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Invasive fungal infections: High mortality and new underlying diseases in Middle East

March 20 2017

A retrospective study of 102 hospitalised patients with invasive candidiasis or aspergillosis in Saudi Arabia and Lebanon (Alothman et al 2017) identifies several non-traditional common co-morbidities including coronary artery disease (24%), congestive heart failure (15%), moderate-to-severe renal disease (16%), and diabetes (41%). In selected and diagnosed patients, some immunocompromising factors were also present, notably corticosteroids prior to admission (20%) and chemotherapy in the prior 3 months (26%). The authors caution their peers: “Earlier consideration ... of IFI in medically comorbid patients may reduce the time to antifungal treatment and improve outcomes.”

This study also highlights a high mortality of 42%, mean hospitalisation period of 32 days, the low use of Aspergillus galactomannan testing (11%), and the delay before a diagnosis of invasive fungal infection was made. They note that the median time from admission to diagnosis was 6 days (range 0 to 92 days), and it took another day for antifungal therapy to be started. A median of 2.5 days (range −3 to 80 days) elapsed between culture collection and treatment given. Fluconazole was the favoured antifungal, but over 50% of the infections were resistant to it.

Invasive fungal infections (IFI) have considerably increased due to advances in medical care in immunocompromised individuals. Aspergillus fumigatus and Candida species remains the most common serious threat in this category. The main host risk factors for invasive fungal infections include neutropenia, haematological malignancies, bone marrow transplantation, prolonged treatment with corticosteroids, prolonged stay in intensive care, chemotherapy, HIV infection, invasive medical procedures, and the newer immune suppressive agents. Other risk factors are malnutrition, solid organ transplantation, severe burns major surgery, and broad-spectrum antibiotics.

This study has limitations, being only diagnosed and partially selected patients. It is the first ‘real-life’ study of the characteristics of patients with invasive fungal diseases in the Middle East.  Guidelines for invasive aspergillosis for the Middle East are published, but this was after this study was undertaken. The study was supported by Pfizer.

Middle East Guidelines for treatment of Invasive aspergillosis.  View other guidelines

 Article  Alothman et al, Infection and drug resistance  10, 35-41 2017.