Clinical Analysis Of 39 Cases Of Hematological Malignancies With Invasive Pulmonary Fungal Infection

Invasive pulmonary fungal infection is a common complication of hematological malignancies, and its incidence rate is increasing gradully. It has provoked people's reconstruction in recent years for its atypia manifestation, high rate of missed diagnosis and high mortality rate.Objective:To improve the comprehension of motivation of hematological malignancies accompanied with invasive pulmonary fungal infection ,to improve therapeutic measure , reduce fungal infection, mortality rate and increase survival rate.Methods: Retrospective study of the infections motivation, fungous infection table, microbiology,treatment and outcome of 39 cases from January, 2003 to december, 2007, who have be clearly diagnosed as hematological malignancies accompanied invasive pulmonary fungal infection.Results: (1)2003 and 2004 ,the average incidence rate of invasive pulmonary fungal infections was 0.51 percent. From 2005 to 2007, the average incidence rate of invasive pulmonary fungal infections was 2.28 percent.. (2) Using chemotherapeutics repeatedly, neutropenia , using glucocorticoid , using carbopenems broad-spectrum antibiotic, low level of albumin and diabetes are main motivations of fungal infection. (3) Identificated fungus was 20 types, Monilia occupies most, Blastomyces albicans was 50%, Smooth Monilia was 25.0%, Candida tropicalis was 15% and Candida krusei was 5%, mold fungus was 5%. 17 examples were sputum, 3 examples were blood. (4) In the 39 cases, there were 4 cases belonged to final-diagnosised case, 1 case belonged to clinical-diagnosised case and 34 cases belonged to draw-up-diagnosised case according to the invasive pulmonary fungal infection diagnostic criteria and therapeutic principle protocol which has been published by chinese journal of internal medicine editorial committee at 2006. (5) The effectiveness of therapy was 53.8%.There were 17 patients died because of invasive fungal infection, the mortality was 34.6%. (6) The effective rate of itraconazole and ambisome was 60%. The effective rate of fluconazol 32.1%.(7)Incidence rate of side effect of fluconazol was 10.7%, 3 cases had enzymology alterations of hepatic function. Incidence rate of side effect of itraconazole was 16%, 2 cases had enzymology alterations of hepatic function, 1 case had gastric reaction, 1 case thrilled and got fever after using this drug. 8 cases used ambisome, 1 case had kaliopenia. 1 case used voriconazole and 1 case used caspofungin , these 2 cases didn't showed obvious side effect.Conclusion: (1)The average incidence rate of invasive pulmonary fungal infections was 2.28 percent from 2005 to 2007, higher than the 03 and 04 average incidence of 0.51 percent, a statistically significant difference (p <0.05). Invasive pulmonary fungal infection in patients with growing, and this should arouse attention to clinicians. (2) Immunodeficiency,neutropenia caused by chemotherapeutics, using glucocorticoid were the main motivations of invasive pulmonary fungal infection. Using broad-spectrum antibiotics, the damage of mucous, low level of albumin and diabetes were alse the motivations of invasive pulmonary fungal infection. (3) In the identificated fungus, Monilia occupied most, occupied 95%. Blastomyces albicans was 50%. (4) Sputum culture and hemoculture were the mian method we got microbiology evidence. But the positive rate was not high. Sputum culture repeatability was bad. The result of sputum culture can not decide whether it was pathopoiesis or field planting. (5) In the 39 cases, Most patients belonged to draw-up-diagnosised case, few patients belonged to final-diagnosised and clinical-diagnosised case according to the invasive pulmonary fungal infection diagnostic criteria and therapeutic principle protocol which has been published by chinese journal of internal medicine editorial committee at 2006. (6) The mortality rate of invasive pulmonary fungal infection was 43.6%, it was very high . (7) The effective rate of itraconazole and ambisome was higher than fluconazol. We didn't have enough experience about voriconazole and caspofungin.