ABSTRACT
We evaluated the outcomes of patients with hematologic diseases diagnosed with acute invasive Aspergillus rhinosinusitis comparing a group of patients diagnosed after voriconazole was available at our center with a historical group of patients diagnosed before voriconazole was available. Voriconazole use was associated with a decrease in mortality and earlier clinical response.
Subject(s)
Anemia, Aplastic/microbiology , Anemia, Aplastic/therapy , Aspergillosis/diagnosis , Hematologic Neoplasms/microbiology , Hematologic Neoplasms/therapy , Pyrimidines/therapeutic use , Triazoles/therapeutic use , Acute Disease , Adolescent , Adult , Aged , Aspergillosis/therapy , Child , Cohort Studies , Female , Humans , Male , Middle Aged , Treatment Outcome , VoriconazoleABSTRACT
The microbiological, clinical, and epidemiological features of most non-Candida albicans Candida species are well known, but much less is known about species such as Candida guilliermondii, an uncommon pathogen causing a variety of deep-seated infections in immunocompromised hosts. To characterize C. guilliermondii fungemia in patients with hematological malignancies and its susceptibility to antifungal drugs, all cases of C. guilliermondii fungemia diagnosed in our department between 1983 and 2005 were retrospectively analyzed and the literature was reviewed. C. guilliermondii caused 29/243 (11.7%) candidemia episodes diagnosed during the study period. Central venous catheters were the documented sources of candidemia in 19/29 episodes (65.5%), and invasive tissue infections were documented in 2 (6.9%). In the remaining eight, the catheter was not removed and the source of the fungemia remained obscure. Seven episodes ended in death, but only one could be attributed to invasive C. guilliermondii infection. Molecular typing data reveal no evidence of common infection sources. Isolates displayed high rates of in vitro susceptibility to amphotericin B (100%), voriconazole (95%), and fluconazole (90%) and lower rates of in vitro susceptibility to flucytosine (86%), itraconazole (76%), and caspofungin (33%). Our literature review confirms that C. guilliermondii is a significantly more frequent cause of candidemia among cancer patients compared with the general hospital population. It accounted for <1% of the total number of Candida bloodstream isolates reported in the articles we reviewed, with higher rates in Europe (1.4%) and Asia (1.8%) compared with North America (0.3%).
Subject(s)
Candida/isolation & purification , Candidiasis/microbiology , Fungemia/microbiology , Hematologic Neoplasms/complications , Antifungal Agents/pharmacology , Candida/classification , Candida/drug effects , Candida/genetics , Candidiasis/etiology , Candidiasis/mortality , Catheterization, Central Venous , DNA Fingerprinting , DNA, Fungal/analysis , DNA, Fungal/genetics , Female , Fungemia/etiology , Fungemia/mortality , Genotype , Humans , Male , Microbial Sensitivity Tests , Random Amplified Polymorphic DNA Technique , Retrospective Studies , Risk FactorsABSTRACT
Trichosporonosis is an uncommon but frequently fatal mycosis in immunocompromised patients. A multicenter retrospective study was conducted to characterize cases of proven or probable invasive trichosporonosis diagnosed over the past 20 years in Italian patients with hematological diseases. Of the 52 cases identified, 17 were classified as Trichosporon sp. infections and 35 were attributed to Geotrichum capitatum. Acute myeloid leukemia accounted for 65.4% of the cases. The incidence rates of Trichosporon sp. and G. capitatum infections in acute leukemia patients were 0.4 and 0.5%, respectively. Overall, 76.9% of cases had positive blood cultures. Pulmonary involvement was documented in 26.9% of cases. Death was reported for 57.1% of G. capitatum infections and for 64.7% of Trichosporon sp. infections. A literature review on trichosporonosis in patients with any underlying disease or condition reveals G. capitatum as a predominantly European pathogen, particularly in certain Mediterranean areas, while Trichosporon sp. infections are seen with similar frequencies on all continents. The majority of published Trichosporon sp. and G. capitatum infections occurred in patients with hematological diseases (62.8 and 91.7%, respectively). Well over half of these were suffering from acute leukemia (68 and 84% of patients with Trichosporon sp. and G. capitatum infections, respectively). Crude mortality rates were 77% for Trichosporon spp. and 55.7% for G. capitatum. The optimal therapy for trichosporonosis has yet to be identified; however, in vitro experiences are providing encouraging evidence of the potential role of the new triazoles, in particular, voriconazole.
