Table 1.
Different Clinical Manifestations, Treatment, and Outcome of Most Important Invasive Fungal Infections in Patients with Hematologic Malignancies
| First Author and Published Time | Species | Clinical Sign | Underlying Disease | Treatment | Surgery | Method for Diagnosis | Outcome | Reference |
|---|---|---|---|---|---|---|---|---|
| Duque (2018) | Candida tropicalis | Renal micro abscesses | A child with lymphoblastic leukemia | LAMB, micafungin and fluconazole | No | PCR | Treated | 88 |
| Niles (2019) | Candida tropicalis | Thyroiditis | An adolescent male with ALL | Micafungin | No | MALDI-TOF MS | Treated Although infections of the thyroid gland are rare, thyroiditis should be suspected in immunocompromised patients. | 114 |
| Ma (2016) | Candida tropicalis | Osteomyelitis | A 52 year-old man with AML | Micafungin | Placing of two tubes for postoperative drainage |
MRI and pus culture | Treated Combination treatment using antifungal agents, surgical debridement, and sufficient drainage is a better way to treat Candida osteomyelitis. |
115 |
| Vicari (2003) | Candida Tropicalis | Septic arthritis as sign of fungemia | A 24-year-old man with ALL | AMB | No | Blood and synovial fluid cultures | Died Fluconazole prophylaxis has resulted in a rise in the proportion of hematogenous candidiasis. |
116 |
| Harada (2019) | Fusarium solani | Pre-engraftment disseminated fusariosis |
A 47-year-old man with AML | AMB for a total of 19 weeks | No | Blood culture, MALDI-TOF and DNA sequencing | Treated with immediate definitive diagnosis, sufficient and long-term administration of appropriate antifungal medication and avoidance of the systemic administration of steroids. | 117 |
| Ichikawa (2020) | Fusarium species | Fungal endophthalmitis and disseminated fusariosis | 16-year-old male with AML | AMB, itraconazole and caspofungin | Surgical resection for Fusarium sinusitis | Vitreal culture | Treated Continuous administration of antifungal agents and vigorous surgical intervention may be necessary for the management of disseminated fusariosis. |
118 |
| Mardani (2019) | Fusarium species | Ecthyma, gangrenosum-like lesions, sinusitis endophthalmitis, and disseminated fusariosis | 35-year-old man diagnosed with AML and prolonged febrile neutropenic | AMB, voriconazole and caspofungin | Endoscopic sinus surgery | BacT/alert Microbial Detection System, PCR sequencing | Died Probably due to the nonrecovery of neutrophil. |
119 |
| Delia (2016) | Fusarium solani | Skin nodules and pneumonia in spite of posaconazole prophylaxis | A 44-year-old male with AML | Voriconazole and AMB | No | Blood culture, skin biopsy and molecular methods | Died Drug-resistant fusariosis. |
120 |
| Fadhel (2019) | Mucorales species | Disseminated lung disease with muscular involvement | A 53-year-old female with AML | AMB and posaconazole | Surgical debridement | Lung and muscle biopsy, 16S sequencing | Treated Diagnosis depends on the analysis of the tissue samples collected from the affected system. |
121 |
| Miura (2019) | Mucorales species | Pulmonary mucormycosis |
A 59-year-old woman with AML | AMB | Right upper lobectomy | HE | Treated Pulmonary mucormycosis undergoing leukemia treatment should be considered for rapid surgical therapy if the infected lesion is limited. |
122 |
| Biddeci (2019) | Mucorales species | Systemic fungal infection complicated by aortitis | A 6 years old girl with ALL | AMB and posaconazole | Urgent surgical intervention and pulmonary lobectomy | HE | Treated Correct diagnosis using a biopsy can significantly help the treatment process. |
123 |
