Invasive aspergillosis in patients with hematological malignancies in the Czech and Slovak republics: Fungal InfectioN Database (FIND) analysis, 2005–2009
Summary Objectives To evaluate risk factors, diagnostic procedures, and treatment outcomes of invasive aspergillosis (IA) in patients with hematological malignancies. Methods A retrospective analysis of data from proven/probable IA cases that occurred from 2005 to 2009 at 10 hematology centers was p...
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| creator | Racil, Zdenek Weinbergerova, Barbora Kocmanova, Iva Muzik, Jan Kouba, Michal Drgona, Lubos Masarova, Lucia Guman, Tomas Tothova, Elena Forsterova, Kristina Haber, Jan Ziakova, Barbora Bojtarova, Eva Vydra, Jan Mudry, Peter Foralova, Renata Sejnova, Daniela Mallatova, Nada Kandrnal, Vit Cetkovsky, Petr Mayer, Jiri |
| description | Summary Objectives To evaluate risk factors, diagnostic procedures, and treatment outcomes of invasive aspergillosis (IA) in patients with hematological malignancies. Methods A retrospective analysis of data from proven/probable IA cases that occurred from 2005 to 2009 at 10 hematology centers was performed. Results We identified 176 IA cases that mainly occurred in patients with acute leukemias (58.5%), mostly those on induction/re-induction treatments (39.8%). Prolonged neutropenia was the most frequent risk factor for IA (61.4%). The lungs were the most frequently affected site (93.8%) and computed tomography detected abnormalities in all episodes; however, only 53.7% of patients had findings suggestive of IA. Galactomannan (GM) detection in serum or bronchoalveolar lavage fluid (positive in 79.1% and 78.8% of episodes, respectively) played a crucial role in IA diagnosis. Neutrophil count and antifungal prophylaxis did not influence the GM positivity rate, but empirical therapy decreased this rate (in serum). Of the IA cases, 53.2% responded to initial antifungal therapy. The combination of voriconazole and echinocandin, even as initial or salvage therapy, did not perform better than voriconazole monotherapy ( p = 0.924 for initial therapy and p = 0.205 for salvage therapy). Neutrophil recovery had a significant role in the response to initial (but not salvage) antifungal therapy. Conclusions Our retrospective analysis identified key diagnostic and treatment characteristics, and this understanding could improve the management of hematological malignancy patients with IA. |
| doi_str_mv | 10.1016/j.ijid.2012.09.004 |
| format | Article |
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Methods A retrospective analysis of data from proven/probable IA cases that occurred from 2005 to 2009 at 10 hematology centers was performed. Results We identified 176 IA cases that mainly occurred in patients with acute leukemias (58.5%), mostly those on induction/re-induction treatments (39.8%). Prolonged neutropenia was the most frequent risk factor for IA (61.4%). The lungs were the most frequently affected site (93.8%) and computed tomography detected abnormalities in all episodes; however, only 53.7% of patients had findings suggestive of IA. Galactomannan (GM) detection in serum or bronchoalveolar lavage fluid (positive in 79.1% and 78.8% of episodes, respectively) played a crucial role in IA diagnosis. Neutrophil count and antifungal prophylaxis did not influence the GM positivity rate, but empirical therapy decreased this rate (in serum). Of the IA cases, 53.2% responded to initial antifungal therapy. The combination of voriconazole and echinocandin, even as initial or salvage therapy, did not perform better than voriconazole monotherapy ( p = 0.924 for initial therapy and p = 0.205 for salvage therapy). Neutrophil recovery had a significant role in the response to initial (but not salvage) antifungal therapy. Conclusions Our retrospective analysis identified key diagnostic and treatment characteristics, and this understanding could improve the management of hematological malignancy patients with IA.