Clinical Analysis Of 53 Cases Of Haematological Malignancies With Fungal Infection

Fungous infection is a common complication of haematologicalmalignancies, and its incidence rate is increasing gradully.Invasive fungalinfections(IFI) has provoked people's reconstruction in recent years for itsatypia manifestation, high rate of missed diagnosis and high mortality rate.Objective:To improve the comprehension for motivation and therapy ofhaematological malignancies accompanied with fungous infection,to improvetherapeutic measure , reduce fungous infection, mortality rate and increasesurvival rate.Methods: Retrospective study of the infections motivation, fungousinfection table , treatment and outcome of 53 cases from February, 2001 toFebruary, 2006, who have be clearly diagnosed as haematological malignanciesaccompanied fungous infection. The ages were 13-76 years old.The average agewas 44.5 ±17.9years old.The median age was 45 years old.28 patients weremales and 25 patients were females.we divided the patients into two groups ,onewas superficial fungous infection group ,the other was invasive fungousinfection group. Superficial fungous infection group had 27 cases, 11 cases weremale,16 cases were female in this group,all the paitients infection part were mouthcavity. The average age was 44.6 ±18.4years old. Invasive fungous infectiongroup had 26 cases, 17 cases were male ,9 cases were female, the average age was44.8±17.6 years old.After being diagnosed fungous infection,most cases werereduced the application of the hormone and the immunity depressant,were givennarrow table antibiotics according to the drug test ,suitable anti-fungi medicineand were strengthened the nourishment, transfused blood or blood plasma.UsingGM-CSF or not was according to the neutrophilic granulocyte numbers. Theblood toutine , focus of infection, electrolyte ,liver and kidney function etc weremonitored irregularly. The curative effect valuation was divided into four classes,cure, show the effect, progress and invalid. Cure plus show the effect aggregate isefficient. We quantitive data were recorded in mean±standard deviation andanalysed the differences between the two groups by t-test ,rank sum test andChi-square test.Results(:1)92.5 percent of these 53 patients had been given broad-spectrumantibiotic before fungous infection. 43.4 percent of these patients had beengiven large glucocorticoid and 73.6 percent of them were agranulocytosis(WBC<0.5×109/L) . The percent of patients who have two and more than twopredisposing factors was 81.1%. (2)Among the patients who have been infectedfungous after being given broad-spectrum antibiotic , it was 7 days whensuperficial fungous infection occurred , while it was 11.2 days when invasivefungous infection occurred. There was significant difference between these twogroup on days of applying antibiotic. (3 )The average time of applingglucocorticoid in superficial fungous infection group was 16.4 days,while it was16.0 days in invasive fungous infection group .There was no significantdifference between these two groups on time of using large glucocorticoid .(4)Agranulocytosis time was 7.6 days in the superficial fungous infectiongroup,while it was 7.7 days in the invasive fungous infection group .There was nostatistical difference between these two groups on the time of agranulocytosis.(5)There were 18 patients have been given carbopenems antibiotic in invasivefungous infection. (6)Identificated fungus was 24 types, belonging to Monilia ,in which Blastomyces albicans was 58.3%, Smooth Monilia was 25.0%, Candidatropicalis was 12.5% and Candida krusei was 4.2%.(7)26 patients were suferedfrom invasive fungous infection, among them low respiratory tract infection was61.5%, gastrointestinal tract infection was 23.1%, fungous septicemia was 11.5%,urinary tract was3.8%.(8)Analysis on the mortality rate of superficial fungousinfection group demonstrated that mortality rate in invadable fungous infectionwas 34.6%. (9)Comparison of anti-fungus medicine showed that the effectiverate of Fluconazol combined Nystatin on superficial fungous infection was 100%;the effective rate of Fluconazol on invasive fungous infection was 28%, andeffective rate of Itraconazole on invasive fungous infection was 69.2%, at thesame time , effective rate of Itraconazole as secondary medicine was 75%. (10)Incidence rate of side effect of Fluconazol was 8.2%,while Itraconazole was18.8%. The enzymology alterations of Hepatic function were not more than 4times, can be reversed by protecting liver, decreasing enzymology andsymptomatic treatment.Conclusion:(1)Using of broad-spectrum antibiotic, large glucocorticoidand agranulocytosis are three main motivations of fungous infection. Patients withmultiple predisposing factors are facilitied to be infected with fungus.(2)Utilization of broad-spectrum antibiotic(>7 days), large glucocorticoid(>16days)and agranulocytosis (>7 days) are predisposing factors for superficialfungous infection.(3)Utilization of broad-spectrum antibiotic(>11days),largeglucocorticoid(>16days), agranulocytosis (>7days) ,carbopenems antibiotic andsuperficial fungous infection are predisposing factors for haematologicalmalignancies accompanied with fungous infection. (4)Blastomyces albicansaccount for the most of infection spectrum. (5)Main infection portions of invasivefungous infection are low respiratory tract(61.5%) and gastrointestinaltract(23.1%). (6)Mortality rate of invasive fungous infection was34.6%.(7)Fluconazol is considered as the first medicine for superficial fungousinfection, however ,for the therapy of invasive fungous infection, effects ofItraconazole is superior to that of Fluconazol, more over the side effects ofItraconazole are no more than that of Fluconazol.