Fungal Empyema Thoracis in Cancer Patients

Masayuki Nigo, MD Jose Munita, MD Macarena Vial, MD Ying Jiang, MS Jeffrey J. Tarrand, MD Carlos Jimenez, MD Dimitrios P. Kontoyiannis, MD, ScD, FIDSA


Background. Fungal empyema thoracis (FET) is a rare life-threatening infection for which the data are scarce. We sought to describe FET in a series of cancer patients and to differentiate true fungal isolates from contaminants in pleural fluid. Methods. We conducted a retrospective chart review of patients who had a fungal isolate in a pleural fluid culture between January 2005 and August 2013. Based on EORTC/MSG diagnostic definition, FET was classified as a proven fungal disease (PFD), probable fungal disease or indeterminate, and risks for fungal infection were grouped as high risk (HR) and intermediate-low risk (IR). Results. A total of 106 fungal isolates were identified in 97 patients (pts). Candida spp. (58%) (mainly C. albicans and C. glabrata) and Aspergillus spp. (10%) were the most frequent pathogens. Compared to Aspergillus, Candida FET was associated with IR (81% versus 36%, P = 0.01), and preceding invasive thorasic or abdominal procedures (44% versus 0%, P = 0.01). In addition, patients with FET due to Candida spp. had frequent surgical drainage for empyema (65% versus 27%, P = 0.04) and better outcome (37% versus 60%, P = 0.32). All 11 pts with Aspergillus FET, and 83% of pts with Candida FET (45 of 54) were classified as a PFD. Three of Aspergillus group and 29% of Candida group (13 of 45); however, did not receive systemic antifungals (SA), but only 1 patient in each group (excluded 1 and 3 patients who lost follow up, respectively) had a poor outcome at six week (1 of 2, 50% and 1 of 10, 10%, respectively). Interestingly, 8 of the 9 Candida untreated patients who had a favorable outcome without SA had IR. In non-Aspergillus molds, Penicillium spp. (N = 12) were mainly isolated, however, excluded from this analysis since it is often considered as a laboratory contamination. Despite 11 patients with saprophytic molds were classified as a PFD, only one of them had persistent positive cultures. Most of the rest (8 of 10) were classified as IR, and did well without SA, except for one whose death was attributed to an underlying cancer. Conclusion. Although Candida FET was more frequent and associated with preceding procedures and IR, Aspergillus FET had a higher mortality. Most saprophytic molds appeared to represent non-pathologic isolates in pleural fluid, especially in IR patients. Disclosures. D. P. Kontoyiannis, Merck: Scientific Advisor, Research support. Pfizer: Research support, Research support. Gilead: Speaker's Bureau, Speaker honorarium. Astellas: Consultant and Speaker's Bureau, Speaker honorarium. F2G: Consultant, Consulting fee. T2 Biosystems: Speaker's Bureau, Speaker honorarium. Mylan, Inc: Speaker's Bureau, Speaker honorarium

Full conference title: 

IDWeek 2015 San Diego, CA
    • IDWeek 2015