Blood Res 2022; 57(S1):
Published online April 30, 2022
https://doi.org/10.5045/br.2022.2022036
© The Korean Society of Hematology
Correspondence to : Dong-Gun Lee, M.D., Ph.D.
Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
E-mail: symonlee@catholic.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Invasive fungal infections (IFIs) are common causes of mortality and morbidity in patients with hematologic diseases. Delayed initiation of antifungal treatment is related to mortality. Aspergillus sp. is the leading cause of IFI followed by Candida sp. Diagnosis is often challenging owing to variable conditions related to underlying diseases. Clinical suspect and prompt management is important. Imaging, biopsy, and non-culture-based tests must be considered together. New diagnostic procedures have been improved, including antigen-based assays and molecular detection of fungal DNA. Among hematologic diseases, patients with acute myeloid leukemia, myelodysplastic syndrome, recipients of hematopoietic stem cell transplantation are at high risk for IFIs. Antifungal prophylaxis is recommended for these high-risk patients. There are continuous attempts to achieve ideal management of IFIs. Scoring system for quality control has been developed with important recommendations of current guidelines. Higher adherence to guidelines is related to decreased mortality in IFIs.
Keywords Hematologic diseases, Invasive fungal infections, Diagnosis, Treatment, Quality control
Blood Res 2022; 57(S1): S101-S111
Published online April 30, 2022 https://doi.org/10.5045/br.2022.2022036
Copyright © The Korean Society of Hematology.
Hyojin Ahn1, Raeseok Lee1,2, Sung-Yeon Cho1,2, Dong-Gun Lee1,2
1Division of Infectious Diseases, Department of Internal Medicine, 2Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
Correspondence to:Dong-Gun Lee, M.D., Ph.D.
Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
E-mail: symonlee@catholic.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Invasive fungal infections (IFIs) are common causes of mortality and morbidity in patients with hematologic diseases. Delayed initiation of antifungal treatment is related to mortality. Aspergillus sp. is the leading cause of IFI followed by Candida sp. Diagnosis is often challenging owing to variable conditions related to underlying diseases. Clinical suspect and prompt management is important. Imaging, biopsy, and non-culture-based tests must be considered together. New diagnostic procedures have been improved, including antigen-based assays and molecular detection of fungal DNA. Among hematologic diseases, patients with acute myeloid leukemia, myelodysplastic syndrome, recipients of hematopoietic stem cell transplantation are at high risk for IFIs. Antifungal prophylaxis is recommended for these high-risk patients. There are continuous attempts to achieve ideal management of IFIs. Scoring system for quality control has been developed with important recommendations of current guidelines. Higher adherence to guidelines is related to decreased mortality in IFIs.
Keywords: Hematologic diseases, Invasive fungal infections, Diagnosis, Treatment, Quality control
Table 1 . Changes of species distribution in the case of candidemia..
Pathogens | Seoul St. Mary’s Hospital (adult hematology unit only) | Korea | United States | Asia | Europea) | ||||
---|---|---|---|---|---|---|---|---|---|
Study period | 2011–2021 | 2011–2016 | 2017–2021 | 2013 | 2021 | 2012 | 2019 | 2016 | 2011 |
References | [16] | [17] | [18] | [19] | [20] | [114] | |||
Total | N=153 (%) | N=84 (%) | N=69 (%) | N=3,564 (%) | N=829 (%) | N=2,329 (%) | N=3,354 (%) | N=861 (%) | N=750 (%) |
38 (24.8) | 27 (32.1) | 11 (15.9) | 1,354 (38.0) | 353 (42.6) | 877 (37.7) | 1,307 (39.0) | 309 (35.9) | (55.2) | |
Non- | 115 (75.1) | 57 (67.9) | 58 (84.1) | 2,210 (62.0) | 476 (57.4) | 1,452 (62.3) | 2,047 (61.0) | 552 (64.1) | (44.8) |
55 (35.9) | 30 (35.7) | 25 (36.2) | 557 (15.6) | 156 (18.8) | 241 (10.3) | 292 (8.7) | 264 (30.7) | (7.3) | |
25 (16.3) | 8 (9.5) | 17 (24.6) | 589 (16.5) | 159 (19.2) | 670 (28.8) | 949 (28.3) | 116 (13.5) | (15.7) | |
16 (10.5) | 10 (11.9) | 6 (8.7) | 20 (0.6) | 15 (1.8) | 32 (1.4) | 72 (2.1) | 6 (0.7) | (2.5) | |
9 (5.9) | 4 (4.8) | 5 (7.2) | 844 (23.7) | 112 (13.5) | 389 (16.7) | 496 (14.8) | 135 (15.7) | (13.7) | |
4 (2.6) | 2 (2.4) | 2 (2.9) | 26 (0.7) | 9 (1.1) | 34 (1.5) | 66 (2.0) | 1 (0.1) | (1.2) | |
1 (0.1) | |||||||||
Others | 6 (3.9) | 3 (3.6) | 3 (4.3) | 174 (4.9) | 24 (2.9) | 86 (3.7) | 172 (5.1) | 30 (3.5) | (2.6) |
a)Without exact number of cases, only percentage..
Table 2 . Antifungal prophylaxis for patients with hematologic diseases in Seoul St. Mary’s Hospital (last revised January 2022)..
Type of patients | Primary | Alternative |
---|---|---|
AML Induction/reinduction chemotherapya) | Posaconazole (T) | Posaconazole (S) |
Fluconazole | ||
HMA/Venetoclasa) | ||
- Secondary/refractory AML | Posaconazole (T) | Posaconazole (S) |
- Relapsed AML (only in 1st and 2nd cycle) | Posaconazole (T) | Fluconazole |
- Otherwise | Fluconazole | |
Other chemotherapy (neutropenia >7 days)a) | Fluconazole | |
Auto-HSCTa),c) | Micafungin | Fluconazole |
Itraconazole | ||
Allo-HSCT (pre-engraftment)a),c) | Micafungin | Itraconazole (S) |
Allo-HSCT (in the presence of GVHD)b) | Posaconazole (T) | Posaconazole (S) |
Fluconazole |
a)Start from absolute neutrophil count ≤1,000 until resolution of neutropenia. b)Until at least 75 days from start or resolution of significant GVHD. c)Voriconazole is only used as secondary prophylaxis in patients with previous proven or probable IPA history..
Abbreviations: AML, acute myeloid leukemia; GVHD, graft versus host disease; HMA, hypomethylating agent; HSCT, hematopoietic stem cell transplantation; S, Syrup; T, Tablet..
Hyun Jung Lee
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