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Shadrivova, O.1; Ryabinin, I.2; Desyatik, E.2; Borzova, Y.2; Volkova, A.3; Popova, M.3; Bogomolova, T.2; Zubarovskaya, L.3; Afanasyev, B.3; Vasilyeva, N.2; Klimko, N.1

doi: 10.1097/01.HS9.0000563380.67217.68
Poster Session II: Infectious diseases

1Department of Clinical Mycology, Allergy and Immunology

2I. Mechnikov North-Western State Medical University

3I.Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russian Federation

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Publications describing invasive aspergillosis (IA) caused by “rare” pathogens are limited. Species identification of the pathogen is necessary for the selection of antifungal therapy, as some Aspergillus spp. may be resistant to antifungal drugs.

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Analysis clinical registry data of patients with IA caused by “rare” pathogens

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Retrospective analysis of patients with IA caused by “rare” pathogens in 1998-2019 yy. For the IA diagnosis EORTC / MSD, 2008 criteria were used. In accordance with the European guidelines, DNA sequencing and MALDI-TOF were used to identify of the “rare” Aspergillus spp.

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In our registry we included 800 patients with IA. In 227 patients Aspergillus spp. were isolated. The “rare” pathogens were detected in 18 (8%), and these patients were included in group I; age varied from 5 to 67 years, median - 40.5,males - 50%. The control group consisted 209 patients with other Aspergillus spp. (A. fumigatus,A. niger and A. flavus), from 1 to 99 years old, median - 47, males - 53%. In both groups IA predominantly occurs in patients with hematologic malignancies (73% vs 76%): acute leukemia - 27% vs 33%, lymphoma - 22% vs 27%, multiple myeloma 12% vs 6%, chronic leukemia 6% in each group, other hematological diseases - 6% vs 4%. We identified, IA caused by ”rare“ pathogens more often developed in children(22% vs 11%, p < 0.05).

In addition to standard risk factors, in patients with ”rare“ pathogens more often was detected lymphocytopenia 67% vs 55%, with duration 21 vs 14 days, p < 0.05, less frequent was noted fever (46% vs 78%, p < 0.05), but significantly more lung damage accompanied by hemoptysis (17% vs 10%, p < 0.05). “Rare” pathogens were A. ustus - 38%, A. nidulans - 22%, A. calidoustus - 8%, A. versicolor- 8%, A.glaucus - 8%, A. candidus - 8%, andA. sydowii - 8%. In controlgroup etiological agents were A. fumigatus - 52%,A. niger - 31%, A. flavus- 17%. Two or more species of Aspergillus were isolated in 44% vs 9%, p < 0.05. Antifungal therapy was used in 100% vs 97% of patients. Twelve weeks overall survival rate was 82% vs 81%. In the group with “rare” pathogens more frequently observed relapse of IA - 33% vs 12%, p <0.05.

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Patients with “rare” pathogens account for 8% of patients with isolated Aspergillus spp. cultures. IA caused by ”rare“ pathogens, more often occurs in children - 22%. The features of IA caused by “rare” pathogens are: long-term lymphocytopenia (67%, median - 21 days), combination of two or more pathogens - 44%, high relapse rate - 33%. Survival of patients with “rare” pathogens does not differ from the total cohort of patients - 82%.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health Inc., on behalf of the European Hematology Association.