</description><identifier>ISSN: 1201-9712</identifier><identifier>EISSN: 1878-3511</identifier><identifier>DOI: 10.1016/j.ijid.2012.09.004</identifier><identifier>PMID: 23084969</identifier><language>eng</language><publisher>Canada: Elsevier Ltd</publisher><subject>Acute Disease ; Adolescent ; Adult ; Aged ; Antifungal Agents - immunology ; Antifungal Agents - therapeutic use ; Antifungal treatment ; Aspergillosis - diagnosis ; Aspergillosis - drug therapy ; Aspergillosis - epidemiology ; Bronchoalveolar Lavage Fluid ; Child ; Child, Preschool ; Czech Republic - epidemiology ; Databases, Factual ; Diagnosis ; Echinocandins - therapeutic use ; Female ; Hematological malignancy ; Humans ; Infectious Disease ; Invasive aspergillosis ; Leukemia - diagnosis ; Leukemia - drug therapy ; Leukemia - epidemiology ; Lung Diseases, Fungal - diagnosis ; Lung Diseases, Fungal - drug therapy ; Lung Diseases, Fungal - epidemiology ; Male ; Mannans - blood ; Middle Aged ; Neutrophils - cytology ; Pulmonary/Respiratory ; Pyrimidines - therapeutic use ; Retrospective Studies ; Slovakia - epidemiology ; Triazoles - therapeutic use ; Voriconazole ; Young Adult</subject><ispartof>International journal of infectious diseases, 2013-02, Vol.17 (2), p.e101-e109</ispartof><rights>2012</rights><rights>Copyright © 2012. Published by Elsevier Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c455t-3f3e0a73f5094269bdf02119a9dbe747b00face258d6977975e5469442f43b533</citedby><cites>FETCH-LOGICAL-c455t-3f3e0a73f5094269bdf02119a9dbe747b00face258d6977975e5469442f43b533</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijid.2012.09.004$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,864,3541,27915,27916,45986</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23084969$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Racil, Zdenek</creatorcontrib><creatorcontrib>Weinbergerova, Barbora</creatorcontrib><creatorcontrib>Kocmanova, Iva</creatorcontrib><creatorcontrib>Muzik, Jan</creatorcontrib><creatorcontrib>Kouba, Michal</creatorcontrib><creatorcontrib>Drgona, Lubos</creatorcontrib><creatorcontrib>Masarova, Lucia</creatorcontrib><creatorcontrib>Guman, Tomas</creatorcontrib><creatorcontrib>Tothova, Elena</creatorcontrib><creatorcontrib>Forsterova, Kristina</creatorcontrib><creatorcontrib>Haber, Jan</creatorcontrib><creatorcontrib>Ziakova, Barbora</creatorcontrib><creatorcontrib>Bojtarova, Eva</creatorcontrib><creatorcontrib>Vydra, Jan</creatorcontrib><creatorcontrib>Mudry, Peter</creatorcontrib><creatorcontrib>Foralova, Renata</creatorcontrib><creatorcontrib>Sejnova, Daniela</creatorcontrib><creatorcontrib>Mallatova, Nada</creatorcontrib><creatorcontrib>Kandrnal, Vit</creatorcontrib><creatorcontrib>Cetkovsky, Petr</creatorcontrib><creatorcontrib>Mayer, Jiri</creatorcontrib><title>Invasive aspergillosis in patients with hematological malignancies in the Czech and Slovak republics: Fungal InfectioN Database (FIND) analysis, 2005–2009</title><title>International journal of infectious diseases</title><addtitle>Int J Infect Dis</addtitle><description>Summary Objectives To evaluate risk factors, diagnostic procedures, and treatment outcomes of invasive aspergillosis (IA) in patients with hematological malignancies. Methods A retrospective analysis of data from proven/probable IA cases that occurred from 2005 to 2009 at 10 hematology centers was performed. Results We identified 176 IA cases that mainly occurred in patients with acute leukemias (58.5%), mostly those on induction/re-induction