DIAGNOSIS AND TREATMENT COMBINATION OF INVASIVE ASPERGiLLOSIS and MUCORMYCOSIS IN HEMATOLOGICAL PATIENTS IN SAINT-PETERSBURG, RUSSIA

Ref ID: 19494

Author:

S Khostelidi1*, M Popova3, A Volkova3, O Shadrivova1, A Kolbin3, T Bogomolova2,
Y Michaylova2, A Polischouk2, C Ignatyeva2, L Zubarovskaya3, B Afanasyev3, N Vasilyeva2,
N Klimko1

Author address:

1Department of Clinical Mycology, North-Western State Medical University named after I.I.Mechnikov,
Saint-Petersburg, Russia
2Kashkin Research Institute of Medical Mycology, North-Western State Medical University named after
I.I.Mechnikov, Saint-P

Full conference title:

6th Advances Against Aspergillosis 2014

Abstract:

Objectives:
To analyze demographic parameters, underlying diseases, etiology, treatment and survival rate
of hematological patients with combination of invasive aspergillosis (IA) and mucormycosis in
St. Petersburg, Russia.
Methods:
The prospective study was conducted during the period 2007-2013 y.y. Diagnosis of IA and
mucormycosis was made according to EORTC/MSG criteria (2008). Species identification of
Aspergillus and mycormycetes was confirmed by sequencing of beta-tubulin and ITS/D1-D2
fragments of fungal ribosomal DNA, respectively.
Results:
We observed 15 hematological patients with IA and mucormycosis. The mean age of patients in
this cohort was 25 years (range 5-56), male and female ratio 1:1, adults were 60%. Main underlying
conditions in hematological patients with IA and mucormycosis were: acute myeloid leukemia –
33%, acute lymphoblastic leukemia – 33%, acute leukemia – 7%, chronic myeloid leukemia – 7%,
chronic lymphoblastic leukemia – 7%, non-Hodgkin’s lymphoma – 7% and Hodgkin’s lymphoma –
7% .
Aspergillus spp. were isolated from 67% of patients. The main agent of IA was: A. fumigatus – 50%,
A. niger – 20%, A. nidulans – 10%, A. flavus – 10%, Aspergillus spp. – 10%. Test «Platelia Aspergillus
EIA» (Bio-Rad) was positive in 60% of patients.
Diagnosis of mucormycosis was confirmed by histology and direct microscopy of biopsy samples
in all patients. Culture of clinical materials was positive in 73% cases: Rhizopus spp. (36%),
Rhizomucor spp. (27%), Rhizomucor pusillus (18%), Lichtheimia corymbifera (9%) and Rhizopus
oryzae (9%). The main sites of infection were lungs (67%), sinuses (33%), gastrointestinal system
(7%), more then two organs were affected in 40% patients.
Antifungal therapy was performed all of patients: voriconazole – 60%, posaconazole – 33%,
amphotericin B deoxycholate – 33%, caspofungin – 33%, amphotericin B lipid complex – 28%.
Combination therapy was used for 33% of patients. Surgical treatment was used in 40% of patients.
Duration of antifungal therapy was 3 – 180 days (median – 65). Overall survival at 12 weeks was
20%.
Conclusion:
The main underlying diseases in hematological patients with IA and mucormycosis – acute leukemia
(73%). The main aetiology agents were A. fumigatus (50%) and Rhizopus spp. (45%). Twelve weeks
overall survival was 20%.

Abstract Number: NULL

Conference Year: 2014

Link to conference website: http://www.AAA2014.org

New link: NULL

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