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Fungal Infections in Patients With Neutropenia

Challenges in Prophylaxis and Treatment

  • Disease Management
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Abstract

Fungal infections are a leading cause of mortality in patients with neutropenia. Candidiasis and aspergillosis account for most invasive fungal infections.

General prophylactic measures include strict hygiene and environmental measures. Haemopoietic growth factors shorten the duration of neutropenia and thus may reduce the incidence of fungal infections. Fluconazole is appropriate for antifungal prophylaxis and should be offered to patients with prolonged neutropenia, such as high-risk patients with leukaemia undergoing remission induction or consolidation therapy and high-risk stem cell transplant recipients.

Empirical antifungal therapy is mandatory in patients with persistent febrile neutropenia who fail to respond to broad-spectrum antibacterials. Intravenous amphotericin B at a daily dose of 0.6 to 1 mg/kg is preferred whenever aspergillosis cannot be ruled out. Lipid formulations of amphotericin B have demonstrated similar efficacy and are much better tolerated.

Fluconazole is the best choice for acute candidiasis in stable patients; amphotericin B should be used in patients with unstable disease. Use of fluconazole is restricted by the existence of resistant strains (Candida krusei and, to a lesser extent, C. glabrata).

Amphotericin B still remains the gold standard for invasive aspergillosis. Lipid formulations of amphotericin B are effective in aspergillosis and because they are less nephrotoxic are indicated in patients with poor renal function. Itraconazole is an alternative in patients who have good intestinal function and are able to eat.

Mucormycosis, trichosporonosis, fusariosis and cryptococcosis are less common but require specific management.

New antifungal agents, especially new azoles, are under development. Their broad in vitro spectrum and preliminary clinical results are promising.

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References

  1. Denning DW, Evans EG, Kibbler CC, et al. Guidelines for the investigation of invasive fungal infections in haematological malignancy and solid organ transplantation. British Society for Medical Mycology. Eur J Clin Microbiol Infect Dis 1997; 16(6): 424–36

    Article  PubMed  CAS  Google Scholar 

  2. Nucci M, Pulcheri W, Spector N, et al. Fungal infections in neutropenic patients: an 8-year prospective study. Rev Inst Med Trop Sao Paulo 1995; 37(5): 397–406

    Article  PubMed  CAS  Google Scholar 

  3. Karabinis A, Hill C, Leclercq B, et al. Risk factors for candidemia in cancer patients: a case-control study. J Clin Microbiol 1988; 26(3): 429–32

    PubMed  CAS  Google Scholar 

  4. Wald A, Leisenring W, van Burik JA, et al. Epidemiology of Aspergillus infections in a large cohort of patients undergoing bone marrow transplantation. J Infect Dis 1997; 175(6): 1459–66

    Article  PubMed  CAS  Google Scholar 

  5. Herbrecht R. The changing epidemiology of fungal infections: are the lipid-forms of amphotericin B an advance? Eur J Haematol 1996; 57 Suppl.: 12–7

    CAS  Google Scholar 

  6. Walsh TJ, Groll AH. Emerging fungal pathogens: evolving challenges to immunocompromised patients for the twenty-first century. Transpl Infect Dis 1999; 1: 247–61

    Article  PubMed  CAS  Google Scholar 

  7. Patterson TF. Approaches to fungal diagnosis in transplantation. Transpl Infect Dis 1999; 1(4): 262–72

    Article  PubMed  CAS  Google Scholar 

  8. Marr KA, Bowden RA. Fungal infections in patients undergoing blood and marrow transplantation. Transpl Infect Dis 1999; 1(4): 237–46

    Article  PubMed  CAS  Google Scholar 

  9. Herbrecht R, Letscher V, Kurtz JE, et al. Amphotericin B lipid complex in the management of new emerging fungal infections. Int J Infect Dis 1997; 1Suppl. 1: S42–6

    Google Scholar 

  10. Uzun O, Anaissie EJ. Antifungal prophylaxis in patients with hematologic malignancies: a reappraisal. Blood 1995; 86(6): 2063–72

