Molecular diagnosis of invasive aspergillosis in patients with hematologic malignancies – new answers to a diagnostic challenge?

2008 ◽  
Vol 2 (7) ◽  
pp. 753-761 ◽  
Author(s):  
Dieter Buchheidt
Keyword(s):  
Invasive Aspergillosis ◽  
Molecular Diagnosis ◽  
Hematologic Malignancies ◽  
Diagnostic Challenge

The Plasmair Decontamination System Is Protective Against Invasive Aspergillosis in Neutropenic Patients

2016 ◽  
Vol 37 (7) ◽  
pp. 845-851 ◽  
Author(s):  
Marie-Paule Fernandez-Gerlinger ◽  
Anne-Sophie Jannot ◽  
Sophie Rigaudeau ◽  
Juliette Lambert ◽  
Odile Eloy ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Severe Infection ◽  
Hematologic Malignancies ◽  
Preventive Strategies ◽  
European Organization ◽  
Exact Test ◽  
Eortc Criteria ◽  
Neutropenic Patients ◽  
Chemotherapy Induced Neutropenia ◽  
The Impact

OBJECTIVEInvasive aspergillosis (IA) is a rare but severe infection caused by Aspergillus spp. that often develops in immunocompromised patients. Lethality remains high in this population. Therefore, preventive strategies are of key importance. The impact of a mobile air decontamination system (Plasmair, AirInSpace, Montigny-le-Bretonneux, France) on the incidence of IA in neutropenic patients was evaluated in this study.DESIGNRetrospective cohort studyMETHODSPatients with chemotherapy-induced neutropenia lasting 7 days or more were included over a 2-year period. Cases of IA were confirmed using the revised European Organization for Research and Treatment of Cancer (EORTC) criteria. We took advantage of a partial installation of Plasmair systems in the hematology intensive care unit during this period to compare patients treated in Plasmair-equipped versus non-equipped rooms. Patients were assigned to Plasmair-equipped or non-equipped rooms depending only on bed availability. Differences in IA incidence in both groups were compared using Fisher’s exact test, and a multivariate analysis was performed to take into account potential confounding factors.RESULTSData from 156 evaluable patients were available. Both groups were homogenous in terms of age, gender, hematological diagnosis, duration of neutropenia, and prophylaxis. A total of 11 cases of probable IA were diagnosed: 10 in patients in non-equipped rooms and only 1 patient in a Plasmair-equipped room. The odds of developing IA were much lower for patients hospitalized in Plasmair-equipped rooms than for patients in non-equipped rooms (P=.02; odds ratio [OR] =0.11; 95% confidence interval [CI], 0.00–0.84).CONCLUSIONIn this study, Plasmair demonstrated a major impact in reducing the incidence of IA in neutropenic patients with hematologic malignancies.Infect Control Hosp Epidemiol 2016;37:845–851

scholarly journals Risk factors for invasive aspergillosis in neutropenic patients with hematologic malignancies

Leukemia ◽  
2005 ◽  
Vol 19 (4) ◽  
pp. 545-550 ◽  
Author(s):  
K Mühlemann ◽  
C Wenger ◽  
R Zenhäusern ◽  
M G Täuber
Keyword(s):  
Risk Factors ◽  
Invasive Aspergillosis ◽  
Hematologic Malignancies ◽  
Neutropenic Patients

scholarly journals Epidemiology and Antifungal Susceptibility Profile of Aspergillus Species: Comparison between Environmental and Clinical Isolates from Patients with Hematologic Malignancies

2019 ◽  
Vol 57 (7) ◽  
Author(s):  
Sung-Yeon Cho ◽  
Dong-Gun Lee ◽  
Won-Bok Kim ◽  
Hye-Sun Chun ◽  
Chulmin Park ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Cryptic Species ◽  
Hematologic Malignancy ◽  
Antifungal Susceptibility ◽  
Hematologic Malignancies ◽  
Clinical Isolates ◽  
Environmental Isolates ◽  
Content Type ◽  
Culture Positive ◽  
Global Data

ABSTRACT Global data on the epidemiology and susceptibility of Aspergillus are crucial in the management of invasive aspergillosis. Here, we aimed to determine the characteristics of clinical and environmental Aspergillus isolates, focusing mainly on hematologic malignancy patients. We prospectively collected all consecutive cases and clinical isolates of culture-positive proven/probable invasive aspergillosis patients from January 2016 to April 2018 and sampled the air inside and outside the hospital. Cryptic species-level identification of Aspergillus, antifungal susceptibilities, and cyp51 gene sequencing were performed, and clinical data were analyzed. This study was conducted as part of the Catholic Hematology Hospital Fungi Epidemiology (CAFÉ) study. A total of 207 proven/probable invasive aspergillosis and 102 clinical and 129 environmental Aspergillus isolates were included in this analysis. The incidence of proven/probable invasive aspergillosis was 1.3 cases/1,000 patient-days during the study period. Cryptic Aspergillus species accounted for 33.8%, with no differences in proportions between the clinical and environmental isolates. Section Nigri presented a high proportion (70.5%) of cryptic species, mainly from A. tubingensis and A. awamori: the former being dominant in environmental samples, and the latter being more common in clinical isolates (P < 0.001). Of 91 A. fumigatus isolates, azole-resistant A. fumigatus was found in 5.3% of all A. fumigatus isolates. Three isolates presented the TR34/L98H mutation of the cyp51A gene. Patients with invasive aspergillosis caused by azole-resistant A. fumigatus showed 100% all-cause mortality at 100 days. This study demonstrates the significant portion of cryptic Aspergillus species and clinical implications of azole resistance and underscores the comparison between clinical and environmental isolates.

