Table 2.
Characteristics of the Histopathologically Proven IMI Cases That Were not Suspected Before Biopsy/Autopsy
| n = 11 | |
|---|---|
| Underlying conditions | |
| Solid-tumora | 4 (36) |
| Hematologic cancer | 3 (27) |
| Lymphomab | 2 |
| Allogeneic HSCT | 1 |
| Auto-immune disordersc | 2 (18) |
| Solid-organ transplantation (heart) | 1 (9) |
| Drug-induced neutropenia | 1 (9) |
| Immunosuppressive conditions d | |
| Neutropenia > 10 dayse | 1 (9) |
| Neutropenia < 10 dayse | 1 (9) |
| Long-course corticosteroid treatmentf | 2 (18) |
| Short-course corticosteroid treatmentg | 2 (18) |
| Other immunosuppressive drugsh | 3 (27) |
| Recent anti-cancer chemotherapy | 2 (18) |
| None | 3 (27) |
| EORTC/MSGERC criteria (before histopathology) i | |
| Host criteria | 6 (55) |
| Clinical and radiological criteria | 4 (36) |
| Mycological criteria | 1 (9)j |
| IMI: possible/no criteria | 3 (27) / 8 (73) |
| Mold pathogen identified on histopathology sample | |
| Aspergillus fumigatus | 3 (27) |
| Rhizopus spp. | 1 (9) |
| “Aspergillus-like” hyphaek | 6 (55) |
| “Mucorales-like” hyphael | 1 (9) |
| Causes of death | n = 9 |
| Attributed to IMIm | 8 (89) |
| Other causen | 1 (11) |
Numbers are N total (percentage).
IMI: invasive mold infections, HSCT: hematopoietic stem cell transplantation, EORTC/MSGERC: European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium.
aPrimary tumor site: cerebral (2), lung (1), multimetastatic cancer of unknown origin discovered at autopsy (1).
bLymphoma in remission (1), casual autopsy finding of low-grade lymphoma (1).
cRheumatoid arthritis (1), idiopathic pulmonary fibrosis (1).
dMore than one possible.
eNeutropenia defined as neutrophil count < 500/mm3 in the past 60 days.
f≥0.3 mg/kg prednisone-equivalent for ≥3 weeks in the past 60 days.
gAny corticosteroid therapy during the past 10 days not fulfilling the definitions of long-course corticosteroid therapy (above).
hCalcineurin inhibitor (1), mycophenolate mofetil (1), anti-tumor necrosis factor alpha (1).
iAccording to EORTC/MSGERC criteria of 2008 and 2020 [15, 16]. Of note, assessment according to the 2008 and 2020 criteria was concordant in all cases.
jOne positive culture for a single colony of “not yet identified” mold in a bronchial aspirate at day -2 before death (considered as contaminant or ignored by the clinician).
kthin septate hyphae evoking Aspergillus.
llarge non-septate hyphae evoking Mucorales.
mAt least partially considered as a cause of death based on autopsy report.
nSuicide (IMI was a casual finding at autopsy).