INVASIVE FUNGAL INFECTION AMONG FEBRILE PATIENTS WITH CHEMOTHERAPY-INDUCED NEUTROPENIA IN THAILAND.
Ployploen PhikulsodBundarika SuwannawiboonMethee ChayakulkeereePublished in: The Southeast Asian journal of tropical medicine and public health (2018)
Invasive fungal infections (IFI) can cause serious morbidity and mortality
among febrile patients with chemotherapy-induced neutropenia (CIN). In
order to evaluate the incidence, treatment outcome and factors associated with IFI
in this patient population in Thailand, we retrospectively reviewed the medical
record of patients admitted to Siriraj Hospital from January 2008 to June 2010.
Criteria used to diagnosed IFI were those of the European Organization for Research
and Treatment of Cancer/Invasive Fungal Infections Cooperative Group
and the National Institute of Allergy and Infectious Diseases/Mycoses Study
Group (EORTC/MSG) consensus 2008 criteria. Three hundred ten episodes of
chemotherapy-induced neutropenia occurred in 233 patients. IFI were found in
37 episodes (12%) and occurred only in patients who received chemotherapy for
hematological malignancies. The incidence of IFI among patients with hematologic
malignancies was 14%. Most commonly occurred in AML patients (17%). Patients
who received aggressive induction chemotherapy regimens for AML had the
highest incidence of IFI (20.5%). Of the 37 episodes, 12 were candidiasis, 5 were
aspergillosis, 1 was zygomycosis, 1 was fusariosis, 10 were probable and 9 were
possible IFI. The IFI-related mortality was 35%. The clinical factor associated with
IFI was a temperature > 39 °C during febrile neutropenia. A higher mortality rate
was seen in patients aged > 40 years and those with a serum albumin level < 3 g/dl.