    PubMed  CAS  Google Scholar 

  11. Lortholary O, Dupont B. Antifungal prophylaxis during neutropenia and immunodeficiency. Clin Microbiol Rev 1997; 10(3): 477–504

    PubMed  CAS  Google Scholar 

  12. Lortholary O, Ascioglu S, Moreau P, et al. Invasive aspergillosis as an opportunistic infection in nonallografted patients with multiple myeloma. Clin Infect Dis 2000; 30(1): 41–6

    Article  PubMed  CAS  Google Scholar 

  13. Guiot HF, Fibbe WE, van’t Wout JW. Risk factors for fungal infection in patients with malignant hematologic disorders: implications for empirical therapy and prophylaxis. Clin Infect Dis 1994; 18(4): 525–32

    Article  PubMed  CAS  Google Scholar 

  14. Working Party of the British Society for Antimicrobial Chemotherapy. Chemoprophylaxis for candidosis and aspergillosis in neutropenia and transplantation: a review and recommendations. J Antimicrob Chemother 1993; 32(1): 5–21

    Article  Google Scholar 

  15. Pfaller MA. Nosocomial candidiasis: emerging species, reservoirs, and modes of transmission. Clin Infect Dis 1996; 22Suppl. 2: S89–94

    Article  PubMed  Google Scholar 

  16. Nemunaitis J. A comparative review of colony-stimulating factors. Drugs 1997; 54(5): 709–29

    Article  PubMed  CAS  Google Scholar 

  17. Yeo E, Alvarado T, Fainstein V, et al. Prophylaxis of oropharyngeal candidiasis with clotrimazole. J Clin Oncol 1985; 3(12): 1668–71

    PubMed  CAS  Google Scholar 

  18. Wingard JR, Vaughan WP, Braine HG, et al. Prevention of fungal sepsis in patients with prolonged neutropenia: a randomized, double-blind, placebo-controlled trial of intravenous miconazole. Am JMed 1987; 83(6): 1103–10

    CAS  Google Scholar 

  19. Palmblad J, Lonnqvist B, Carlsson B, et al. Oral ketoconazole prophylaxis for Candida infections during induction therapy for acute leukaemia in adults: more bacteraemias. J Intern Med 1992; 231(4): 363–70

    Article  PubMed  CAS  Google Scholar 

  20. Benhamou E, Hartmann O, Nogues C, et al. Does ketoconazole prevent fungal infection in children treated with high dose chemotherapy and bone marrow transplantation? Results of a randomized placebo-controlled trial. Bone Marrow Transplant 1991; 7(2): 127–31

    PubMed  CAS  Google Scholar 

  21. Alangaden G, Chandrasekar PH, Bailey E, et al. Antifungal prophylaxis with low-dose fluconazole during bone marrow transplantation: the Bone Marrow Transplantation Team. Bone Marrow Transplant 1994; 14(6): 919–24

    PubMed  CAS  Google Scholar 

  22. Samonis G, Rolston K, Karl C, et al. Prophylaxis of oropharyngeal candidiasis with fluconazole. Rev Infect Dis 1990; 12Suppl. 3: S369–73

    Article  PubMed  Google Scholar 

  23. Winston DJ, Chandrasekar PH, Lazarus HM, et al. Fluconazole prophylaxis of fungal infections in patients with acute leukemia: results of a randomized placebo-controlled, double-blind, multicenter trial. Ann Intern Med 1993; 118(7): 495–503

    PubMed  CAS  Google Scholar 

  24. Rotstein C, Bow EJ, Laverdiere M, et al. Randomized placebo-controlled trial of fluconazole prophylaxis for neutropenic cancer patients: benefit based on purpose and intensity of cytotoxic therapy. The Canadian Fluconazole Prophylaxis Study Group. Clin Infect Dis 1999; 28(2): 331–40

    Article  PubMed  CAS  Google Scholar 

  25. Slavin MA, Osborne B, Adams R, et al. Efficacy and safety of fluconazole prophylaxis for fungal infections after marrow transplantation: a prospective, randomized, double-blind study. J Infect Dis 1995; 171(6): 1545–52

