Invasive oro-facial fungal infections in patients with hematological malignancies: Report of 27 cases due to Aspergillus and non-Aspergillus species

Myoken Y., Sugata T., Mikami Y., Murayama S.Y.

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Purpose: Little is known about the characteristics and backgrounds that occur during the progression of invasive oro-facial fungal infections in immunocompromised patients. The aim of this study was to examine the clinicopathological features, antifungal susceptibilities, epidemiology and prognosis of these patients helping the early diagnosis and treatment of the disease. Patients and Methods: The patients with hematological malignancies who developed invasive oro-facial infections between 1990 and 2002 were studied. Fungal infections were identified with histological, microbiological, and molecular methods. The in vitro susceptibility studies were performed by the broth microdilution method M-3SP. Clinical records of the patients were reviewed and the following information was collected: underlying illness, neutropenia, and antifungal medication. Results: Twenty seven patients had positive fungal infections in histological examinations and 15 patients showed a positive culture for one of the following organisms: Aspergillus species in 13 patients (A. flavus in 10, A. terreus in 2, and A. fumigatus in 1), as well as Exophiala dermatitis, Trichoderma longibrachiatum, and Fusarium moniliforme in I patient each. Eleven patients were diagnosed as aspergillosis by in situ hybridization technique. The infection dramatically developed stage by stage into hemifacial necrosis with serious pain during neutropenia. All patients received surgery and were basically treated with amphotericin B in combination with itraconazole, or micafungin, In vitro susceptibility studies showed that non-Aspergillus species had elevated MICs against itraconazole and micafungin. Twenty-two of 27 patients survived with recovery of neutrophils. Conclusion: The high survival rate associated with invasive oro-facial fungal infections could be achieved with early diagnosis based on clinical findings and aggressive therapy in addition to the improvement of the patient's hematologic status. Myoken Y et al. Clinical Infectious Disease 33: 1975-S0, 2001 Myoken Y et al. Journal of Oral and Maxillofacal Surgery 66: 1905-12, 200S

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17th International Society for Human and Animal Mycology
    • ISHAM 17th (2009)