Fungal-associated pneumonia in patients with hematological malignancies

IF 1.4 4区医学 Q4 IMMUNOLOGY

Indian Journal of Medical Microbiology Pub Date : 2024-07-01 DOI:10.1016/j.ijmmb.2024.100654

Sarai Pineda-Benítez, Beda D. Islas-Muñoz, Pamela Alatorre-Fernández, Cyntia Ibanes-Gutiérrez C, Patricia Volkow-Fernández, Patricia Cornejo-Juárez

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引用次数: 0

Abstract

Purpose

Patients with hematologic malignancies (HM) are at high risk of invasive lung fungal infections (ILFI). To describe the main characteristics, treatment, and outcomes for five years in adult patients with HM and fungal pneumonia.

Methods

We conducted a retrospective study at Instituto Nacional de Cancerología (INCan), a referral tertiary care oncology hospital with 135 beds in Mexico City, Mexico. We included all cases of fungal pneumonia in patients with HM from January 1, 2017, to December 31, 2022. Cases were classified as proven, probable, and possible according to EORTC/MSG criteria 2021.

Results

Two hundred ten patients were included; the mean age was 40 years. The most frequent HM was acute lymphoblastic leukemia (n = 74) and acute myeloid leukemia (n = 68). One hundred forty patients (66.7%) had severe neutropenia for a median of 16 days. All patients had a CT thorax scan; in 132 (62.9%), multiple nodules were documented. Serum galactomannan (GM) was positive in 21/192 (10.9%) and bronchoalveolar lavage in 9/36 (25%). Fifty-three patients (25.2%) died in the first month. In the multivariate analysis for mortality in the first 30 days, hypoalbuminemia, shock, possible ILFI, and inappropriate antifungal treatment were statistically associated.

Conclusions

In high-risk HM patients, CT thorax scan and GM help diagnose ILFI. An appropriate antifungal improves mortality.

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血液恶性肿瘤患者的真菌相关肺炎。

目的：血液系统恶性肿瘤（HM）患者是侵袭性肺真菌感染（ILFI）的高风险人群。目的：描述患有血液系统恶性肿瘤和真菌性肺炎的成年患者的主要特征、治疗方法和五年来的治疗效果：我们在墨西哥国家癌症研究所（INCan）开展了一项回顾性研究，这是一家位于墨西哥墨西哥城的三级肿瘤转诊医院，拥有 135 张病床。我们纳入了2017年1月1日至2022年12月31日期间HM患者的所有真菌性肺炎病例。根据 EORTC/MSG 2021 标准，病例被分为已证实、可能和可能：结果：共纳入 210 例患者，平均年龄为 40 岁。最常见的HM是急性淋巴细胞白血病（74人）和急性髓细胞白血病（68人）。140名患者（66.7%）患有严重的中性粒细胞减少症，中位数为16天。所有患者都进行了胸部 CT 扫描，其中 132 人（62.9%）有多发结节记录。21/192（10.9%）例患者的血清半乳甘露聚糖（GM）呈阳性，9/36（25%）例患者的支气管肺泡灌洗呈阳性。53 名患者（25.2%）在第一个月内死亡。在前30天死亡率的多变量分析中，低白蛋白血症、休克、可能的ILFI和不恰当的抗真菌治疗在统计学上相关：结论：对于高危HM患者，胸部CT扫描和GM有助于诊断ILFI。结论：对于高危 HM 患者，CT 胸部扫描和 GM 有助于诊断 ILFI，适当的抗真菌治疗可提高死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Indian Journal of Medical Microbiology IMMUNOLOGY-

CiteScore

2.20

自引率

0.00%

发文量

154

审稿时长

73 days

期刊介绍： Manuscripts of high standard in the form of original research, multicentric studies, meta analysis, are accepted. Current reports can be submitted as brief communications. Case reports must include review of current literature, clinical details, outcome and follow up. Letters to the editor must be a comment on or pertain to a manuscript already published in the IJMM or in relation to preliminary communication of a larger study. Review articles, Special Articles or Guest Editorials are accepted on invitation.