Invasive aspergillosis in hematooncological patients: advantages and disadvantages of various diagnostic methods, treatment options and financial costs of therapy

Česká verzia

Authors: Z. Ráčil ¹; J. Mayer ¹; I. Kocmanová ²; B. Wagnerová ¹; J. Winterová ¹; F. Folber ¹; M. Lengerová ¹; M. Moulis ³; D. Žáčková ¹; L. Šmardová ¹; A. Janíková ¹; M. Navrátil ¹; D. Dvořáková ¹; J. Vorlíček ¹
Authors place of work: Interní hematoonkologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jiří Vorlíček, CSc. ¹; Oddělení klinické mikrobiologie FN Brno, pracoviště Bohunice, přednostka prim. MUDr. Alena Ševčíková ²; Ústav patologie Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jirka Mačák, CSc. ³
Published in the journal: Vnitř Lék 2008; 54(2): 157-168
Category: Original Contributions

Summary

Background:
Invasive aspergillosis (IA) is a leading invasive fungal infection in hematooncological patients. The aim of this study was to analyse the incidence, diagnostic procedures and treatment of IA in hematooncological department in large hospital in the Czech Republic.

Patients and methods:
A retrospective analysis of medical and laboratory records from patients hospitalised in our department with proven/probable IA between January 2000 and December 2006 was performed.

Results:
52 cases of IA in 51 patients were identified (17.3 % proven IA/82.7 % probable IA). Number of IA cases notably increased during study period (1 case of IA in 2000 vs 21 cases of IA in 2006) and majority of them was of nosocomial origin (61.5 %). Pulmonary aspergillosis was diagnosed in 46 cases (88.5 %). Patients treated for acute leukemia or undergoing allogeneic stem cell transplantation represent the group at the highest risk of IA (in total 52 % of cases). Fever and signs of pulmonary involvement were the most common clinical signs of infection (presented in 92.3 % and 69.2 cases respectively). Conventional diagnostic methods including autopsy were able to diagnose only 15 cases of IA (28.8 %). In all other cases (71.2 %) the diagnosis was done by detection of galactomannan (GM) in serum. Introduction of GM monitoring enabled erlier initiation of antifungal treatment by 4 days. Initial therapy of IA led to the treatment response (partial and complete) in 18 (34.6 %) of infections - the highest percentage of response has been seen in voriconazole monotherapy group (42 %) and when combination of voriconazole and caspofungin has been used (83 %). Salvage therapy was initiated due to the failure of initial treatment in 21 (40.3 %) of cases. Patients were treated mostly with combination of voriconazole and caspofungin and/or monotherapy with voriconazole has been used with treatment response 55 % and 50 % respectively. Introduction of new antifungal drugs together with increased number of patients with IA led to the marked increase of total costs spent on treatment of IA per year - from 11,5 thousands CZK in 2000 to 6,2 millions CZK in 2006.

Conclusions:
IA is the most frequent cause of infection-related mortality in patients with haematological malignancies. Routine use of non-culture base methods in diagnosis of IA together with treatment using new, effective antifungals can improve prognosis of patients with this life threatening infection.

Key words:
invasive fungal infection - Aspergillus - invasive aspergillosis - galactomannan - early diagnosis - antifungal therapy - hematological malignancies

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