The Significance of a Positive Respiratory Culture for Aspergillus versicolor in Cancer Patients

ESSAM GIRGAWY, MD, ISSAM I. RAAD, MD, AMAR SAFDAR, MD, GERALD P. BODEY, MD and DIMITRIOS P. KONTOYIANNIS, MD, UT

Author address: 

MD Anderson Cancer Ctr., Houston, TX

Abstract: 

The significance of rare non-fumigatus Aspergillus species as a cause of invasive aspergillosis (IA) has not been studied extensively. We evaluated the significance of positive respiratory cultures (BAL and sputum) for A. versicolor at our institution from 01/2000 to 01/2002. Forty-eight cultures positive for this rare mold were identified. Fifteen cases (31%) met the criteria for probable invasive pulmonary aspergillosis (IPA) according to the definitions set forth by the MSG/EORTC. Fourteen patients had hematological malignancy as underlying disease, and one patient had a solid tumor with BMT. Possible predisposing factors for IA were; BMT in 8 patients [53% 4 matchedunrelated, and 4 matched-related donor transplants], neutropenia in 7 patients (47%), steroids in 9 patients (60%), and GVHD in 2 patients (13%). Twelve of these 15 patients had positive respiratory cultures for A. versicolor in conjunction with other respiratory pathogens; 3 mold, 7 with yeast, 6 bacterial, 3 viral, and 1 with PCP. Seven (43%) patients received antifungal prophylaxis known to be active against Aspergillus spp,including amphotericin B lipid formulations, voriconazole, itraconazole and caspofungin. Nine patients (60%) were treated with combination antifungal therapy (including two or more of the following drugs; Amphotericin B Lipid formulations, caspofungin, itraconazole, posaconazole, and voriconazole). The remaining 6 patients received single drug therapy (3 with amphotericin B lipid formulations and voriconazole, itraconazole, or posaconazole, one patient each). The duration of treatment was 182 days (range 5-164 days). Eleven patients died (73%) despite antifungal treatment. IPA due to A. versicolor significantly contributed to their demise, in 91% of the cases. In conclusion, the presence of a positive respiratory culture for A. versicolor is associated with a poor outcome in patients with hematological malignancy. A. versicolor should be considered as a potential opportunistic mycosis in immunocompromised hosts.
2003

abstract No: 

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Full conference title: 

41st Annual Meeting Infectious Diseases Society of America
    • Infectious Diseases Society of America 41st