| Jeurkar (2019) | Mucorales species | Angioinvasive mucormycosis in frontal lobe that lead to cerebral edema, tonsillar herniation and brainstem infarction (source of infection was lung) | A 64-year-old female with AML | Prophylactic and treatment with voriconazole but AMB was not considered due to lack of consideration for mucormycosis. | No | HE | Died The combination of prolonged neutropenia, pulmonary nodules, and long-term voriconazole prophylaxis should have prompted further workup of mucormycosis prior to HSCT. |
124 |
| Ozhak-baysan (2010) |
Aspergillus alliaceus and Aspergillus flavus | Pulmonary infection | A 64-year-old male with an AML | AMB and Voriconazole | No | Microscopic examination, BAL and fluid culture and PCR with sequences |
Died Only voriconazole showed a low MIC against A. alliaceus, demonstrating that this drug is a better choice for the treatment of both strains. |
125 |
| Le (2020) | Aspergillus fumigatus | Central nervous system Aspergillosis infection |
A 74-year-old male with CLL | Voriconazole | Craniotomy to evacuate the brain abscess | MRI and culture | Treated Early recognition and treatment of aspergillosis in CLL patients who present neurological symptoms can be lifesaving. |
126 |
| Rößler (2017) | Aspergillus fumigatus | Invasive pulmonary aspergillosis with multiple fungal abscesses | A patient in his early 70s with progressive AML | AMB and voriconazole | No | CT scan and BAL fluid culture | Died Azole resistance in A. fumigatus is an increasingly important phenomenon, leading to breakthrough infections despite prophylaxis. |
127 |
| Antonogiannaki (2019) | Aspergillus species | Invasive Aspergillus tracheobronchitis | A 50-year-old with hairy cell leukemia and previous Plasmodium falciparum infection | AMB | No | High resolution CT, BAL examination and direct smear | Died Previous P. falciparum infection was an additional predisposing factor for the manifestation of Aspergillus infection. |
128 |
| Turki (2017) | Aspergillus spp. and Aspergillus fumigatus | Cerebral aspergillosis and pneumonia | A 53 year old patient with LGL, Immune thrombocytopenia and combined antibody deficiency | AMB and voriconazole | No | MRI, chest radiography, CT and HE | Treated In cerebral involvement, prolonged treatment was recommended, and this patient showed no further relapse after 12 months of effective voriconazole treatment. |
129 |
| Inoue (2020) | Cryptococcus species | Cellulitis of the left mandible | 31-year-old man with AML | LAMB, flucytosine and fluconazole | Surgical debridement | HE | Treated The surgical site healed after the operation. |
130 |
| Suleman (2019) | Cryptococcus neoformans | Cryptococcal meningitis and skin disease | 60-year-old man with CLL | AMB, flucytosine and fluconazole | NO | Blood and CSF culture | Treated Physicians should be aware of possibility of disseminated cryptococcosis in patients with treatment-naïve CLL. |
23 |
| Ramirez 2019 | Trichosporon asahii | Disseminated Infection | 42-year-old male with AML | Caspofungin then LAMB and voriconazole. | NO | Culture, HE and MALDI-TOF | Died Invasive trichosporonosis is an acute fatal condition that occurs in immunosuppressed patients, usually under antifungal selective pressure. |
131 |
| Nguyen (2018) | Trichosporon asahii | Disseminated Infection | 10-year-old boy with ALL | Micafungin, AMB and voriconazole | No | Culture | Died It is important to consider trichosporonosis in the evaluation of a critically ill individual with neutropenia and a rash, because the initial cutaneous presentation may appear benign and delayed therapy results in death. |
132 |
Abbreviations: AMB, amphotericin B; LAMB, liposomal Amphotericin B; ALL, acute lymphocytic leukemia; AML, acute myeloid leukemia; CLL, chronic lymphocytic leukemia; PCR, polymerase chain reaction; MALDI-TOF MS, matrix-assisted laser desorption/ionization mass spectrometry; MRI, magnetic resonance imaging; HSCT, hematopoietic stem cell transplant; BAL, bronchoalveolar lavage; CT, computed tomography; HE, histopathologic examination; CSF, cerebrospinal fluid; MIC, minimum inhibitory concentration.