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Revista do Instituto de Medicina Tropical de São Paulo

On-line version ISSN 1678-9946

Rev. Inst. Med. trop. S. Paulo vol.37 no.5 São Paulo Sept./Oct. 1995

http://dx.doi.org/10.1590/S0036-46651995000500004 

MICOLOGY

 

Fungal infections in neutropenic patients. A 8-year prospective study

 

Infecções fúngicas em pacientes neutropênicos. Estudo prospectivo de 8 anos

 

 

Marcio NucciI,II; Wolmar PulcheriI; Nelson SpectorI; Ana Paula BuenoII; Paulo Cesar BachaII; Maria Julieta CaiubyI; Andrea DerossiII; Rosane CostaII; José Carlos MoralsI; Halley Pacheco de OliveiraI

IServiços de Hematologia, Patologia Clínica e Anatomia Patológica, Hospital Universitário (HUCFF) - Universidade Federal do Rio de Janeiro
IISeção de Hematologia, Laboratório de Micologia, Hospital Universitário (HUPE) - Universidade do Estado do Rio de Janeiro

Correspondence to

 

 


SUMMARY

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.

Keywords: Aspergillosis; Fusarium sp. infections; Candidiasis; Trichosporon sp. infections; Opportunistic fungal infections.


RESUMO

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 casos (60%). Os fatores de risco para infecção fúngica em análise multivariada foram: presença de cateter venoso central (p<0,001), duração maior de neutropenia <100/mm3 (p<0,001), uso de corticosteróides (p<0,001), bacteremia por germes gram-positivos (p=0,002) e idade menor (p=0.03). Em análise multivariada apenas recuperação da neutropenia (p<0,001) esteve associada com bom prognóstico, enquanto que o diagnóstico de infecção por Fusarium sp. (p=0,006) se correlacionou com um mau prognóstico. A taxa de óbito foi de 43%. Não houve diferença estatisticamente significante nas taxas de óbito em pacientes que receberam (52%) ou não (50%) terapia anti-fúngica. A identificação de grupos de risco, síndromes específicas e fatores prognósticos pode contribuir para a redução na elevada letalidade das infecções fúngicas em pacientes neutropênicos.


 

 

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Correspondence to:
Dr. Marcio Nucci
Hospital Universitário Clementino Fraga Filho
Av. Brigadeiro Trompovsky s/n
21941-590 Rio de Janeiro, RJ, Brasil

Recebido para publicação em 11/05/1995
Aceito para publicação em 15/09/1995

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