Invasive Fungal Infections in Patients with Acute Leukemia

Abstract

Invasive fungal infections, a serious problem among cancer patients, are increasing in incidence, and can cause morbidity and mortality. Such infections may hinder additional treatment, especially for patients with leukemia. We report here our experiences in the management of invasive fungal infection in patients with acute leukemia. A total of 18 patients were enrolled in the study: 12 had microabscesses of the liver and/or spleen and/or kidneys; four had sinonasal infections; and two had pulmonary infections. Most of the patients (88.9%) received amphotericin B during treatment for fungal infection. Thirteen patients achieved complete response without evidence of fungal infection in follow-up. In the study, there were 11 mortalities, including five patients who died during therapy and six who later died as a result of relapse or refractoriness of the leukemia. We suggest that many patients may have a good response to antifungal therapy, and that fungal infection does not have to preclude additional chemotherapy after proper management. The state of the underlying disease has a strong impact on outcome.

Invasive Fungal Infections in Patients with Hematologic Malignancies (Aurora Project): Lights and Shadows During 18-Months Surveillance

“…Although the actual incidence of the IFIs has increased, its real frequency is often underestimated because of the difficulty in diagnosis [ 15 ]. In fact, although the use of laboratory tests has expanded in recent years, IFIs diagnosis continue to be hampered by non-specific clinical manifestations and difficulties in obtaining appropriate biological samples for mycological investigations.…”

“…Such investigations usually require invasive procedures (e.g., histological samples, bronchoalveolar lavage) often precluded by cytopenia or by the critical condition of these patients. Moreover, the newer diagnostic approaches, focusing on the detection of surrogate markers such us circulating fungal antigens or metabolites (e.g., galactomannan and (1,3)-β- d -glucan), need serum samples repeated over time because of their occasional presence in the blood [ 15 ].…”

Case report of rare chronic myelogenous leukemia related multibacterial splenic abscess presenting with scrotal swelling

“…The etiology is commonly fungal, not multibacterial. 2–4 Another rare exception is from a case report of a CML patient who presented with peritonitis from a splenic abscess containing Escherichia coli . 1 …”