treatments (39.8%). Prolonged neutropenia was the most frequent risk factor for IA (61.4%). The lungs were the most frequently affected site (93.8%) and computed tomography detected abnormalities in all episodes; however, only 53.7% of patients had findings suggestive of IA. Galactomannan (GM) detection in serum or bronchoalveolar lavage fluid (positive in 79.1% and 78.8% of episodes, respectively) played a crucial role in IA diagnosis. Neutrophil count and antifungal prophylaxis did not influence the GM positivity rate, but empirical therapy decreased this rate (in serum). Of the IA cases, 53.2% responded to initial antifungal therapy. The combination of voriconazole and echinocandin, even as initial or salvage therapy, did not perform better than voriconazole monotherapy ( p = 0.924 for initial therapy and p = 0.205 for salvage therapy). Neutrophil recovery had a significant role in the response to initial (but not salvage) antifungal therapy. Conclusions Our retrospective analysis identified key diagnostic and treatment characteristics, and this understanding could improve the management of hematological malignancy patients with IA.</description><subject>Acute Disease</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Antifungal Agents - immunology</subject><subject>Antifungal Agents - therapeutic use</subject><subject>Antifungal treatment</subject><subject>Aspergillosis - diagnosis</subject><subject>Aspergillosis - drug therapy</subject><subject>Aspergillosis - epidemiology</subject><subject>Bronchoalveolar Lavage Fluid</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Czech Republic - epidemiology</subject><subject>Databases, Factual</subject><subject>Diagnosis</subject><subject>Echinocandins - therapeutic use</subject><subject>Female</subject><subject>Hematological malignancy</subject><subject>Humans</subject><subject>Infectious Disease</subject><subject>Invasive aspergillosis</subject><subject>Leukemia - diagnosis</subject><subject>Leukemia - drug therapy</subject><subject>Leukemia - epidemiology</subject><subject>Lung Diseases, Fungal - diagnosis</subject><subject>Lung Diseases, Fungal - drug therapy</subject><subject>Lung Diseases, Fungal - epidemiology</subject><subject>Male</subject><subject>Mannans - blood</subject><subject>Middle Aged</subject><subject>Neutrophils - cytology</subject><subject>Pulmonary/Respiratory</subject><subject>Pyrimidines - therapeutic use</subject><subject>Retrospective Studies</subject><subject>Slovakia - epidemiology</subject><subject>Triazoles - therapeutic use</subject><subject>Voriconazole</subject><subject>Young Adult</subject><issn>1201-9712</issn><issn>1878-3511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ksFu1DAQhiMEoqXwAhyQj0UiwXbiJEYICW1ZWKkqh8LZcpzJrlPHTu1k0XLiHbjydDwJDls4cOA0I_n7x5r_nyR5SnBGMClf9pnudZtRTGiGeYZxcS85JXVVpzkj5H7s41PKK0JPkkch9DgSZVk_TE5ojuuCl_w0-bGxexn0HpAMI_itNsYFHZC2aJSTBjsF9EVPO7SDQU7OuK1W0qBBGr210ioNv9lpB2j1FdQOSduia-P28gZ5GOfGaBVeofVst1G2sR2oSbsrdCEn2cgA6Hy9ubp4HmXSHOLHLxDFmP389j0W_jh50EkT4MldPUs-r999Wn1ILz--36zeXqaqYGxK8y4HLKu8Y5gXtORN22FKCJe8baAqqgbjTiqgrG5LXlW8YsCKkhcF7Yq8YXl-lpwf547e3c4QJjHooMAYacHNQRBaR7wkZEHpEVXeheChE6PXg_QHQbBYUhG9WFIRSyoCcxE9j6Jnd_PnZoD2r-RPDBF4fQQgbrnX4EWIzloFrfbRMNE6_f_5b_6RK6PtEtQNHCD0bvbR3riHCFEjrpe7WM5iqZRRnP8CuuWzQQ</recordid><startdate>20130201</startdate><enddate>20130201</enddate><creator>Racil, Zdenek</creator><creator>Weinbergerova, Barbora</creator><creator>Kocmanova, Iva</creator><creator>Muzik, Jan</creator><creator>Kouba, Michal</creator><creator>Drgona, Lubos</creator><creator>Masarova, Lucia</creator><creator>Guman, Tomas</creator><creator>Tothova, Elena</creator><creator>Forsterova, Kristina</creator><creator>Haber, Jan</creator><creator>Ziakova, Barbora</creator><creator>Bojtarova, Eva</creator><creator>Vydra, Jan</creator><creator>Mudry, Peter</creator><creator>Foralova, Renata</creator><creator>Sejnova, Daniela</creator><creator>Mallatova, Nada</creator><creator>Kandrnal, Vit</creator><creator>Cetkovsky, Petr</creator><creator>Mayer, Jiri</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130201</creationdate><title>Invasive