Invasive mold infections of the central nervous system in patients with hematologic cancer or stem cell transplantation (2000-2016): uncommon, with improved survival but still deadly often.
J Infect. 2017 Sep 14;:
Authors: Economides MP, Ballester LY, Kumar VA, Jiang Y, Tarrand J, Prieto V, Torres HA, Kontoyiannis DP
BACKGROUND: Historically considered to have very poor outcome, there is paucity of recent data regarding invasive mold infections (IMIs) of the central nervous system (CNS) in patients with hematologic cancer (HC) or stem cell transplantation (SCT).
METHODS: We reviewed the records of HC patients and/or SCT recipients who were diagnosed with CNS IMIs (EORTC/MSG criteria) at MD Anderson Cancer Center (1/1/2000-6/31/2016). Risk factors for survival at day (d) 42 post diagnosis were assessed.
RESULTS: We identified 40 such patients (16 with proven infection). The incidence density was 3.8 cases/100000 patient days and mortality remained stable throughout the study period. Most patients had active HC and neutropenia at diagnosis (95% and 53% respectively). Of the 25 patients with a microbiological diagnosis, Aspergillus spp and Mucorales accounted for 85% of cases. CNS IMIs were deemed to be secondary to hematogenous spread in 31 (77%), mostly (90%) fungal pneumonia. CNS lesions typically presented as a solitary ring-enhancing abscesses in MRI (26; 65%). Most patients (34; 85%) received lipid AMB and were treated with combination therapy (33; 83%); Mortality 42d was 48 %. In univariate analysis, lack of surgical drainage (p=0.01), absence of giant cells (p=0.01) and granulomas (p=0.03) were associated with increased 42d mortality. In multivariate analysis, co-infection was associated with increased (p=0.005), while steroid tapering (p=0.01) was associated with decreased mortality.
CONCLUSIONS: Although less lethal, improved outcome in these uncommon infections was related only to immune response in histopathology, steroid tapering and possibly surgical drainage.
PMID: 28919347 [PubMed - as supplied by publisher]