Invasive fusariosis in patients with hematologic malignancies at a cancer center: 1998–2009
Accepted 28 January 2010. published online 04 March 2010.
Summary
Background
Fusarium species cause severe infections in patients with hematologic malignancies. Few data are available concerning the outcome of fusariosis in the era of the expanding antifungal armamentarium.
Methods
We retrospectively identified patients with hematologic malignancy and positive cultures for Fusarium species at the MDACC (1998–2009). The diagnosis of proven or probable fusariosis was made according to modified EORTC/MSG criteria.
Results
Forty-four cases (75% proven) were identified over study period. Most (71%) patients had uncontrolled hematological malignancy and 21 patients (47%) received hematopoietic stem cell transplantation (85% allogeneic). Most patients (82%) were neutropenic at diagnosis (75% < 100/mm3). Patients had overlapping clinical syndromes: sinus 27%, pulmonary 75%, skin 68%, fungemia 36% and disseminated infection 70%. Bacterial (54%), fungal (36%) and viral (27%) co-infections were common. Most patients (84%) received combination therapy (typically a lipid formulation of amphotericin B and a triazole) with a mean duration of 28 days. Mortality at 12 weeks was 66%; 50% of deaths were attributable to Fusarium. Factors associated with increased likelihood of death at 12 weeks, included albumin <3.5 mg/dL, fungemia, and ICU admission; neutrophil recovery and fusariosis limited to skin were associated with improved survival (P < 0.05). Fungemia with Fusarium spp (OR 15.9; 1.1–231; P = 0.042) was the only risk factor independently associated with 12-week mortality with only 1/17 (6%) of patients still alive at 12 weeks.
Conclusions
Fusariosis, although uncommon, continues to have poor prognosis in neutropenic leukemic patients who present with fungemia.
aDepartment of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
bCollege of Pharmacy, University of Houston, Houston, TX, USA
Corresponding author. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Box 402, Houston, TX 77030, USA. Tel.: +1 713 792 6237; fax: +1 713 745 6839.
ABSTRACT