title: Fungal empyema thoracis in cancer patients.
abstract: OBJECTIVE
  Fungal empyema thoracis (FET) is a rare life-threatening infection. We sought to describe the clinical characteristics of FET in a large academic cancer center.
  
  
  METHODS
  We conducted a retrospective chart review of all cancer patients who had a fungal isolate from the pleural fluid culture between 1/2005 and 8/2013.
  
  
  RESULTS
  A total of 106 fungal isolates were identified in 97 patients. Yeasts accounted for 62% of the isolates whereas 38% were identified as molds. The most frequent pathogens were Candida spp. (58%) and Aspergillus spp. (12%). All patients with Aspergillus and 83% with Candida met criteria for proven fungal disease. Compared to the Aspergillus group, Candida FET was associated with recent abdominal or thoracic surgical procedures (44% vs. 0%, p = 0.01). Overall, 6-week mortality was high, with no significant differences between Candida and Aspergillus (31% vs. 45%, respectively [p = 0.48]). Only 1 out of 11 patients with uncommon molds died at 6 weeks, despite only 2 of them received appropriate antifungal therapy.
  
  
  CONCLUSIONS
  Development of FET carries a high mortality in cancer patients. A history of a recent surgical procedure is a risk factor for FET due to Candida. Isolation of uncommon molds is likely to represent a contamination of the pleural fluid.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nigo
authors.affiliation: Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Macarena R
authors.initials: MR
authors.lastname: Vial
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Munita
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tarrand
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Jimenez
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: dkontoyi@mdanderson.org.
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016724:Empyema, Pleural / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005658:Fungi / Q000145:classification / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000382:microbiology; D009369:Neoplasms / Q000150:complications*; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult
keywords: Cancer; Empyema; Fungal empyema; Invasive fungal infection