Invasive aspergillosis caused by Aspergillus non-fumigatus in children and adults after haematopoietic stem cell transplantation (HSCT) & chemotherapy

Author:

Marina Popova 1, Yuliya Rogacheva *1, Alisa Volkova 1, Inna Markova 1, Alexander Shvetcov 1, Ilya Nikolaev 1, Olga Pinegina 1, Svetlana Ignatyeva 2, Tatiyana Bogomolova 2, Aleksandr Siniaev 1, Asmik Gevorgian 1, Olesya Paina 1, Tatiyana Bykova 1, Elena Darskaya 1,Oleg Goloshapov 1, Maria Vladovskaya 1, Sergey Bondarenko 1, Ivan Moiseev 1, Ludmila Zubarovskaya 1, Nikolai Klimko 1;2, Boris Afanasyev 1

Author address:

1 Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg, Saint Petersburg, Russian Federation; 2 I.I. Mechnikov North-Western State Medical University, Ministry of Health of Russia, Saint Petersburg, Russian Federation

Full conference title:

European Congress of Clinical Microbiology and Infectious Diseases 2020

Date: 2 July 2020

Abstract:

Background: Invasive aspergillosis (IA) is a major cause of morbidity in hematological patients. Aspergillosis caused by non-fumigatus Aspergillus species is poorly studied.

Materials/methods: We design the retrospective study in order to investigate the epidemiology of IA caused by Aspergillus non-fumigatus as a single agent in large cohort of patients after HSCT and chemotherapy from 2013 to 2018 in CIC725. According to EORTC/MSG 2008 criteria 1 proven and 29 probable cases were diagnosed in patients with hematological malignances and non-malignant hematological diseases. The median age was 26 (3-60) y.o., males – 53%. The median follow up time was 10 months; for survivors – 17,5 months.

Results:The most common underlying diseases in patients with A. non-fumigatus IA were acute lymphoblastic leukemia (37%) and acute myeloid leukemia (30%). A. non-fumigatus IA was more often diagnosed in allo-HSCT recipients (90%) then after chemotherapy (10%). Most of the patients at the moment of IA diagnosed received antifungal prophylaxis with fluconazole (83%) or echinocandins (6,7%). Breakthrough IA (prophylaxis with voriconazole – 2, posaconazole – 1) was diagnosed in 10% of patients. Etiology agents were A.niger – 60%, A. flavus – 34%, A.glaucus – 3%, and A.terreus – 3%. The main sites of infection were lungs (80%), paranasal sinuses (10%), or combination lungs and paranasal sinuses (10%). A. non-fumigatus IA developed in combination with other infections in 20% (n=6): Klebsiella pneumonia – 33,3%, Pseudomonas aeruginosa – 33,3%, Kocuria kristinae – 16,7%, Trichoderma viride – 16,7%. The median time of onset of A. non-fumigatus IA after allo-HSCT was 155 (19- 922) days. Antifungal therapy was used in all patients: voriconazole – 73,3%, lipid amphotericin B – 6,7%, posaconazole – 6,7%, combination therapy – 13,3%. A. non-fumigatus IA developed on the background of acute graft-versus-host diseases(GVHD) grade 2-3 + glucocorticoids therapy (25%) and CMV reactivation (19%). Overall survival(OS) at 12 weeks from the diagnosis was 83,3%. Death could be attributed to IA was registered in one case.

Conclusions: Aspergillus non-fumigatus invasive aspergillosis affected patients predominantly with acute leukemia (67%) and allo-HSCT recipients (90%). Aspergillus niger was the main etiology agent. Aspergillus non-fumigatus IA developed on the background of CMV reactivation and acute GVHD. OS at 12 weeks from the IA diagnosis was 83,3%.

Presenter email address: juli_rogacheva@mail.ru

Abstract Number: 8144

Link to conference website:

Link Conference abstract: 

ECCMID 2020

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