Ten-Year Survey of Incidence of Infection as a Cause of Death in Hematologic Malignancies: Study of 90 Autopsied Cases

Abstract

We investigated 90 autopsied cases with hematologic malignancy, including malignant lymphoma (ML), acute leukemia (AL), and adult T-cell leukemia (ATL) peculiar to our district, during the 10-year period 1982-1991 to determine the change in incidence of infection as a cause of death. We divided the cases into two groups representing the first half decade (1982-1986) and the second half decade (1987-1991) and compared the findings made in the two groups. Although infection was the major cause of death in those autopsied cases, the incidence of fatal infections decreased during the latter period. The incidence of fatal bacterial infections decreased, while fungal infections showed a relative increase. Pneumocystis carinii pneumonia and cytomegalovirus (CMV) infection occurred more frequently in patients with ATL than in those with ML or AL. Combined infection by more than three pathogens was observed in 2 cases of ATL. Our study revealed the characteristics of ATL specific to our district, and indicated the need to apply new strategies to prevent and treat fungal and viral infections in patients with hematologic malignancies.

Pneumocystis jirovecii pneumonia in patients with acute myeloid leukaemia

“…While PJP has been well known among patients with haematological malignancies, PJP in association with AML is uncommonly reported, except in the setting of allogeneic stem cell transplantation . The most common haematological malignancy associated with PJP is non‐Hodgkin lymphoma . As treatment of lymphoma often includes steroids, it is not surprising that such patients are susceptible to PJP infections.…”

“…2,8,9 The most common haematological malignancy associated with PJP is non-Hodgkin lymphoma. [9][10][11] As treatment of lymphoma often includes steroids, it is not surprising that such patients are susceptible to PJP infections. Addition of rituximab in treatment may lead to more severe immunosuppression and prophylaxis has been advocated.…”

Impact of open lung biopsy for undiagnosed pulmonary infiltrates in patients with hematological malignancies

“…In some patients death may ensue within a few days after respiratory symptoms and signs became evident. Diffuse pulmonary infiltration may be caused by viral, bacterial, or fungal infection in less than half of the patients [2,[6][7][8]. It may be caused by noninfectious etiologies such as hemorrhage, malignant infiltrations, adverse drug reaction, and opportunistic neoplasms.…”

HTLV-1 in Ophthalmology

“…According to our nationwide survey, the most frequent infectious manifestation among ATL patients was CMV retinitis (Kamoi et al, 2018; Table 1). CMV is well established as the most frequent pathogen underlying opportunistic infections among ATL patients (Suzumiya et al, 1993;Maeda et al, 2015), and CMV infection occurs more frequently in patients with ATL than in those with other leukemias (Funai et al, 1995). Among ATL patients, HTLV-1-infected CD4-positive T cells can transform into malignant cells, losing the normal function of CD4-positive T cells.…”