Abstract

Opportunistic mycoses show distinct regional incidence patterns throughout the world and may exhibit different epidemiologic features depending on the geographic region. A prospective cohort study involving 8 brazilian centers was undertaken in order to characterize the epidemiology of invasive fungal infections in patients with acute myeloid leukemia and in hematopoietic stem cell transplant recipeints. Among 969 patients, 132 (14%) developed an invasive fungal infection. Aspergillosis (58%), invasive candidiasis (15%) and fusariosis (14%) were the most frequent mycoses. The incidence of invasive aspergillosis was 28% among patients with acute myeloid leukemia and 3% among hematopoietic stem cell transplant recipients, whereas fusariosis occurred in 3% of acute myeloid leukemia patients and in 2% of transplant recipients. Among hematopoietic stem cell transplpant recipients, the incidence of invasive aspergillosis was 4 times higher in allogeneic than in autologous transplantation. Likewise, invasive fusariosis was more common in allogeneic transplpant recipients (2.3% vs. 0.9%). The clinical presentation of invasive fusariosis was typical, with frequent positive blood cultures and metastatic skin lesions. However, a substantial number of cases had a cotaneous portal of entry, usually as cellulitis in patients with onychomycosis or intertrigus. Deoxycholate amphotericin B was given as primary treatment for invasive aspergillosis in 75% of cases, despite the poor results compared to voriconazole. This may have been due to budgetary restrictions in the 8 public hospitals. On the other hand, voriconazole was the most frqeuent agent used as second line therapy. ਀吀栀攀 欀渀漀眀氀攀搀最攀 漀昀 琀栀攀 攀瀀椀搀攀洀椀漀氀漀最椀挀 挀栀愀爀愀挀琀攀爀椀猀琀椀挀猀 椀渀 愀 挀攀爀琀愀椀渀 爀攀最椀漀渀 椀猀 椀洀瀀漀爀琀愀渀琀 戀漀琀栀 氀漀挀愀氀氀礀 戀甀琀 愀氀猀漀 最氀漀戀愀氀氀礀Ⰰ 最椀瘀攀渀 琀栀攀 攀砀瀀愀渀猀椀漀渀 漀昀 琀爀愀瘀攀氀椀渀最 愀渀搀 洀椀最爀愀琀椀漀渀 琀栀爀漀甀最栀 搀椀昀昀攀爀攀渀琀 爀攀最椀漀渀猀 漀昀 琀栀攀 最氀漀戀攀⸀ 㰀⼀昀漀渀琀㸀㰀⼀瀀㸀㰀戀爀㸀㰀戀㸀䬀攀礀眀漀爀搀㨀 㰀⼀戀㸀☀渀戀猀瀀㬀愀猀瀀攀爀最椀氀氀漀猀椀猀Ⰰ 昀甀猀愀爀椀漀猀椀猀Ⰰ 椀渀瘀愀猀椀瘀攀 洀礀挀漀猀椀猀Ⰰ 椀洀洀甀渀漀猀甀瀀瀀爀攀猀猀攀搀㰀⼀琀搀㸀㰀⼀琀爀㸀㰀⼀琀愀戀氀攀㸀㰀⼀琀爀㸀㰀⼀琀搀㸀㰀⼀琀愀戀氀攀㸀㰀⼀戀漀搀礀㸀㰀⼀栀琀洀氀㸀