    Article  PubMed  CAS  Google Scholar 

  26. Goodman JL, Winston DJ, Greenfield RA, et al. A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. N Engl J Med 1992; 326(13): 845–51

    Article  PubMed  CAS  Google Scholar 

  27. Ninane J. A multicentre study of fluconazole versus oral polyenes in the prevention of fungal infection in children with hematological or oncological malignancies: Multicentre Study Group. Eur J Clin Microbiol Infect Dis 1994; 13(4): 330–7

    Article  PubMed  CAS  Google Scholar 

  28. Philpott-Howard JN, Wade JJ, Mufti GJ, et al. Randomized comparison of oral fluconazole versus oral polyenes for the prevention of fungal infection in patients at risk of neutropenia: Multicentre Study Group. J Antimicrob Chemother 1993; 31(6): 973–84

    Article  PubMed  CAS  Google Scholar 

  29. Brammer KW. Management of fungal infection in neutropenic patients with fluconazole. Hamatol Bluttransfus 1990; 33: 546–50

    CAS  Google Scholar 

  30. Menichetti F, Del Favero A, Martino P, et al. Preventing fungal infection in neutropenic patients with acute leukemia: fluconazole compared with oral amphotericin B: the GIMEM A Infection Program. Ann Intern Med 1994; 120(11): 913–8

    PubMed  CAS  Google Scholar 

  31. Takatsuka H, Takemoto Y, Okamoto T, et al. Fluconazole versus amphotericin B for the prevention of fungal infection in neutropenic patients with hematologic malignancy. Drugs Exp Clin Res 1999; 25(4): 193–200

    PubMed  CAS  Google Scholar 

  32. Young GA, Bosly A, Gibbs DL, et al. A double-blind comparison of fluconazole and nystatin in the prevention of candidiasis in patients with leukaemia: Antifungal Prophylaxis Study Group. Eur J Cancer 1999; 35(8): 1208–13

    Article  PubMed  CAS  Google Scholar 

  33. Glasmacher A, Hahn C, Leutner C, et al. Breakthrough invasive fungal infections in neutropenic patients after prophylaxis with itraconazole. Mycoses 1999; 42(7–8): 443–51

    Article  PubMed  CAS  Google Scholar 

  34. Glasmacher A, Molitor E, Hahn C, et al. Antifungal prophylaxis with itraconazole in neutropenic patients with acute leukaemia. Leukemia 1998; 12(9): 1338–43

    Article  PubMed  CAS  Google Scholar 

  35. Menichetti F, Del Favero A, Martino P, et al. Itraconazole oral solution as prophylaxis for fungal infections in neutropenic patients with hematologic malignancies: a randomized, placebo-controlled, double-blind, multicenter trial. GIMEMA Infection Program. Gruppo Italiano Malattie Ematologiche dell’ Adulto. Clin Infect Dis 1999; 28(2): 250–5

    Article  PubMed  CAS  Google Scholar 

  36. Montesinos J, Sola C, Maroto P, et al. Incidence of fungal infections and efficacy of itraconazole prophylaxis in solid tumor patients treated with high-dose chemotherapy and autologous peripheral blood stem cell transplantation: a prospective non-randomized sequential study. Support Care Cancer 2000; 8: 150

    Google Scholar 

  37. Huijgens PC, Simoons-Smit AM, van Loenen AC, et al. Fluconazole versus itraconazole for the prevention of fungal infections in haemato-oncology. J Clin Pathol 1999; 52(5): 376–80

    Article  PubMed  CAS  Google Scholar 

  38. Morgenstern GR, Prentice AG, Prentice HG, et al. A randomized controlled trial of itraconazole versus fluconazole for the prevention of fungal infections in patients with haematological malignancies. U.K. Multicentre Antifungal Prophylaxis Study Group. Br J Haematol 1999; 105(4): 901–11

    Article  PubMed  CAS  Google Scholar 

  39. Yamada T, Dan K, Nomura T. Prevention of bacterial and fungal infections in acute leukemia patients: a new and potent combination of oral norfloxacin and amphotericin B. Intern Med 1993; 32(9): 710–5

