Investigation Of Secondary Invasive Mycosis In Leukemia Patients And Analysis Of Related Factors

Objective: To investigate the incidence of secondary invasive mycosis in leukemia patients in blood ward of county and municipal hospitals,and to explore the possible factors affecting the occurrence of secondary invasive mycosis in leukemia patients.Methods: The data of 1023 leukemia patients hospitalized in the hematology ward of Zhucheng Hospital of Traditional Chinese Medicine(county and municipal hospitals)from January 2013 to December 2017 was analyzied.The basic information and disease-related information of patients were collected by questionnaires;the patient’s medical records were consulted to collect relevant examination results,clinical manifestations,leukemia classification and complications;the results of chest X-ray,CT,ultrasound and laboratory results were analyzed;the incidence of invasive fungal diseases in leukemia patients and the possible related factors of the occurrence of invasive fungal diseases in leukemia patients were also analyzed.retrospectively.The data analysis of this study was carried out by SPSS17.0.P < 0.05 was considered to have statistical significance.Results: Among 1023 inpatients with leukemia,257 were diagnosed as invasive fungal diseases,including 19 confirmed cases,20 clinical cases,38 suspected cases and 180 undetermined cases.Of the 19 confirmed cases,7 were Candida albicans,4 were Candida tropicalis,4were Aspergillus,2 was Candida viscosus and 2 was Mucor respectively.Among the 19 confirmed inpatients cases,12 inpatients were fungal,blood fungal culture was positive,3 inpatients were histopathologically found fungal hyphae in lung biopsy specimens,2 inpatients were pleural and ascites cytopathology showing yeast cells,and 1 inpatients case fungal trophozoites was found in bronchoalveolar lavage fluid,and 1 inpatients case was positive for cerebrospinal fluid cryptococcal antigen.All confirmed cases were treated with anti-fungal targets.Host disease was found in 20 inpatients cases of clinical diagnosis,characteristic changes of imaging and positive G/GM test.Among these inpatients cases,18 cases were lower respiratory tract infection,1 case was sinus infection,and 1 case was central nervous system infection..All clinically diagnosed inpatients cases were treated with antifungal targets.Host factors and clinical and imaging factors were required in 38 inpatients cases,36 cases were respiratory infections,1 case was central nervous system infection,and 1 case was sinus infection.All the diagnosed inpatients cases were driven by antifungal diagnosis.A diagnosis of only 180 inpatients cases of undetermined inpatients cases with host factors.All undetermined inpatients cases were driven by antifungal diagnostics.There were no clinical,radiographic,and microbiological specific changes in the undetermined case group,so such cases were not included in the analysis by univariate analysis.The purpose of this study was to study the rate of fungal infection and the predisposing factors.Therefore,detailed statistics on the specific drugs and prognosis of the patients were not included.From 2013 to 2017,the number of invasive fungal cases diagnosed as confirmed,clinically diagnosed and suspected to be diagnosed and the proportion of total cases of leukemia accounted for 46(23.83%),49(24.37%),54(25.83%),51(25.12%)and 57(26.26%)respectively.Fungal infection rate showed an overall upward trend.logistic regression analysis showed that the risk of fungal infections was patients older than 70 years old(P=0.032),and those with neutrophil count less than 0.5 *109/L,(P=0.025).using glucocorticoids for fungal infections was higer(P = 0.034).The risk of fungal infection was higher in patients with hospitalization days greater than 20 days(P=0.012).Conclusion: 1.The proportion of secondary invasive fungal diseases in leukemia patients in county and municipal hospitals is also high(the same as that in the third-class hospitals in China),and it is on the rise.2.Candida albicans infection is still the most common fungal infection in leukemia patients.The lower respiratory tract infection is the is the most common sites,3.The age elder than 70 years old,the duration of granulocytopenia and the time hospitalized more than 20 days with Long-term hormone therapy for more than 7 days is an independent risk factor for secondary invasive mycosis disease in leukemia patients.