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The times.. they are a changing
Dr. Hamdi AkanAnkara University Medical School
Dept. of Hematology
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United States, 1980-1997
Mortality duıe to invasive mycosisMcNeil MM, et al. Clin Infect Dis 2001;33:641-7
Mortality duıe to invasive mycosisMcNeil MM, et al. Clin Infect Dis 2001;33:641-7
Candida Aspergillus Other Mycoses
From De Bauw
Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem
Pfaller and Diekema Clin. Microbiol. Rev..2007; 20: 133-163
Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem
Pfaller and Diekema Clin. Microbiol. Rev..2007; 20: 133-163
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IAIC
Results of autopsy after fluconazole prophylaxis for hematological malignancies
Kami et al. Brit J Haematol 2002; 117:40-6
Results of autopsy after fluconazole prophylaxis for hematological malignancies
Kami et al. Brit J Haematol 2002; 117:40-6
720 patients
252InvasiveFungal
infections
positive blood cultures 8/37 (22%) C. albicans 11/24 (46%) non-albicans
CandidaAspergillusZygomycetesTrichosporonFusariumCryptococcusunknown
949191
34
80’s:14%
90’s:10%
From Ben De Pauw
Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem
Pfaller and Diekema Clin. Microbiol. Rev..2007; 20: 133-163
Comparison of invasive fungal infection after nonmyeloablative and myeloablative HCT
(1993-1998)
Fukuda, T. et al. Blood 2003;102:827-833
N=1673
ns
N=163All IFI Aspergillosis
Risk factors, timing, and mortality of aspergillosis after RIC vs conventional SCT
Daly 2003, Fukuda 2004, Kojima 2004
1. Aspergillosis occurs LATER after RIC (d120 vs d90)
2. Case FATALITY rates are comparable
3. Aspergillosis is the first cause of infectious mortality
NEW DRUGS!
Opportunistic infections in 547 organ transplant recipients receiving alemtuzumab, a humanized
monoclonal CD-52 antibody.Peleg AY, et al,. Clin Infect Dis. 2007 Jan 15;44(2):204-12.
CONCLUSIONS: Patients who received alemtuzumab for the
treatment of allograft rejection were significantly more likely to
develop an opportunistic infection, compared with patients who
received alemtuzumab for induction therapy only. Such data
have implications for new antimicrobial prophylactic strategies.
Infliximab use in patients with severe graft-versus-host disease and other emerging risk factors of non-Candida invasive fungal infections in allogeneic hematopoietic stem cell transplant
recipients: a cohort study. Francisco MM et al. Blood, 15 October 2003, Vol. 102, No. 8, pp. 2768-2776
We conclude that infliximab administration is associated
with a significantly increased risk of non-Candida IFI
in HSCT recipients with severe GVHD disease. Pre-
emptive systemic antifungal therapy against molds
should be considered in patients who develop severe
GVHD after HSCT if infliximab is used.
NO GOOD NEWS?
Invasive aspergillosis following hematopoietic cell transplantation: outcomes and prognostic factors
associated with mortality.Upton A, Kirby KA, Carpenter P, Boeckh M, Marr KA
Clin Infect Dis. 2007 Feb 15;44(4):531-40.
• CONCLUSIONS: There has been a significant decrease in
mortality in patients with a diagnosis of IA following HCT in
recent years, coinciding with multiple changes in transplantation
practices, including use of nonmyeloablative conditioning
regimens, receipt of peripheral blood stem cells, more prompt
diagnosis of IA, and use of voriconazole.
Yüksek riskli hastalar
GM 2 kez >0.5PA. AC. grafide
infiltrat veya İFİ ile uyumlu bulgu, belirti
Pozitif kültür, mikroskopi
5 günden fazla nötropenik ateş
Toraks CT ve/veya Sinus CTToraks CT ve BAL
Halo belirtisi
Atipik infiltrat
Bronkoskopi ve BAL
Normal
+ -
Geniş spektrumlu antifungal tedavi Antifungal tedavi verme, izlemeye devam et
Galactomannan and Computed Tomography–Based Preemptive Antifungal Therapy in Neutropenic Patients at High Risk for Invasive
Fungal Infection: A Prospective Feasibility Study. Maertens J, et al. CID 2005; 41:1242–50
In the febrile neutropenic group, antifungal treatment was needed in 35% of the patients treated empirically, this is only 7.7% in patients in the preemptively treated group.
Most of the patients who died had an underlying diease not in remision (76.9% vs. 30% three mo.).
Time to listen to an expert!
Dr. J. Maertens
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