Abstract

RABAGLIATI B, Ricardo et al. Invasive fungal disease in hemato-oncological and hematopoietic stem cell transplantation patients from Hospital Clinico Universidad Católica, Santiago-Chile using revised EORTC/MSG diagnostic criteria. Rev. chil. infectol. [online]. 2009, vol.26, n.3, pp. 212-219. ISSN 0716-1018.  doi: 10.4067/S0716-10182009000400002.

Introduction: Invasive fungal disease (IFD) is a severe complication oceurring mostly in haemato-oncological (H-O) patients and hematopoietic stem cell transplant (HSCT) receptors. Our aim was to describe the IFD oceurring in our H-O and HSCT patients according to the EORTC/MSG revised criteria. Patients and Methods: IFD surveillance was performed in adult patients of the Hospital Clínico Universidad Católica, Santiago, Chile, from January 2004 to January 2008. Results: A total of 41 IFD episodes were identified in 39 patients; mean age was 46.6 ± 9.9 years, and 87.8% and 12.2% oceurred in H-O and HCTS patients respectively. 15/41(36.6%) episodes were proven, 36.6% probable and 11/41 (26.8%) possible. In 26 (63.4%) episodes aspergillosis was diagnosed (20 pulmonary, 3 sinus, 1 laryngeal and 1 case with pulmonary and cerebral involvement). In 7 patients (17.1%) candidiasis was diagnosed, 5 with a proven bloodstream infection and 2 with possible hepatosplenic candidiasis; mucormyeosis was diagnosed in 4 (9.8%) Fusarium infection was demonstrated in 2 patients (4.9%), and Mucor and Aspergillus pulmonary coinfection and Alternaría sp rhino-sinusitis in one patient each. The frequency of IFD among febrile neutropenic patients was 26.2% and 6.4% in H-O and HSCT receptors respectively. The overall mortality was 36%. Conclusions: Aspergillosis is the most common IFD infection among H-O patients and HSCT receptors in our center. Candidiasis followed although only in H-O patients most probably because of routine use of antifungal prophylaxis in HSCT recipients. Continuous surveillance is required to develop local guidelines and to evalúate antifungal strategies in different clinical scenarios.

Keywords : Febrile neutropenia; hematopoietic stem cell transplantation; mycoses; etiology; cancer; chemotherapy complications.