Invasive fungal infection in patients with hematologic disorders in a Brazilian tertiary care hospital

ABSTRACT INTRODUCTION: Invasive fungal infections (IFIs) are an important complication in immunocompromised individuals, particularly neutropenic patients with hematological malignancies. In this study, we aimed to verify the epidemiology and diagnosis of IFIs in patients with hematologic problems at a tertiary hospital in Goiânia-GO, Brazil. METHODS: Data from 117 patients, involving 19 cases of IFIs, were collected. The collected data included diagnosis methods, demographics, clinical characteristics, and in vitro susceptibility to different antifungal agents. Among the 19 cases, 12 were classified as proven IFI and 7 as probable invasive aspergillosis with detection of galactomannan in blood and presence of lung infiltrates in radiographic images. Logistic regression analysis showed that the proven and probable IFIs were associated with increased risk of death. Statistical analysis demonstrated that age, sex, and underlying disease were not independently associated with risk of death in IFI patients. RESULTS: Most bloodstream isolates of Candida spp. exhibited low minimum inhibitory concentrations (MICs) to all antifungal agents tested. Voriconazole and amphotericin had the lowest MICs for Aspergillus spp. and Fusarium spp., but Fusarium spp. showed the least susceptibility to all antifungals tested. Amphotericin B, fluconazole, and itraconazole were found to be inactive in vitro against Acremonium kiliense; but this fungus was sensitive to voriconazole. CONCLUSIONS: Considering the high number of IFI cases, with crude mortality rate of 6%, we could conclude that IFIs remain a common infection in patients with hematological malignancies and underdiagnosed ante mortem. Thus, IFIs should be monitored closely.

Helicobacter pylori infection in patients with hematological diseases

Helicobacter pylori [H. pylori] is a well known bacterial pathogen implicated in gastric diseases. Some studies refer to it's possible role in some hematological diseases. The aim of this study is to determine the association between Helicobacter pylori infection and some hematological diseases. This is a case-control study of 337 patients with a hematological disease [including acute and chronic leukaemias, Hodgkin's and non Hodgkin's lymphomas, hairy cell leukaemia, multiple myeloma, immune thrombocytopenic purpura and aplastic anemia] who were admitted to or attended hematology center at Marjan Teaching Hospital - Babylon - Iraq during the period from 1/7/2006 to 1/1/2009. Age and sex matched control group of 337 patients who have no hematological disease. They were taken during the same period and from the same geographical area [Babylon go vernorate]. Tests for H. pylori were done for both groups using One Step H. pylori Test Device with 93.7% total accuracy rate. H. pylori test was positive in 33.5% [113/337] and 37.3% [126/337] of control and patient groups respectively, while dyspeptic symptoms were found in 18.1% [61/337] and 39.4% [133/337] of control and patient groups respectively. There was no significant association between H. pylori infection and hematological diseases tested in this study in Iraqi patients from Babylon, however dyspeptic symptoms were more common in patients on steroids or chemotherapy

Haematogenous tuberculosis

Haematogenous tuberculosis is a tuberculosis affection of multiple organs not related to each other except by blood stream. In this study there were 40 patients with haematogenous tuberculosis out of 1419 patients with different chest diseases admitted to Taif Chest Hospital [which is the biggest hospital for chest diseases in the Kingdom of Saudi Arabia] during a period of one year forming incidence of 2.82%, this indirectly denotes that kingdom Saudi Arabia is an intermediate prevalence area according to WHO Classification. The total number of tuberculosis patients whether pulmonary or extrapulmonary admitted to Taif chest hospital during that period was 577, out of them 40 patients were haematogenous tuberculosis [6.93%] which is a high incidence one and this raises the importance of BCG vaccination as BCG does not prevent infection but prevent haematogenous dissemination