Invasive fungal infections are one of the main causes of morbidity and mortality in patients with haematological malignancies. Prolonged neutropenic period, damaged mucosal integrity; chemotherapeutic agents such as cytarabine, purine analogues and impaired cellular immunity are risk factors for fungal infections in these patients. Candidal infections and aspergillus species are the mostly encountered aetiological agents. Clinical evaluation of the patient, radiological findings and if possible for eligible patients fiberoptic bronchoscopy and bronchoalveolar lavage are preferred methods for demonstrating invasive fungal infections. In spite of these diagnostic procedures accurate diagnosis rate is as low as 9%. Ampotericin B 1-4 mg/kg/day provides improvement in 50-60% of the patients. In our department nine patients with acute leukaemia in induction or consolidation phase of their treatment were diagnosed as having invasive fungal infection. In four of these patients pulmonary aspergillosis was demonstrated by thorax computerized tomography one of whom the diagnosis was verified pathologically and microbiologically after lobectomy. In two of the five patients with hepatosplenic candidiasis microbiologic documentation was performed by hepatic biopsy besides abdominal ultrasonography. All patients received liposomal amphotericin B in varying doses, 1-3 mg/kg/day (Total: 3-10g) according to their clinical status. None of the patients had severe side-effects that caused cessation of antifungal treatment. Parenteral amphotericin B treatment stopped when clinical infection subsided and radiological lesions were regressed. Itracanazole in a daily dose of 400 mg p.o. started as long-term maintenance therapy until following chemotherapy. During febrile neutropenic period they were put on amphotericin B in doses 1-3 mg/kg/day. One of the patients with hepatosplenic cadidiasis also underwent allogeneic haematopoietic stem cell transplantation and no progression of the lesions was in amphotericin B coverage. Six of these patients are still alive and in complete remission except one patient. One of the remaining 3 patients died of progressive pulmonary infection and the others died of disease progression free of fungal infection. In conclusion previous fungal infections does not constitute an absolute contraindication for further myeloablative treatment under liposomal amphotericin B application both for prophylaxis and treatment.
Full conference title:
11th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 11th (2001)