Prevalence of fungal DNAemia mediated by putatively non-pathogenic fungi in immunocompromised patients with febrile neutropenia: a prospective cohort study

IF 29.5 1区 医学 Q1 HEMATOLOGY Journal of Hematology & Oncology Pub Date : 2024-08-07 DOI:10.1186/s13045-024-01583-0
Chantal Lucini, Klára Obrová, Isabella Krickl, Filomena Nogueira, Iva Kocmanová, Susanne Herndlhofer, Karoline V. Gleixner, Wolfgang R. Sperr, Tijana Frank, Nuno Andrade, Christina Peters, Gernot Engstler, Michael Dworzak, Andishe Attarbaschi, Martine van Grotel, Marry M. van den Heuvel-Eibrink, Ivan S Moiseev, Yuliya Rogacheva, Ludmilla Zubarovskaya, Natalia Zubarovskaya, Herbert Pichler, Anita Lawitschka, Elisabeth Koller, Felix Keil, Jiří Mayer, Barbora Weinbergerová, Peter Valent, Thomas Lion
{"title":"Prevalence of fungal DNAemia mediated by putatively non-pathogenic fungi in immunocompromised patients with febrile neutropenia: a prospective cohort study","authors":"Chantal Lucini, Klára Obrová, Isabella Krickl, Filomena Nogueira, Iva Kocmanová, Susanne Herndlhofer, Karoline V. Gleixner, Wolfgang R. Sperr, Tijana Frank, Nuno Andrade, Christina Peters, Gernot Engstler, Michael Dworzak, Andishe Attarbaschi, Martine van Grotel, Marry M. van den Heuvel-Eibrink, Ivan S Moiseev, Yuliya Rogacheva, Ludmilla Zubarovskaya, Natalia Zubarovskaya, Herbert Pichler, Anita Lawitschka, Elisabeth Koller, Felix Keil, Jiří Mayer, Barbora Weinbergerová, Peter Valent, Thomas Lion","doi":"10.1186/s13045-024-01583-0","DOIUrl":null,"url":null,"abstract":"Invasive fungal disease (IFD) presents a life-threatening condition in immunocompromised patients, thus often prompting empirical administration of antifungal treatment, without adequate mycological evidence. Over the past years, wide use of antifungal prophylaxis resulted in decreased occurrence of IFD but has contributed to changes in the spectrum of fungal pathogens, revealing the occurrence of previously rare fungal genera causing breakthrough infections. The expanding spectrum of clinically relevant fungal pathogens required the implementation of screening approaches permitting broad rather than targeted fungus detection to support timely onset of pre-emptive antifungal treatment. To address this diagnostically important aspect in a prospective setting, we analyzed 935 serial peripheral blood (PB) samples from 195 pediatric and adult patients at high risk for IFD, involving individuals displaying febrile neutropenia during treatment of hematological malignancies or following allogeneic hematopoietic stem cell transplantation. Two different panfungal-PCR-screening methods combined with ensuing fungal genus identification by Sanger sequencing were employed. In the great majority of PB-specimens displaying fungal DNAemia, the findings were transient and revealed fungi commonly regarded as non-pathogenic or rarely pathogenic even in the highly immunocompromised patient setting. Hence, to adequately exploit the diagnostic potential of panfungal-PCR approaches for detecting IFD, particularly if caused by hitherto rarely observed fungal pathogens, it is necessary to confirm the findings by repeated testing and to identify the fungal genus present by ensuing analysis. If applied appropriately, panfungal-PCR-screening can help prevent unnecessary empirical therapy, and conversely, contribute to timely employment of effective pre-emptive antifungal treatment strategies.","PeriodicalId":16023,"journal":{"name":"Journal of Hematology & Oncology","volume":"52 1","pages":""},"PeriodicalIF":29.5000,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hematology & Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13045-024-01583-0","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEMATOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Invasive fungal disease (IFD) presents a life-threatening condition in immunocompromised patients, thus often prompting empirical administration of antifungal treatment, without adequate mycological evidence. Over the past years, wide use of antifungal prophylaxis resulted in decreased occurrence of IFD but has contributed to changes in the spectrum of fungal pathogens, revealing the occurrence of previously rare fungal genera causing breakthrough infections. The expanding spectrum of clinically relevant fungal pathogens required the implementation of screening approaches permitting broad rather than targeted fungus detection to support timely onset of pre-emptive antifungal treatment. To address this diagnostically important aspect in a prospective setting, we analyzed 935 serial peripheral blood (PB) samples from 195 pediatric and adult patients at high risk for IFD, involving individuals displaying febrile neutropenia during treatment of hematological malignancies or following allogeneic hematopoietic stem cell transplantation. Two different panfungal-PCR-screening methods combined with ensuing fungal genus identification by Sanger sequencing were employed. In the great majority of PB-specimens displaying fungal DNAemia, the findings were transient and revealed fungi commonly regarded as non-pathogenic or rarely pathogenic even in the highly immunocompromised patient setting. Hence, to adequately exploit the diagnostic potential of panfungal-PCR approaches for detecting IFD, particularly if caused by hitherto rarely observed fungal pathogens, it is necessary to confirm the findings by repeated testing and to identify the fungal genus present by ensuing analysis. If applied appropriately, panfungal-PCR-screening can help prevent unnecessary empirical therapy, and conversely, contribute to timely employment of effective pre-emptive antifungal treatment strategies.