    Article  PubMed  CAS  Google Scholar 

  40. O’Donnell MR, Schmidt GM, Tegtmeier BR, et al. Prediction of systemic fungal infection in allogeneic marrow recipients: impact of amphotericin prophylaxis in high-risk patients. J Clin Oncol 1994; 12(4): 827–34

    PubMed  Google Scholar 

  41. Rousey SR, Russler S, Gottlieb M, et al. Low-dose amphotericin B prophylaxis against invasive Aspergillus infections in allogeneic marrow transplantation. Am J Med 1991; 91(5): 484–92

    Article  PubMed  CAS  Google Scholar 

  42. Perfect JR, Klotman ME, Gilbert CC, et al. Prophylactic intravenous amphotericin B in neutropenic autologous bone marrow transplant recipients. J Infect Dis 1992; 165(5): 891–7

    Article  PubMed  CAS  Google Scholar 

  43. Kelsey SM, Goldman JM, McCann S, et al. Liposomal amphotericin (AmBisome) in the prophylaxis of fungal infections in neutropenic patients: a randomised, double-blind, placebo-controlled study. Bone Marrow Transplant 1999; 23(2): 163–8

    Article  PubMed  CAS  Google Scholar 

  44. Buchanan AG, Riben PD, Rayner EN, et al. Nystatin prophylaxis of fungal colonization and infection in granulocytopenic patients: correlation of colonization and clinical outcome. Clin Invest Med 1985; 8(2): 139–47

    PubMed  CAS  Google Scholar 

  45. Hofstra W, Vries-Hospers HG, van der Waaij D. Concentrations of amphotericin B in faeces and blood of healthy volunteers after the oral administration of various doses. Infection 1982; 10(4): 223–7

    Article  PubMed  CAS  Google Scholar 

  46. Ezdinli EZ, O’Sullivan DD, Wasser LP, et al. Oral amphotericin for candidiasis in patients with hematologic neoplasms: an autopsy study. JAMA 1979; 242(3): 258–60

    Article  PubMed  CAS  Google Scholar 

  47. Wingard JR, Merz WG, Rinaldi MG, et al. Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. N Engl J Med 1991; 325(18): 1274–7

    Article  PubMed  CAS  Google Scholar 

  48. Wingard JR, Merz WG, Rinaldi MG, et al. Association of Torulopsis glabrata infections with fluconazole prophylaxis in neutropenic bone marrow transplant patients. Antimicrob Agents Chemother 1993; 37(9): 1847–9

    Article  PubMed  CAS  Google Scholar 

  49. Kunova A, Trupl J, Spanik S, et al. Candida glabrata, Candida krusei, non-albicans Candida spp., and other fungal organisms in a sixty-bed national cancer center in 1989–1993: no association with the use of fluconazole. Chemotherapy 1995; 41(1): 39–44

    Article  PubMed  CAS  Google Scholar 

  50. Bodey GP, Anaissie EJ, Elting LS, et al. Antifungal prophylaxis during remission induction therapy for acute leukemia fluconazole versus intravenous amphotericin B. Cancer 1994; 73(8): 2099–106

    Article  PubMed  CAS  Google Scholar 

  51. Schwartz S, Behre G, Heinemann V, et al. Aerosolized amphotericin B inhalations as prophylaxis of invasive aspergillus infections during prolonged neutropenia: results of a prospective randomized multicenter trial. Blood 1999; 93(11): 3654–61

    PubMed  CAS  Google Scholar 

  52. Pizzo PA, Robichaud KJ, Gill FA, et al. Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia. Am J Med 1982; 72(1): 101–11

    Article  PubMed  CAS  Google Scholar 

  53. EORTC International Antimicrobial Therapy Cooperative Group. Empiric antifungal therapy in febrile granulocytopenic patients. Am J Med 1989; 86 (6 Pt 1): 668–72

    Article  Google Scholar 

  54. Malik IA, Moid I, Aziz Z, et al. A randomized comparison of fluconazole with amphotericin B as empiric antifungal agents in cancer patients with prolonged fever and neutropenia. Am J Med 1998; 105(6): 478–83

