Results
We analyzed 152 IFD (133 proven and 19 probable). All probable IFD were pulmonary aspergillosis, with high-resolution computerized tomography scans presenting dense, well-circumscribed lesions with a halo sign, air crescent sign, cavities or segmental or lobar consolidation, with galactomannan antigen detected in plasma. Table 1 depicts the demographics and other characteristics of patients. There were 133 fungal isolates in 133 patients (table 2).
[Table 1]
[Table 2]
There were 43 deaths attributed to IFD (28.3%), and survival probabilities were lower for pulmonary IFD (46.9%, log rank test p = 0.0017), for the diagnosis of leukemia (62.5%, p = 0.004), and neutropenia <500 cells/mm3 (55.4%, p < 0.0001). For Candida fungemia, survival probabilities were higher (76.6%, p = 0.043). Figure 1 depicts the Kaplan Meier survival curves for these conditions. Table 3 shows the Weibull hazard ratios and accelerated failure time models for the event “death caused by IFD”.
[Figure 1]
[Table 3]
Most of the cases of leukemia (51/56, 91%) were in children older than 4 years; about 72% of the patients were older than 4 years, but out of the 43 deaths, 38 (88%) were in this age group. Non-Candida and non-Cryptococcus yeasts caused fungemia in 16 patients, with three deaths (18.7%). In four patients, there were pulmonary lesions accompanying Candida fungemia, and Cryptococcus was isolated in lung biopsy in one case; all other cases of fungal pneumonia were associated with filamentous fungi. Pulmonary involvement could be correlated in chi-square tests with the diagnosis of leukemia (18/56 cases, 32%, p = 0.01), relapse of disease (17/41 cases, 41%, p = 0.0002), and neutropenia (23/74 cases, 31%, p = 0.0002).
In the HSCT patients, there were eight deaths (25.8%). Fungemia was diagnosed in 16 patients (51.6%) and pulmonary fungal infections in 12 (38.7%).