title: Invasive fungal infections in lymphoproliferative disorders: a monocentric retrospective experience.
abstract: Invasive fungal infections (IFIs) seem to be a relevant cause of morbidity and mortality in patients with chronic lymphoproliferative disorders. We studied retrospectively the epidemiology, clinical manifestations and outcome of invasive fungal infections in 42 patients with lymphoproliferative diseases, treated between January 2004 and February 2012 for probable or proven IFI. In our entire population (1355 patients) of chronic lymphoproliferative malignancies, the incidence of probable/proven IFI was 3% (molds 2.3%, yeasts 0.5%, mixed infections 0.2%). Eight patients developed a yeast infection documented by blood cultures in seven cases and by the microscopic observation of Candida spp. in the vitreum after vitrectomy in one case. Among molds we diagnosed three proven infections by histologic evidence of Aspergillus spp. (n = 2) and Mucor (n = 1) in the lung and 28 probable mycoses. Three mixed infections from both molds and yeasts were also observed. Twenty-two cases showed positivity of galactomannan antigen in the serum (n = 16), in bronchoalveolar lavage (BAL) fluid (n = 4) or in both (n = 2). Cultures were positive in 11 cases. The overall rate of response to therapy was 64%. Fungal-attributable mortality rate was 17%, with a significant difference between molds and yeasts (16% vs. 25%, p = 0.03). At univariate analysis, the only risk factors related to mortality were severe and prolonged neutropenia (p = 0.003) and age (p = 0.03). Among molds, the rapid start of antifungals was probably partially responsible, together with new drugs, for the reduction of mortality, despite the severe immunosuppression of these patients.
authors.affiliation: Division of Hematology.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Nosari
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Pioltelli
authors.forename: Marta
authors.initials: M
authors.lastname: Riva
authors.forename: Laura
authors.initials: L
authors.lastname: Marbello
authors.forename: Michele
authors.initials: M
authors.lastname: Nichelatti
authors.forename: Antonino
authors.initials: A
authors.lastname: Greco
authors.forename: Alfredo
authors.initials: A
authors.lastname: Molteni
authors.forename: Eleonora
authors.initials: E
authors.lastname: Vismara
authors.forename: Cristina
authors.initials: C
authors.lastname: Gabutti
authors.forename: Alberto
authors.initials: A
authors.lastname: Volonterio
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Lombardi
authors.forename: Enrica
authors.initials: E
authors.lastname: Morra
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015994:Incidence; D008232:Lymphoproliferative Disorders / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009181:Mycoses / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents
keywords: Mold infections; attributable mortality; chronic lymphoproliferative disorders; epidemiology; yeast infections