Article
Vol. 11. No. 2
99
Eur, J. Clin. Microbiol. Infect. Dis., February 1992, p. 99-109 0934-9723/92/02 0099-11 $ 3.00/0
Fungal Infections in Cancer Patients: An International Autopsy Survey _(3. B o d e y l , , B. B u e l t m a n n 2. W D u ~ u i d 3, D. G i b b s 4, H. H a n a k 5, M. H o t c h i 6, G. Mall 7, • o 8, E M e u n i e r 9, S. Milliken " " ~10, S. N a o e 11, M. O k u d a l r• a 12 , D. S c e v o l a 13, J. van't W o u t 14 P" M a r t m
In an attempt to estimate the frequency of fungal infections among cancer patients, a survey of autopsy examinations was conducted in multiple institutions in Europe, Japan and Canada. Fungai infections were identified most often in leukemic patients and transplant recipients (25 % each). Fifty-eight percent of fungal infections were caused by Candida spp. and 30 % by Aspergillus spp. There was considerable variability in the frequency of fungal infections in different countries. Nevertheless, this study clearly demonstrates that fungal infections represent a common complication in cancer patients, especially in patients with leukemia.
The proportion of cancer patients who develop fungal infections has increased dramatically during the past three decades. The majority of these infections occur in patients with acute leukemia and in bone marrow transplant recipients. Prior to the availability of antibacterial agents, less than 5 % of patients with acute leukemia died of fungal infection, whereas presently these infections are responsible for as any as 40 % of fatalities at some institutions. rthermore, the frequency of fungal infections is increasing among patients with other malignanCies, although they still account for only a minority of infections in patients with solid tumors,
has been reported from institutions in the U S A , especially from cancer centers or university hospitals. Much less is known about the frequency of fungal infections in cancer patients in other areas of the world. The general impression is that fungal infections are also increasing in frequency in other countries, but possibly to a lesser extent than in the USA. The presumed lower frequency of fungal infections in Europe may be due to lack of recognition of these infections or to a lesser use of intensive chemotherapeutic regimens. Consequently, this survey was conducted as an attempt to estimate the frequency of fungal infections in other countries, predominantly Western E u r o p e and Japan.
Since many fungal infections remain undetected antemortem, most of the information on the frequency of these infections has been acquired from autopsy surveys. The majority of this information
Materials and Methods
~
son Cancer Center, 1515 Holcombe Blvd. 2 ~, . 7), Houston Texas, 77030 USA. 3 •mversity of Ulm,' UIm, GermantY~eal Canada Montreal General Hos ital. Mon 4 Pfizer Internation . . . . P ,~,-... v~t. lqew York, USA s6 ttanusch c'' "~ustr'~a' St. . Hos,,ital"'~C[e':, v , -na, A . 7 ~jnmshu.University Hospital, Matsumoto, Japan. 8 Unlversxty of Heidelberg, Heidelberg, Germany. 9 E~)t~e4sltyLa Sapienza, Rome, Italy. 10R I
Vol. 11. No. 2
99
Eur, J. Clin. Microbiol. Infect. Dis., February 1992, p. 99-109 0934-9723/92/02 0099-11 $ 3.00/0
Fungal Infections in Cancer Patients: An International Autopsy Survey _(3. B o d e y l , , B. B u e l t m a n n 2. W D u ~ u i d 3, D. G i b b s 4, H. H a n a k 5, M. H o t c h i 6, G. Mall 7, • o 8, E M e u n i e r 9, S. Milliken " " ~10, S. N a o e 11, M. O k u d a l r• a 12 , D. S c e v o l a 13, J. van't W o u t 14 P" M a r t m
In an attempt to estimate the frequency of fungal infections among cancer patients, a survey of autopsy examinations was conducted in multiple institutions in Europe, Japan and Canada. Fungai infections were identified most often in leukemic patients and transplant recipients (25 % each). Fifty-eight percent of fungal infections were caused by Candida spp. and 30 % by Aspergillus spp. There was considerable variability in the frequency of fungal infections in different countries. Nevertheless, this study clearly demonstrates that fungal infections represent a common complication in cancer patients, especially in patients with leukemia.
The proportion of cancer patients who develop fungal infections has increased dramatically during the past three decades. The majority of these infections occur in patients with acute leukemia and in bone marrow transplant recipients. Prior to the availability of antibacterial agents, less than 5 % of patients with acute leukemia died of fungal infection, whereas presently these infections are responsible for as any as 40 % of fatalities at some institutions. rthermore, the frequency of fungal infections is increasing among patients with other malignanCies, although they still account for only a minority of infections in patients with solid tumors,
has been reported from institutions in the U S A , especially from cancer centers or university hospitals. Much less is known about the frequency of fungal infections in cancer patients in other areas of the world. The general impression is that fungal infections are also increasing in frequency in other countries, but possibly to a lesser extent than in the USA. The presumed lower frequency of fungal infections in Europe may be due to lack of recognition of these infections or to a lesser use of intensive chemotherapeutic regimens. Consequently, this survey was conducted as an attempt to estimate the frequency of fungal infections in other countries, predominantly Western E u r o p e and Japan.
Since many fungal infections remain undetected antemortem, most of the information on the frequency of these infections has been acquired from autopsy surveys. The majority of this information
Materials and Methods
~
son Cancer Center, 1515 Holcombe Blvd. 2 ~, . 7), Houston Texas, 77030 USA. 3 •mversity of Ulm,' UIm, GermantY~eal Canada Montreal General Hos ital. Mon 4 Pfizer Internation . . . . P ,~,-... v~t. lqew York, USA s6 ttanusch c'' "~ustr'~a' St. . Hos,,ital"'~C[e':, v , -na, A . 7 ~jnmshu.University Hospital, Matsumoto, Japan. 8 Unlversxty of Heidelberg, Heidelberg, Germany. 9 E~)t~e4sltyLa Sapienza, Rome, Italy. 10R I
