Fungal infections in neutropenic patients: a 8-year prospective study Infecções fúngicas em pacientes neutropênicos: estudo prospectivo de 8 anos

• Published in: Revista do Instituto de Medicina Tropical de São Paulo
• Main Authors: Marcio Nucci, Wolmar Pulcheri, Nelson Spector, Ana Paula Bueno, Paulo Cesar Bacha, Maria Julieta Caiuby, Andrea Derossi, Rosane Costa, José Carlos Morals, Halley Pacheco de Oliveira
• Format: Article in Journal/Newspaper
• Language: English
• Published: Universidade de São Paulo (USP) 1995
• Subjects: Aspergillosis; Fusarium sp. infections; Candidiasis; Trichosporon sp. infections; Opportunistic fungal infections; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1590/S0036-46651995000500004; https://doaj.org/article/2fece8b3dbf349e89711880227d44dab

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. Com o objetivo de melhor caracterizar incidência, epidemiologia, síndromes específicas, tratamento e prognóstico associado com infecções fúngicas sistêmicas em pacientes neutropênicos foi feito um estudo prospectivo de 8 anos. Durante este período foram diagnosticadas 30 infecções fúngicas em 30 pacientes neutropênicos febris (10%). Houve 15 casos de candidíase, 5 aspergiloses pulmonares, 3 sinusites por Aspergillus fumigatus, 5 infecções por Fusarium sp., uma infecção por Trichosporon sp., e uma infecção por Rhodotorula rubra. As hemoculturas foram positivas em 18 ...