Title : Invasive fungal infections caused by non-Candida yeast-like fungi: Result of a prospective study
Abstract:
Invasive fungal infections are a growing problem in critically ill patients and are associated with increased morbidity and mortality. Most of them are due to Candida and Aspergillus species. Successful treatment of these infections and the use of antifungal prophylaxis have led to the emergence of breakthrough fungal infections caused by rare yeast-like fungi (Trichosporon sp?., Rhodotorula sp?., Geotrichum sp?., Sa?charomyces sp?., Malassezia sp.).
Objective: to study the clinical and laboratory features of severe fungal infections caused by rare yeast-like pathogens to optimize their diagnosis and treatment.
Materials and Methods. A prospective study was conducted in the period 2000-2025. We used EORTC/MSG (European Organization for Research and Treatment of Cancer Mycoses study group), 2020 to diagnose mycoses.
Results. We examined 36 adult patients aged 18 to 70 years (median – 32 years), men – 59%, women - 42%.
The main background conditions were oncohematological diseases – 50%. surgical interventions – 42%, injuries/burns – 17%, AIDS – 11%, cancer of solid organs - 8%.
The main risk factors were ICU stay (83%), agranulocytosis (47%) and CVC for more than 14 days (36%). Mycosis proceeded mainly as a fungemia (72%), as well as damage to the central nervous system (17%), lungs (11%) and gastrointestinal tract (3%). 2 or more organs were affected in 11% of patients.
The causative agents of mycoses were: Trichosporon sp?. (36%), Rodotorula sp?. (33%), Geotrichum sp?. (17%), Sa?charamyses sp?. (6%), Malassesia spp. (6%), Blastobotrus spp.(3%).
13% of patients were diagnosed postmortem, the remaining patients received antimycotics: fluconazole (47%), amphotericin B deoxycholate (42%), voriconazole (28%), and echinocandins (14%). The overall survival rate of patients within 30 days was 58%. 86% of patients received antimycotics therapy (14% of patients were diagnosed postmortem).
Conclusions:
1. Invasive mycoses caused by rare yeast–like micromycetes develop mainly in patients staying in the ICU for a long time - 83% of patients.
2. The main risk factors: the use of CVC for more than 14 days (36%) and agranulocytosis (47%).
3. The main pathogens: Trichosporon spr. (36%) and Rodotorula spr. (33%).
4. The main clinical variant is fungemia (72%).
5. The overall 30-day survival rate was 58%.
