Epidemiology and Risk Factors of Invasive Fungal Infections
Invasive fungal infections (IFI) are well-known and feared infectious complications among patients with hematologic malignancies. This chapter aims to provide an overview of the epidemiology of IFI according to the different categories of onco-hematologic
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Epidemiology and Risk Factors of Invasive Fungal Infections Frédéric Lamoth
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Introduction
Invasive fungal infections (IFI) are well-known and feared infectious complications among patients with hematologic malignancies. The prolonged immunosuppressive state resulting from deep and long-lasting neutropenia following myeloablative chemotherapies or long-term anti-rejection therapies post hematopoietic stem cell transplantation (HSCT) represents the highest risk for the development of such infections. The epidemiology of IFI is difficult to assess, as their diagnosis often relies on a scale of probability (proven, probable, possible) according to the definitions of the European Organization for Research and Treatment of Cancer (EORTC) and Mycoses Study Group (MSG) (De Pauw et al. 2008). Given the limited sensitivity of culture, most IFIs nowadays are diagnosed in the absence of positive cultures and species identification. Multiple studies have assessed the incidence, distribution of fungal pathogens and risk factors of IFI among patients with hematologic malignancies. The epidemiology of IFI can be influenced by several factors, such as the geographical situation
F. Lamoth (*) Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
(temperate versus tropical regions), environmental conditions (e.g., building renovation works), diagnostic procedures (e.g., use of serological or molecular diagnostic tests), definition and classification of IFI (inclusion or not of probable and possible cases) or use of antifungal prophylaxis. This chapter aims to provide an overview of the epidemiology of IFI according to the different categories of onco-hematological patients and the type of fungal pathogens.
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ematopoietic Stem Cell H Transplantation (HSCT)
The cumulative incidence of IFI was estimated at 3.4% per year among a large cohort of HSCT recipients in the United States with molds accounting for about two-thirds of cases (Kontoyiannis et al. 2010). Among allogeneic HSCT recipients, the risk was higher among recipients from mismatched related or matched unrelated donors (8.1% and 7.7% per year, respectively) compared to matched related donors (5.8%). IFI were rarely observed among autologous HSCT recipients (1.2% per year), who experience shorter duration of neutropenia (usually less than 10 days) and a predominant cellular- mediated immune depression in follow-up. Data from the European continent show a similar epidemiological picture as illustrated by a large Italian cohort reporting an overall incidence of IFI of 3.7% over 5 years
© Springer Nature Switzerland AG 2021 O. A. Cornely, M. Hoenigl (eds.), Infection Management in Hematology, Hematologic Malignancies, https://doi.org/10.1007/978-3-030-57317-1_1
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F. Lamoth
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among all HSCT r ecipients (7.8% among allogeneic HSCT recipients) with the difference that recip
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