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Volume 17, Number 10—October 2011

CME ACTIVITY - Research

Invasive Non-Aspergillus Mold Infections in Transplant Recipients, United States, 2001–2006

Benjamin J. ParkComments to Author , Peter G. Pappas, Kathleen A. Wannemuehler, Barbara D. Alexander, Elias J. Anaissie, David R. Andes, John W. Baddley, Janice M. Brown, Lisa M. Brumble, Alison G. Freifeld, Susan Hadley, Loreen Herwaldt, James I. Ito, Carol A. Kauffman, G. Marshall Lyon, Kieren A. Marr, Vicki A. Morrison, Genovefa Papanicolaou, Thomas F. Patterson, Trish M. Perl, Mindy G. Schuster, Randall Walker, John R. Wingard, Thomas J. Walsh, and Dimitrios P. Kontoyiannis

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (B.J. Park, K.A. Wannemuehler); University of Alabama at Birmingham Medical Center, Birmingham, Alabama, USA (P.G. Pappas, J.W. Baddley); Duke University Medical Center, Durham, North Carolina, USA (B.D. Alexander); University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA (E.J. Anaissie); University of Wisconsin–Madison, Madison, Wisconsin, USA (D.R. Andes); Stanford University School of Medicine, Stanford, California, USA (J.M. Brown); Mayo Clinic, Jacksonville, Florida, USA (L.M. Brumble); University of Nebraska Medical Center, Omaha, Nebraska, USA (A.G. Freifeld); Tufts Medical Center, Boston, Massachusetts, USA (S. Hadley); University of Iowa Hospital, Iowa City, Iowa, USA (L. Herwaldt); City of Hope National Medical Center, Duarte, California, USA (J.I. Ito); University of Michigan, Ann Arbor, Michigan, USA (C.A. Kauffman); Veterans Affairs Ann Arbor Healthcare System–Medicine, Ann Arbor (C.A. Kauffman); Emory University School of Medicine, Atlanta (G.M. Lyon); Johns Hopkins Medical Institutions, Baltimore, Maryland, USA (K.A. Marr, T.M. Perl); Fred Hutchinson Cancer Research Center, Seattle, Washington, USA (K.A. Marr); University of Minnesota, Minneapolis, Minnesota, USA (V.A. Morrison); Veterans Affairs Medical Center, Minneapolis (V.A. Morrison); Memorial Sloan Kettering Cancer Center, New York, New York, USA (G. Papanicolaou); University of Texas Health Sciences Center, San Antonio, Texas, USA (T.F. Patterson); South Texas Veterans Healthcare System, San Antonio (T.F. Patterson); Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA (M.G. Schuster); Mayo Clinic, Rochester, Minnesota, USA (R. Walker); University of Florida, Gainesville, Florida, USA (J.R. Wingard); National Institutes of Health, Bethesda, Maryland, USA (T.J. Walsh); MD Anderson Cancer Center, Houston, Texas, USA (D.P. Kontoyiannis)

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Table 3

Characteristics of HCT and SOT patients* with proven or probable invasive Mucorales, Fusarium spp., or Scedosporium spp. infection, as reported in TRANSNET, United States, 2001–2006†