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
发热性中性粒细胞减少症免疫功能低下患者中由假定非致病性真菌介导的真菌 DNA 血症的患病率:一项前瞻性队列研究
侵袭性真菌病(IFD)是一种威胁免疫力低下患者生命的疾病,因此往往需要在没有充分真菌学证据的情况下进行经验性抗真菌治疗。过去几年中,抗真菌预防性治疗的广泛使用减少了侵袭性真菌感染的发生率,但也导致了真菌病原体谱的变化,揭示了以前罕见的真菌属引起突破性感染的情况。临床相关真菌病原体的范围不断扩大,这就要求采用筛查方法,允许广泛而不是有针对性地检测真菌,以支持及时开始先发制人的抗真菌治疗。为了在前瞻性环境中解决这一重要的诊断问题,我们分析了 195 名儿童和成人 IFD 高危患者的 935 份序列外周血(PB)样本,其中包括在血液恶性肿瘤治疗期间或异体造血干细胞移植后出现发热性中性粒细胞减少症的患者。我们采用了两种不同的泛真菌-PCR 筛选方法,并随后通过桑格测序鉴定真菌属。在绝大多数出现真菌DNA血症的PB标本中,发现的真菌都是一过性的,即使在免疫力高度低下的患者环境中,发现的真菌也通常被认为是非致病性或极少致病性的。因此,要充分发挥泛真菌 PCR 方法在检测 IFD 方面的诊断潜力,尤其是由迄今为止很少观察到的真菌病原体引起的 IFD,就必须通过重复检测来确认结果,并通过随后的分析来确定存在的真菌属。如果应用得当,泛真菌 PCR 筛查有助于避免不必要的经验性治疗,反之,也有助于及时采用有效的先期抗真菌治疗策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
48.10
自引率
2.10%
发文量
169
审稿时长
6-12 weeks
期刊介绍: The Journal of Hematology & Oncology, an open-access journal, publishes high-quality research covering all aspects of hematology and oncology, including reviews and research highlights on "hot topics" by leading experts. Given the close relationship and rapid evolution of hematology and oncology, the journal aims to meet the demand for a dedicated platform for publishing discoveries from both fields. It serves as an international platform for sharing laboratory and clinical findings among laboratory scientists, physician scientists, hematologists, and oncologists in an open-access format. With a rapid turnaround time from submission to publication, the journal facilitates real-time sharing of knowledge and new successes.
期刊最新文献
Correction: Non-invasive diagnosis of esophageal cancer by a simplified circulating cell-free DNA methylation assay targeting OTOP2 and KCNA3: a double-blinded, multicenter, prospective study Lenvatinib and immune-checkpoint inhibitors in hepatocellular carcinoma: mechanistic insights, clinical efficacy, and future perspectives Bortezomib-releasing silica-collagen xerogels for local treatment of osteolytic bone- and minimal residual disease in multiple myeloma Tumor-derived G-CSF induces an immunosuppressive microenvironment in an osteosarcoma model, reducing response to CAR.GD2 T-cells myCAF-derived exosomal PWAR6 accelerates CRC liver metastasis via altering glutamine availability and NK cell function in the tumor microenvironment
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1