cancer treatment centre over a 20-year period (1989-2008). The autopsy rate and IFI prevalence both declined significantly during the study period. The prevalence of Aspergillus spp. decreased significantly from the first 15 years of the study (from 0.12 to 0.14 cases per 100 autopsies to 0.07 in 2004-2008; P = 0.04), with only Mucorales accounting for a greater proportion of IFIs over the duration of the study period (0.06 to 0.2 cases per 100 autopsies, P = 0.04). After 2003, moulds accounted for the majority of infections identified at autopsy in the spleen, kidney, heart and gastrointestinal tract. Despite a trend of decreasing prevalence from 1989 to 2004, invasive candidiasis increased in prevalence during later periods 2004-2008 (0.02-0.05 per 100 autopsies) with decreasing kidney, heart and spleen involvement. Despite a declining autopsy rate, these data suggest a decreasing prevalence overall of IFIs with changing patterns of dissemination in patients with haematological malignancies.
authors.affiliation: Departments of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Russell E
authors.initials: RE
authors.lastname: Lewis
authors.forename: Lizebeth
authors.initials: L
authors.lastname: Cahyame-Zuniga
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Leventakos
authors.forename: Georgios
authors.initials: G
authors.lastname: Chamilos
authors.forename: Ronen
authors.initials: R
authors.lastname: Ben-Ami
authors.forename: Pheroze
authors.initials: P
authors.lastname: Tamboli
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tarrand
authors.forename: Gerald P
authors.initials: GP
authors.lastname: Bodey
authors.forename: Mario
authors.initials: M
authors.lastname: Luna
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; D002648:Child; D002675:Child, Preschool; D005260:Female; D005658:Fungi / Q000145:classification / Q000302:isolation & purification; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D015995:Prevalence; D055815:Young Adult
keywords: Aspergillosis; candidemia; epidemiology