Characteristic‡ Mucorales, no. (%), n = 105 Fusarium spp., no. (%), n = 37 Scedosporium spp., no. (%), n = 27 Total, no. (%),
N = 169
Male sex 58 (56.9) 26 (70.3) 12 (44.4) 96 (57.8)
White race 86 (90.5) 34 (94.4) 21 (91.3) 141 (91.6)
Proven IFI 61 (58.1) 21 (56.8) 13 (48.1) 95 (56.2)
Diabetes mellitus at time of fungal infection 46 (43.8) 9 (56.8) 7 (25.9) 62 (36.7)
Prior IFI 23 (21.9) 8 (19.5) 10 (24.4) 41 (24.3)
Prior aspergillosis
17 (16.2)
1 (2.7)
4 (14.8)
22 (13.0)
Antemortem clinical involvement§
Pulmonary only 52 (53.1) 14 (38.9) 16 (59.3) 82 (50.9)
Sinus only 12 (12.2) 2 (5.6) 1 (3.7) 15 (9.3)
Skin only 9 (9.2) 3 (8.3) 0 12 (7.5)
Disseminated 13 (13.3) 8 (22.2) 7 (25.9) 28 (17.4)
Rhinocerebral only 3 (3.1) 1 (2.8) 0 4 (2.5)
Other¶
3 (3.1)
6 (16.7)
2 (7.4)
11 (6.8)
Death at 90 d 57 (58.2) 18 (51.4) 15 (57.7) 90 (56.6)
HCT
77 (73.3)
31 (24.3)
16 (59.3)
124 (73.4)
Underlying condition
ALL 7 (9.1) 1 (3.2) 2 (12.5) 10 (8.1)
AML 21 (27.3) 11 (35.5) 3 (18.8) 35 (28.2)
CML 7 (9.1) 2 (6.5) 4 (25) 13 (10.5)
HL 4 (5.2) 1 (3.2) 0 5 (4)
NHL 15 (19.5) 8 (25.8) 3 (18.8) 26 (21)
AA 3 (3.9) 1 (3.2) 0 4 (3.2)
MM 5 (6.5) 1 (3.2) 1 (6.3) 7 (5.6)
MDS
10 (13)
1 (3.2)
1 (6.3)
12 (9.7)
HCT graft donor
Autologous 8 (10.4) 4 (12.9) 0 12 (9.7)
Allogeneic matched-related 34 (44.2) 13 (41.9) 7 (43.8) 54 (43.5)
Allogeneic mismatched-related 4 (5.2) 4 (12.9) 2 (12.5) 10 (8.1)
Allogeneic unrelated
30 (39)
10 (32.3)
7 (43.8)
47 (37.9)
Other characteristics
Neutropenia# 39 (50.6) 17 (54.8) 4 (25) 60 (48.4)
Steroids at diagnosis 59 (76.6) 24 (77.4) 14 (87.5) 97 (78.2)
Myeloablative preconditioning 46 (59.7) 18 (58.1) 11 (68.8) 75 (60.5)
Acute GvHD 32 (41.6) 7 (22.6) 6 (37.5) 45 (36.3)
Chronic GvHD 29 (37.7) 14 (45.2) 7 (43.8) 50 (40.3)
Steroid treatment 58 (75.3) 19 (61.3) 13 (81.3) 90 (72.6)
GvHD grade 1 or 2 18 (23.4) 4 (12.9) 4 (25.0) 26 (21.0)
GvHD grade 3 or 4 35 (45.4) 14 (45.2) 5 (31.3) 54 (43.5)
SOT
28 (26.7)
6 (51.4)
11 (40.7)
45 (26.6)
Organ transplanted
Heart 3 (10.7) 1 (16.7) 0 4 (8.9)
Lung 8 (28.6) 2 (33.3) 9 (81.8) 19 (42.2)
Kidney 9 (32.1) 1 (16.7) 2 (18.2) 12 (26.7)
Liver
9 (32.1)
2 (33.3)
0
11 (24.4)
Organ rejection within previous 30 d 13 (48.1) 3 (50) 8 (72.7) 24 (54.5)

*Includes 3 patients with 2 infections each; 2 patients had separate Fusarium and Scedosporium infections; 1 person had separate mucormycosis and scedosporiosis.
†Denominators vary because of missing data. HCT, hematopoietic cell transplant; SOT, solid organ transplant; TRANSNET, Transplant-Associated Infection Surveillance Network; IFI, invasive fungal infection; ALL, acute lymphocytic leukemia; AML, acute myelogenous leukemia; CML, chronic myelogenous leukemia; HL, Hodgkin lymphoma; NHL, non-Hodgkin lymphoma; AA, aplastic anemia; MM, multiple myeloma; MDS, myelodysplastic syndrome; GvHD, graft-versus-host disease.
‡Median ages (interquartile ranges) are as follows: patients with Mucorales infection, 51 y (39–57 y); patients with Fusarium spp. infection, 45 y (32–59 y); patients with Scedosporium spp. infection, 46 y (38–59 y); and all patients, 49 y (36–57 y).
§Antemortem organ involvement was classified according to recorded sites of infection; disseminated infection was defined as infection in noncontiguous organs.
¶Esophageal (1 Scedosporium spp.); heart (3 Mucorales); blood (6 Fusarium spp., 1 Scedosporium sp.).
#Defined as an absolute neutrophil count <500/μL, within 60 d before development of invasive fungal infection.

*Includes 3 patients with 2 infections each; 2 patients had separate Fusarium and Scedosporium infections; 1 person had separate mucormycosis and scedosporiosis.
†Denominators vary because of missing data. HCT, hematopoietic cell transplant; SOT, solid organ transplant; TRANSNET, Transplant-Associated Infection Surveillance Network; IFI, invasive fungal infection; ALL, acute lymphocytic leukemia; AML, acute myelogenous leukemia; CML, chronic myelogenous leukemia; HL, Hodgkin lymphoma; NHL, non-Hodgkin lymphoma; AA, aplastic anemia; MM, multiple myeloma; MDS, myelodysplastic syndrome; GvHD, graft-versus-host disease.
‡Median ages (interquartile ranges) are as follows: patients with Mucorales infection, 51 y (39–57 y); patients with Fusarium spp. infection, 45 y (32–59 y); patients with Scedosporium spp. infection, 46 y (38–59 y); and all patients, 49 y (36–57 y).
§Antemortem organ involvement was classified according to recorded sites of infection; disseminated infection was defined as infection in noncontiguous organs.
¶Esophageal (1 Scedosporium spp.); heart (3 Mucorales); blood (6 Fusarium spp., 1 Scedosporium sp.).
#Defined as an absolute neutrophil count <500/μL, within 60 d before development of invasive fungal infection.

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