A Retrospective Analysis Of Clinical Features And Prognostic Factors Of Fungal Infection In Acute Leukemia

【Objective】To investigate and analyse the data of etiology,diagnosis,treatment and prognostic factors of acute leukemia patients with fungal infection to help to understand clinical features and help to make more valuable decision in clinical practice.【Methods】The cases of fungal infection in acute leukemia patients,between 2010 /4 and 2010/11,were collectefd retrospectively from hematology department of Fujian Medical University attached Xiehe Hospital. Schedule table were made to record the detail information of each patient. To record the clinical symptoms,physical sign,imaging study,etiology distribution,therapeutic drug,curative effect and death.Based on the outcome,the patients in each subgroup were grouped into dead patients and survivors,effective group and not effective group.Data recorded include age,site of infection,previous history of fungus infection.Factors associated with prognosis were identified following a review of the medical case notes and contribution of these factors to prognosis was determined by chi-square test and Logistic regression analysis.【Results】(1)108 cases were diagnosed with fungal infection in 799 cases of patients with acute leukemia,infection rate was 25.67%,which include 1confimed cases,57 cases of clinicalIy diagnosed,50 cases of possible infections and mortality rate was 11.46%(11 cases).(2)In this study,82 fungus were detected in 58 cases,69 of which saccharomyce(s84.15%),9 of which mould(10.98%) and 4 of which filamentous fungi(4.88%).(3)Respiratory tract is the most common infection site(87.96%),followed by digestive(31.48%),oral(12.04%),urinary system(3.70%),sepsis(0.93%),80 of which are single infection site(74.07%),28 of which are equal or greater than two infection sites(25.93%).(4)Clinical manifestations of fungal infection in acute leukemia patients are unspecific and the chief symptom is fever,then the symptoms of system appear.(5)In this study,67 bacteria were detected in 46 cases(42.59%),the first three are escherichia coli,klebsiella pneumoniae,viridans streptococcus,and 23 casesare sepsis patients(21.30%);(6)Imaging perfornance is unspecific,Changes of lesions in High—resoIution CT of the lung are increase of lung markings,dot-like,patchy dense shadow,multi-node,small nodes,infIatable bronchial symptoms,pleural effusion,mediastinal lymphnode enlargement,pleural thickening .3 cases of which show"halo sign",4 cases of which show"crescent sign".(7) Fluconazole,itraconazole,amphoterincin B are mostly used in our hematology department ,The effects of itraconazole,amphoterincin B are superior to fluconazole ,and the curative effect of fluconazole in superficial fungal are superior to deep fungal infection.20 cases in application of amphotericin B with side effects,as foIlows:chill,hyperpyrexia,hypokaliemia,11 cases in application of itraconazole with side effects,as foIlows:Chest stuffiness,dizziness,nausea,vomiting,abdominal distention. Allergic dermatitis occurs in 1 case in application of caspofungin .No adverse effect was found during the application of other antifungal drug .(8)According to multivariate Logistic regression analysis, age≥60years old (P=0.047 , OR=4.144),duration of granulopenia≥2weeks(P=0.020 , OR=4.187),previous history of fungus infection(P=0.012,OR=4.903),multiple organ failure (P=0.047,OR=9.789)are the the factors associated with the curative effect of fungal infection,relapsed and refractory acute leukemia(P=0.005,OR=23.820),previous history of fungal infection(P=0.012,OR=13.826),multiple organ failure (P=0.004,OR=16.963)are the the factors associated with the mortality.【Conclusion】(1) The incidence of fungal infection in acute leukemia was 27.54%,and mortality rate was 11.46%(.2)The common site of infection is the respiratory tract,intestinal tract,oral cavity,candida is the major infection fungus.(3)Clinical manifestations of fungal infection in acute leukemia patients are unspecific and the chief symptom is fever,then the symptoms of system appear.Changes of lesions in High—resoIution CT of the lung are various,except halo sign and crescent sign as specificity,others have no differential diagnosis(.4)The total treatment effect are similar in fluconazole,itraconazole,amphoterincin B,and the curative effect of fluconazole in superficial fungal infection are superior to deep fungal infection,so we can choose the drug for the fungal infection in acute leukemia patients according to individuality,combination therapy and updated medicine are necessary.(5)according to multivariate Logistic regression analysis, age≥60,the duration of neutropenia≥2weeks,previous history of fungal infection,multiple organ failure are the the factors associated with the curative effect of fungal infection.The duration of neutropenia≥2weeks,previous history of fungal infection,multiple organ failure are the the factors associated with the mortality of fungal infection.