Advancing genomic approaches to the molecular diagnosis of mitochondrial disease

2018 ◽  
Vol 62 (3) ◽  
pp. 399-408 ◽  
Author(s):  
Sarah Louise Stenton ◽  
Holger Prokisch
Keyword(s):  
Molecular Diagnosis ◽  
Mitochondrial Disease ◽  
Genetic Diagnosis ◽  
Mitochondrial Diseases ◽  
Candidate Gene Approach ◽  
Disease Genes ◽  
Variant Interpretation ◽  
Diagnostic Challenge ◽  
Whole Exome ◽  
Prior Analysis

Mitochondrial diseases present a diagnostic challenge due to their clinical and genetic heterogeneity. Achieving comprehensive molecular diagnosis via a conventional candidate-gene approach is likely, therefore, to be labour- and cost-intensive given the expanding number of mitochondrial disease genes. The advent of whole exome sequencing (WES) and whole genome sequencing (WGS) hold the potential of higher diagnostic yields due to the universality and unbiased nature of the methods. However, these approaches are subject to the escalating challenge of variant interpretation. Thus, integration of functional ‘multi-omics’ data, such as transcriptomics, is emerging as a powerful complementary tool in the diagnosis of mitochondrial disease patients for whom extensive prior analysis of DNA sequencing has failed to return a genetic diagnosis.

Liposomal amphotericin B in combination with caspofungin for invasive aspergillosis in patients with hematologic malignancies

Cancer ◽  
2007 ◽  
Vol 110 (12) ◽  
pp. 2740-2746 ◽  
Author(s):  
Denis Caillot ◽  
Anne Thiébaut ◽  
Raoul Herbrecht ◽  
Stéphane de Botton ◽  
Arnaud Pigneux ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Hematologic Malignancies ◽  
Liposomal Amphotericin B

Ten Years of Experience with Invasive Aspergillosis: Has Anything Changed?.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3687-3687
Author(s):  
Gloria Mattiuzzi ◽  
Jorge Cortes ◽  
Jennifer Ho ◽  
Hagop M. Kantarjian
Keyword(s):  
Mortality Rate ◽  
Invasive Aspergillosis ◽  
Hematologic Malignancies ◽  
Mortality Rates ◽  
Antifungal Drugs ◽  
Lymphocytic Leukemia ◽  
Myelogenous Leukemia ◽  
Myelocytic Leukemia ◽  
Incidence And Mortality ◽  
The Moment

Abstract Abstract 3687 Poster Board III-623 Invasive Aspergillosis (IA) has represented a threat for patients and physicians for many years. This is especially true for patients with hematologic malignancies. Several new antifungal agents with broad antifungal activity became available in 2000 ushering in a new millennium with hopes that with this new armamentarium of antifungal drugs will decrease mortality due to IA and perhaps even prevent them better. Mortality rates due to IA have been described in recent reports as acceptable and even in some cancer centers significantly lower than before. The objective of the present study was to evaluate IA in patients with hematologic malignancies in the leukemia department at MDACC during the past 10 years (1998 to 2007) and compare the incidence and mortality rates between these two times periods. Methods retrospective review of all patients that presented at the leukemia department at MDACC from January 1998 to December 2007. Proven or probable IA was defined as per EORTC criteria. Results From 1998 to 2007, 12,845 patients were presented to our department, including 4,243 pts with acute myelogenous leukemia (AML); 940 with acute lymphocytic leukemia (ALL); 3,642 with chronic lymphocytic leukemia (CLL); and 4,276 with other type of leukemia (chronic myelocytic leukemia, low risk-myelodysplastic syndrome and miscellaneous). Overall median age was 58 (range 17-83); 60% were male, 83% did not have history of diabetes mellitus; 71% were neutropenic (ANC < 500) at the moment of the infection; and 11% had a previous bone marrow transplantation. The overall incidence of IA has significantly decreased from 4 % to 2% over the 10 study years (p= 0.005, IRR=0.45), however, the overall mortality rate (60%) has not decreased significantly. Comparison between the incidence of IA and mortality in the different subsets of patients between 1998-1999 and 2000-2007 is shown in Table 1 The incidence of IA decreased significantly between the two time periods only in patients with AML and in patients with ALL (p<0.001 and 0.004, respectively). However, although there has been a reduction in the mortality rate in all the subsets of patients in the two periods, this difference is not significant. Overall, A. fumigatus was the pathogen more frequently isolated (30%), followed by A. flavus (21%), A. terreus (18%) and A. niger (11%). In 10% of the episodes more than one Aspergillus species was isolated. In conclusion, our data suggests that the incidence of IA in patients with leukemia traditionally at high risk for IA has significantly decreased since 2000. Despite the availability of new antifungal drugs for the treatment of IA, the mortality rate in patients with hematological malignancies has not significantly decreased. Disclosures: Mattiuzzi: Merck: Research Funding.

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