aspergillosis in patients with hematological malignancies in the Czech and Slovak republics: Fungal InfectioN Database (FIND) analysis, 2005–2009</title><author>Racil, Zdenek ; Weinbergerova, Barbora ; Kocmanova, Iva ; Muzik, Jan ; Kouba, Michal ; Drgona, Lubos ; Masarova, Lucia ; Guman, Tomas ; Tothova, Elena ; Forsterova, Kristina ; Haber, Jan ; Ziakova, Barbora ; Bojtarova, Eva ; Vydra, Jan ; Mudry, Peter ; Foralova, Renata ; Sejnova, Daniela ; Mallatova, Nada ; Kandrnal, Vit ; Cetkovsky, Petr ; Mayer, Jiri</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c455t-3f3e0a73f5094269bdf02119a9dbe747b00face258d6977975e5469442f43b533</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Acute Disease</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Antifungal Agents - immunology</topic><topic>Antifungal Agents - therapeutic use</topic><topic>Antifungal treatment</topic><topic>Aspergillosis - diagnosis</topic><topic>Aspergillosis - drug therapy</topic><topic>Aspergillosis - epidemiology</topic><topic>Bronchoalveolar Lavage Fluid</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Czech Republic - epidemiology</topic><topic>Databases, Factual</topic><topic>Diagnosis</topic><topic>Echinocandins - therapeutic use</topic><topic>Female</topic><topic>Hematological malignancy</topic><topic>Humans</topic><topic>Infectious Disease</topic><topic>Invasive aspergillosis</topic><topic>Leukemia - diagnosis</topic><topic>Leukemia - drug therapy</topic><topic>Leukemia - epidemiology</topic><topic>Lung Diseases, Fungal - diagnosis</topic><topic>Lung Diseases, Fungal - drug therapy</topic><topic>Lung Diseases, Fungal - epidemiology</topic><topic>Male</topic><topic>Mannans - blood</topic><topic>Middle Aged</topic><topic>Neutrophils - cytology</topic><topic>Pulmonary/Respiratory</topic><topic>Pyrimidines - therapeutic use</topic><topic>Retrospective Studies</topic><topic>Slovakia - epidemiology</topic><topic>Triazoles - therapeutic use</topic><topic>Voriconazole</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Racil, Zdenek</creatorcontrib><creatorcontrib>Weinbergerova, Barbora</creatorcontrib><creatorcontrib>Kocmanova, Iva</creatorcontrib><creatorcontrib>Muzik, Jan</creatorcontrib><creatorcontrib>Kouba, Michal</creatorcontrib><creatorcontrib>Drgona, Lubos</creatorcontrib><creatorcontrib>Masarova, Lucia</creatorcontrib><creatorcontrib>Guman, Tomas</creatorcontrib><creatorcontrib>Tothova, Elena</creatorcontrib><creatorcontrib>Forsterova, Kristina</creatorcontrib><creatorcontrib>Haber, Jan</creatorcontrib><creatorcontrib>Ziakova, Barbora</creatorcontrib><creatorcontrib>Bojtarova, Eva</creatorcontrib><creatorcontrib>Vydra, Jan</creatorcontrib><creatorcontrib>Mudry, Peter</creatorcontrib><creatorcontrib>Foralova, Renata</creatorcontrib><creatorcontrib>Sejnova, Daniela</creatorcontrib><creatorcontrib>Mallatova, Nada</creatorcontrib><creatorcontrib>Kandrnal, Vit</creatorcontrib><creatorcontrib>Cetkovsky, Petr</creatorcontrib><creatorcontrib>Mayer, Jiri</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Racil, Zdenek</au><au>Weinbergerova, Barbora</au><au>Kocmanova, Iva</au><au>Muzik, Jan</au><au>Kouba, Michal</au><au>Drgona, Lubos</au><au>Masarova, Lucia</au><au>Guman, Tomas</au><au>Tothova, Elena</au><au>Forsterova, Kristina</au><au>Haber, Jan</au><au>Ziakova, Barbora</au><au>Bojtarova, Eva</au><au>Vydra, Jan</au><au>Mudry, Peter</au><au>Foralova, Renata</au><au>Sejnova, Daniela</au><au>Mallatova, Nada</au><au>Kandrnal, Vit</au><au>Cetkovsky, Petr</au><au>Mayer, Jiri</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Invasive