title: Invasive fungal diseases in patients with acute lymphoid leukemia.
abstract: Invasive fungal disease (IFD) represents an important complication in patients with acute lymphoid leukemia (ALL). The objectives of this study were to determine the prevalence of IFD in ALL patients with neutropenia, identify factors associated with IFD, and estimate the impact of IFD on the outcome. All patients with ALL who developed febrile neutropenia from 1987 to 2013 were evaluated. Cases of IFD were classified as proven or probable. Factors associated with IFD were evaluated by comparing episodes with and without a diagnosis of IFD. Among 350 episodes of febrile neutropenia, 31 IFDs were diagnosed (8.8%). Prolonged neutropenia was the only factor associated with IFD caused by yeasts. Factors associated with IFD caused by molds by multivariate analysis were the period after 2008, receipt of allogeneic transplant, relapsed ALL and prolonged neutropenia. Patients in relapse should receive induction chemotherapy in rooms with HEPA filter and receive antifungal prophylaxis.
authors.affiliation: a Department of Internal Medicine , University Hospital, Universidade Federal de Juiz de Fora , Juiz de Fora , MG Brazil ;
authors.forename: Andrea
authors.initials: A
authors.lastname: Nicolato
authors.affiliation: b Department of Preventive Medicine , University Hospital, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil ;
authors.forename: Simone A
authors.initials: SA
authors.lastname: Nouér
authors.affiliation: c Department of Internal Medicine , University Hospital, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil.
authors.forename: Marcia
authors.initials: M
authors.lastname: Garnica
authors.affiliation: c Department of Internal Medicine , University Hospital, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Portugal
authors.affiliation: c Department of Internal Medicine , University Hospital, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil.
authors.forename: Angelo
authors.initials: A
authors.lastname: Maiolino
authors.affiliation: c Department of Internal Medicine , University Hospital, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil.
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D018890:Chemoprevention; D002648:Child; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009181:Mycoses / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D009503:Neutropenia / Q000209:etiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Acute lymphoid leukemia; invasive fungal disease; mortality; prevalence; risk