    Article  PubMed  CAS  Google Scholar 

  55. Viscoli C, Castagnola E, Van Lint MT, et al. Fluconazole versus amphotericin B as empirical antifungal therapy of unexplained fever in granulocytopenic cancer patients: a pragmatic, multicentre, prospective and randomised clinical trial. Eur J Cancer 1996; 32A(5): 814–20

    Article  PubMed  CAS  Google Scholar 

  56. Walsh TJ, Finberg RW, Arndt C, et al. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia: National Institute of Allergy and Infectious Diseases Mycoses Study Group. N Engl J Med 1999; 340(10): 764–71

    Article  PubMed  CAS  Google Scholar 

  57. Prentice HG, Hann IM, Herbrecht R, et al. A randomized comparison of liposomal versus conventional amphotericin B for the treatment of pyrexia of unknown origin in neutropenic patients. Br J Haematol 1997; 98(3): 711–8

    Article  PubMed  CAS  Google Scholar 

  58. White MH, Bowden RA, Sandler ES, et al. Randomized, double-blind clinical trial of amphotericin B colloidal dispersion vs. amphotericin B in the empirical treatment of fever and neutropenia. Clin Infect Dis 1998; 27(2): 296–302

    Article  PubMed  CAS  Google Scholar 

  59. Wingard JR, White MH, Anaissie EJ, et al. A randomized double-blind safety study of Ambisome and Abelcet in febrile neutropenic patients. Proceedings of the Focus on Fungal Infections 9; 1999 Mar 17–19; San Diego (CA), O15

  60. Polsky B. Treatment of thrush in oncology patients. J Mycol Med 1996; 6 Suppl. 2: 20–5

    Google Scholar 

  61. Akova M, Akalin HE, Uzun O, et al. Efficacy of fluconazole in the treatment of upper gastrointestinal candidiasis in neutropenic patients with cancer: factors influencing the outcome. Clin Infect Dis 1994; 18(3): 298–304

    Article  PubMed  CAS  Google Scholar 

  62. Peters C, Minkov M, Matthes-Martin S, et al. Leucocyte transfusions from rhG-CSF or prednisolone stimulated donors for treatment of severe infections in immunocompromised neutropenic patients. Br J Haematol 1999; 106(3): 689–96

    Article  PubMed  CAS  Google Scholar 

  63. Viscoli C, Girmenia C, Marinus A, et al. Candidemia in cancer patients: a prospective, multicenter surveillance study by the Invasive Fungal Infection Group (IFIG) of the European Organization for Research and Treatment of Cancer (EORTC). Clin Infect Dis 1999; 28 1071–9

    Article  PubMed  CAS  Google Scholar 

  64. Anaissie EJ, Darouiche RO, Abi-Said D, et al. Management of invasive candidal infections: results of a prospective, randomized, multicenter study of fluconazole versus amphotericin B and review of the literature. Clin Infect Dis 1996; 23(5): 964–72

    Article  PubMed  CAS  Google Scholar 

  65. Edwards JE, Bodey GP, Bowden RA, et al. International conference for the development of a consensus on the management and prevention of severe candidal infections. Clin Infect Dis 1997; 25(1): 43–59

    Article  PubMed  Google Scholar 

  66. Walsh TJ, Hiemenz J, Pizzo PA. Evolving risk factors for invasive fungal infections: all neutropenics are not the same. Clin Infect Dis 1994; 18(5): 793–8

    Article  PubMed  CAS  Google Scholar 

  67. Denning DW. Invasive aspergillosis. Clin Infect Dis 1998; 26(4): 781–803

    Article  PubMed  CAS  Google Scholar 

  68. Tiphine M, Letscher-Bru V, Herbrecht R. Amphotericin B and its new lipids formulations: pharmacologic characteristics, clinical efficacy, and tolerability. Transpl Infect Dis 1999; 1(4): 273–83

    Article  PubMed  CAS  Google Scholar 

  69. Ellis M, Spence D, de Pauw B, et al. An EORTC international multicenter randomized trial (EORTC number 19923) comparing two dosages of liposomal amphotericin B for treatment of invasive aspergillosis. Clin Infect Dis 1998; 27(6): 1406–12