aspergillosis in patients with hematological malignancies in the Czech and Slovak republics: Fungal InfectioN Database (FIND) analysis, 2005–2009</atitle><jtitle>International journal of infectious diseases</jtitle><addtitle>Int J Infect Dis</addtitle><date>2013-02-01</date><risdate>2013</risdate><volume>17</volume><issue>2</issue><spage>e101</spage><epage>e109</epage><pages>e101-e109</pages><issn>1201-9712</issn><eissn>1878-3511</eissn><abstract>Summary Objectives To evaluate risk factors, diagnostic procedures, and treatment outcomes of invasive aspergillosis (IA) in patients with hematological malignancies. Methods A retrospective analysis of data from proven/probable IA cases that occurred from 2005 to 2009 at 10 hematology centers was performed. Results We identified 176 IA cases that mainly occurred in patients with acute leukemias (58.5%), mostly those on induction/re-induction treatments (39.8%). Prolonged neutropenia was the most frequent risk factor for IA (61.4%). The lungs were the most frequently affected site (93.8%) and computed tomography detected abnormalities in all episodes; however, only 53.7% of patients had findings suggestive of IA. Galactomannan (GM) detection in serum or bronchoalveolar lavage fluid (positive in 79.1% and 78.8% of episodes, respectively) played a crucial role in IA diagnosis. Neutrophil count and antifungal prophylaxis did not influence the GM positivity rate, but empirical therapy decreased this rate (in serum). Of the IA cases, 53.2% responded to initial antifungal therapy. The combination of voriconazole and echinocandin, even as initial or salvage therapy, did not perform better than voriconazole monotherapy ( p = 0.924 for initial therapy and p = 0.205 for salvage therapy). Neutrophil recovery had a significant role in the response to initial (but not salvage) antifungal therapy. Conclusions Our retrospective analysis identified key diagnostic and treatment characteristics, and this understanding could improve the management of hematological malignancy patients with IA.</abstract><cop>Canada</cop><pub>Elsevier Ltd</pub><pmid>23084969</pmid><doi>10.1016/j.ijid.2012.09.004</doi><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1201-9712 |
| ispartof | International journal of infectious diseases, 2013-02, Vol.17 (2), p.e101-e109 |
| issn | 1201-9712 1878-3511 |
| language | eng |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; ScienceDirect Journals (5 years ago - present); EZB-FREE-00999 freely available EZB journals |
| subjects | Acute Disease Adolescent Adult Aged Antifungal Agents - immunology Antifungal Agents - therapeutic use Antifungal treatment Aspergillosis - diagnosis Aspergillosis - drug therapy Aspergillosis - epidemiology Bronchoalveolar Lavage Fluid Child Child, Preschool Czech Republic - epidemiology Databases, Factual Diagnosis Echinocandins - therapeutic use Female Hematological malignancy Humans Infectious Disease Invasive aspergillosis Leukemia - diagnosis Leukemia - drug therapy Leukemia - epidemiology Lung Diseases, Fungal - diagnosis Lung Diseases, Fungal - drug therapy Lung Diseases, Fungal - epidemiology Male Mannans - blood Middle Aged Neutrophils - cytology Pulmonary/Respiratory Pyrimidines - therapeutic use Retrospective Studies Slovakia - epidemiology Triazoles - therapeutic use Voriconazole Young Adult |
| title | Invasive aspergillosis in patients with hematological malignancies in the Czech and Slovak republics: Fungal InfectioN Database (FIND) analysis, 2005–2009 |
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