Fungal infections in neutropenic patients: a 8-year prospective study
Marcio Nucci,Marcio Nucci,Wolmar Pulcheri,Nelson Spector,Ana Paula S. Bueno,Paulo Cesar Bacha,Maria Julieta Caiuby,Andrea Derossi,Rosane Orofino Costa,José Carlos Morals,Halley Pacheco de Oliveira +10 more
TL;DR: Identifying patients at risk, specific syndromes and prognostic factors may help to reduce the high mortality associated with disseminated fungal infections in neutropenic patients.
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Abstract: In this paper we report a eight-year prospective study designed to further characterize incidence, epidemiology, specific syndromes, treatment and prognosis associated with fungal infections in neutropenic patients. During the study period 30 fungal infections were diagnosed in 30 patients among 313 episodes of fever and neutropenia (10%). There were 15 cases of candidiasis, 5 pulmonary aspergillosis, 3 sinusitis by Aspergillus fumigatus, 5 infections by Fusarium sp., one infection by Trichosporon sp., and one infection due to Rhodotorula rubra. Blood cultures were positive in 18 cases (60%). The predisposing factors for fungal infection in multivariate analysis were the presence of central venous catheter (p<0.001), longer duration of profound (<100/mm3) neutropenia (p<0.001), the use of corticosteroids (p<0.001), gram-positive bacteremia (p=0.002) and younger age (p=0.03). In multivariate analysis only recovery of the neutropenia (p<0.001) was associated with good prognosis whereas the diagnosis of infection by Fusarium sp. (p=0.006) was strongly associated with a poor outcome. The death rate was 43%. There was no statistically significant difference in the death rate between patients who did receive (52%) or did not receive (50%) antifungal treatment. Identifying patients at risk, specific syndromes and prognostic factors may help to reduce the high mortality associated with disseminated fungal infections in neutropenic patients.
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Citations
Nosocomial fungal infections: epidemiology, diagnosis, and treatment
TL;DR: The mortality of nosocomial fungal infections remains high, and new therapeutic and preventative strategies are needed.
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Rhodotorula infection. A systematic review of 128 cases from literature.
TL;DR: Rhodotorula was the drug of choice in the treatment of fungemia and most of the eye infections were treated with topical amphotericin, although all patients lost their vision, and the overall mortality of Rhodotorula infection was 12.6%.
Parenchymal organ, and not splenic, immunity correlates with host survival during disseminated candidiasis.
Brad Spellberg,Douglas A. Johnston,Quynh T. Phan,John E. Edwards,Samuel W. French,Samuel W. French,Ashraf S. Ibrahim,Scott G. Filler +7 more
TL;DR: This is the first demonstration that host survival during systemic infection correlates with the type of immune response engendered in a nonlymphoid, parenchymal organ and not with the response in the spleen, and provides in vivo confirmation that hyphal formation by C. albicans induces type 2 or IL-10-dominant host responses in tissues.
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