Contributions
Abstract: PB2058
Type: Publication Only
Background
Hematological malignancies and their treatment are main risk factors for invasive fungal infections (IFD). Less frequent IFD such as scedosporiosis and lomentosporiosis (IS/IL) are emerging complications in such patients, with mortality rates up to 90%. Efficient diagnostic and treatment approaches for IS/IL are not known or validated yet. Furthermore, intrinsic resistance to almost all available antifungals hamper appropriate treatment decisions.
Aims
Clinical data were collected, to describe clinical presentation and management of IS/IL in hematological patients and to identify effective treatment strategies.
Methods
Data of probable and proven IS/IL cases collected from the literature and FungiScope™, an international web-based registry, were analysed. Data collected include demographics, underlying conditions, sites of infection, antifungal treatment, susceptibility to antifungals and outcome.
Results
Clinical data of 29 patients with infections caused by Scedosporium spp. and 28 by Lomentospora prolificans) with a hematologic disease were collected. Most patients had acute leukaemia (52.6%), lymphoma (15.8%) or chronic leukaemia (8.8%); 29.8% received allogeneic HSCT. Blood stream infection was confirmed in 21 (75%) IL patients and 1 (3.4%) IS patient. Other most frequently affected organs were lung, eye and CNS (49.1%, 24.6%, 19.3%). All patients received antifungal drugs for treatment (median 22 days, IQR 5 – 92 days) and 28.1% patients were surgically treated in addition. L. prolificans isolates had MICs of 1 mg/L and higher for amphotericin B, voriconazole, posaconazole, and caspofungin. Scedosporium spp. isolates had voriconazole MICs of 1 mg/L and lower. Most patients were treated with voriconazole (68.4%) and/or amphotericin B (56.1%). Terbinafine in combination with voriconazole was frequently used for treatment of IL (35.7%). Day‑42 and overall mortality was higher in IL (71.4% and 85.7%) than IS patients (27.6% and 55.2%).
Conclusion
IS/IL are rare, life threatening diseases in hematological patients. Despite aggressive antifungal treatment strategies, outcome remains poor. More effective treatment strategies are urgently needed to improve patient outcome.
Session topic: 31. Infectious diseases, supportive care
Abstract: PB2058
Type: Publication Only
Background
Hematological malignancies and their treatment are main risk factors for invasive fungal infections (IFD). Less frequent IFD such as scedosporiosis and lomentosporiosis (IS/IL) are emerging complications in such patients, with mortality rates up to 90%. Efficient diagnostic and treatment approaches for IS/IL are not known or validated yet. Furthermore, intrinsic resistance to almost all available antifungals hamper appropriate treatment decisions.
Aims
Clinical data were collected, to describe clinical presentation and management of IS/IL in hematological patients and to identify effective treatment strategies.
Methods
Data of probable and proven IS/IL cases collected from the literature and FungiScope™, an international web-based registry, were analysed. Data collected include demographics, underlying conditions, sites of infection, antifungal treatment, susceptibility to antifungals and outcome.
Results
Clinical data of 29 patients with infections caused by Scedosporium spp. and 28 by Lomentospora prolificans) with a hematologic disease were collected. Most patients had acute leukaemia (52.6%), lymphoma (15.8%) or chronic leukaemia (8.8%); 29.8% received allogeneic HSCT. Blood stream infection was confirmed in 21 (75%) IL patients and 1 (3.4%) IS patient. Other most frequently affected organs were lung, eye and CNS (49.1%, 24.6%, 19.3%). All patients received antifungal drugs for treatment (median 22 days, IQR 5 – 92 days) and 28.1% patients were surgically treated in addition. L. prolificans isolates had MICs of 1 mg/L and higher for amphotericin B, voriconazole, posaconazole, and caspofungin. Scedosporium spp. isolates had voriconazole MICs of 1 mg/L and lower. Most patients were treated with voriconazole (68.4%) and/or amphotericin B (56.1%). Terbinafine in combination with voriconazole was frequently used for treatment of IL (35.7%). Day‑42 and overall mortality was higher in IL (71.4% and 85.7%) than IS patients (27.6% and 55.2%).
Conclusion
IS/IL are rare, life threatening diseases in hematological patients. Despite aggressive antifungal treatment strategies, outcome remains poor. More effective treatment strategies are urgently needed to improve patient outcome.
Session topic: 31. Infectious diseases, supportive care