1097. Clinical Description of Invasive Fungal Infection (IFI) secondary to Acremonium spp in Patients with Hematologic Malignancy (HM)/ Hematopoietic Cell Transplantation (HCT)
Session: Poster Abstract Session: Infections in Hematopoietic Stem Cell Transplant and Cancer Chemotherapy Recipients
Saturday, October 22, 2011
Room: Poster Hall B1
  • IDSA 2011 Acremonium 10 22 2011.pdf (112.6 kB)
  • Background: Acremonium spp are an emerging cause of IFI in the HM/ HCT.  Optimal treatment is not well defined and reported outcomes are poor, with mortality similar to that of Fusarium spp.

    Methods: Chart review of HM/ HCT patients (>18 years of age) with proven or probable IFI caused by Acremonium spp., from 1990 to 2011, as defined by the European Organization for Research and Treatment of Cancer/ Mycosis Study group.

    Results: 9 cases of IFI were identified (5 proven and 4 probable). Median age 47 years. 5 had acute leukemia, 1 chronic leukemia, 3 lymphoma and 1 multiple myeloma. 5/ 9 had matched allogenic HCT (3 unrelated, 2 related donor) and 4 HM. 1 HCT had active chronic graft versus host disease (cGVHD). 4 HCT’s were on immunosuppressants. 7 were on steroids. 4 had fungemia (1 each with skin and brain lesions), 4 had sinus involvement, 3 had pneumonia, and 2 had skin lesions. 3 were in remission, 2 relapsed after HCT and 4 had refractory disease.  7 were receiving antifungal prophylaxis at diagnosis (amphotericin B product - 2, echinocandin - 3, and fluconazole - 2). Median duration of antifungal prophylaxis was 41 days.  Serology: 6 had aspergillus galactomannan antigen tests with 1 serum positive (proven case), and 2 positive in bronchoalveolar lavage fluid with no microbiologic evidence of aspergillus co-infection (1 proven and 1 probable). 5 had beta D-glucan test: 3 positives (2 had proven infection). Treatment: 1 died before initiation of treatment, 3 had monotherapy (voriconazole 2, echinocandin 1) and 5 had amphotericin B product in combination with echinocandin (1) or azole (4). 3 had sinus debridement and 2 had tunneled catheter removed. 2 fungal isolates from proven cases had antifungal susceptibility; MIC for echinocandins >8, and in one MIC for posaconazole > 16. Median duration of treatment was 44 days. 5 (56%) died within 90 days of onset of IFI. 4 deaths occurred in 6 patients with relapsed/ refractory disease (67%).

    Conclusion: Acremonium spp. IFI in the HM/ HCT population has high mortality despite aggressive antifungal therapy, especially in persistent hematologic disorder/ neutropenic state.

    Subject Category: O. Transplant infectious diseases

    Sanjeet Dadwal, MD1, Jane Kriengkauykiat, PharmD1, Bernard Tegtmeier, PhD2 and James Ito, MD1, (1)City of Hope National Medical Center, Duarte, CA, (2)City of Hope, Duarte, CA


    S. Dadwal, None

    J. Kriengkauykiat, None

    B. Tegtmeier, None

    J. Ito, Astellas: Speaker's Bureau, Speaker honorarium
    Merck: Speaker's Bureau, Speaker honorarium
    Pfizer: Speaker's Bureau, Speaker honorarium
    Sigma Tau: Consultant, Consulting fee

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.