    Article  PubMed  CAS  Google Scholar 

  70. White MH, Anaissie EJ, Kusne S, et al. Amphotericin B colloidal dispersion vs. amphotericin B as therapy for invasive aspergillosis. Clin Infect Dis 1997; 24(4): 635–42

    PubMed  CAS  Google Scholar 

  71. Lee FY, Mossad SB, Adal KA. Pulmonary mucormycosis: the last 30 years. Arch Intern Med 1999; 159(12): 1301–9

    Article  PubMed  CAS  Google Scholar 

  72. Lehrer RI, Howard DH, Sypherd PS, et al. Mucormycosis. Ann Intern Med 1980; 93(1): 93–108

    Google Scholar 

  73. Morrison VA, McGlave PB. Mucormycosis in the BMT population. Bone Marrow Transplant 1993; 11(5): 383–8

    PubMed  CAS  Google Scholar 

  74. Morduchowicz G, Shmueli D, Shapira Z, et al. Rhinocerebral mucormycosis in renal transplant recipients: report of three cases and review of the literature. Rev Infect Dis 1986; 8(3): 441–6

    Article  PubMed  CAS  Google Scholar 

  75. St Germain G, Robert A, Ishak M, et al. Infection due to Rhizomucor pusillus: report of four cases in patients with leukemia and review. Clin Infect Dis 1993; 16(5): 640–5

    Article  PubMed  CAS  Google Scholar 

  76. Van Cutsem J, Van Gerven F, Fransen J, et al. Treatment of experimental zygomycosis in guinea pigs with azoles and with amphotericin B. Chemotherapy 1989; 35(4): 267–72

    Article  PubMed  Google Scholar 

  77. Koçak R, Tetiker T, Koçak M, et al. Fluconazole in the treatment of three cases of mucormycosis. Eur J Clin Microbiol Infect Dis 1995; 14(6): 559–61

    Article  PubMed  Google Scholar 

  78. Otcenasek M, Buchta V. In vitro susceptibility to 9 antifungal agents of 14 strains of Zygomycetes isolated from clinical specimens. Mycopathologia 1994; 128(3): 135–7

    Article  PubMed  CAS  Google Scholar 

  79. Kumar B, Kaur I, Chakrabarti A, et al. Treatment of deep mycoses with itraconazole. Mycopathologia 1991; 115(3): 169–74

    Article  PubMed  CAS  Google Scholar 

  80. Herbrecht R, Letscher V, Andres E, et al. Zygomycosis treated with amphotericin B colloidal dispersion: review of 22 cases [abstract]. Blood 1996; 88Suppl. 1, Pt 1: 502a

    Google Scholar 

  81. Yohai RA, Bullock JD, Aziz AA, et al. Survival factors in rhino-orbital-cerebral mucormycosis. Surv Ophthalmol 1994; 39(1): 3–22

    Article  PubMed  CAS  Google Scholar 

  82. Tedder M, Spratt JA, Anstadt MP, et al. Pulmonary mucormycosis: results of medical and surgical therapy. Ann Thorac Surg 1994; 57(4): 1044–50

    Article  PubMed  CAS  Google Scholar 

  83. Herbrecht R, Koenig H, Waller J, et al. Trichosporon infections: clinical manifestations and treatment. J Mycol Med 1993; 3 129–36

    Google Scholar 

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Authors and Affiliations

  1. Département d’Hématologie et d’Oncologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    Raoul Herbrecht & Shanti Natarajan-Amé

  2. Unité de Mycologie, Institut Pasteur, Paris, France

    Ségolène Neuville & Olivier Lortholary

  3. Institut de Parasitologie et de Pathologie Tropicale, Strasbourg, France

    Valérie Letscher-Bru

  4. Service de Médecine Interne - Maladies Infectieuses et Tropicales, Hôpital Avicenne, Bobigny, France

    Olivier Lortholary

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  1. Raoul Herbrecht
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Herbrecht, R., Neuville, S., Letscher-Bru, V. et al. Fungal Infections in Patients With Neutropenia. Drugs & Aging 17, 339–351 (2000). https://doi.org/10.2165/00002512-200017050-00002

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