Session: Poster Abstract Session: Fungal Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Cutaneous manifestations are very common in immunocompromized hosts with hematologic malignancies and the differential diagnosis is broad. The present study was designed in order to describe the clinical and microbiological data and identify predictors of bacterial vs. fungal infections in patients with leukemia, new skin lesions and documented infection.

Methods: We reviewed the demographic, clinical and laboratory information in the medical records of all patients from the leukemia service at M.D. Anderson Cancer Center, who had a biopsy performed for new skin lesions and suspected infection, between January 2004 and December 2007. Patients who had received hematopoietic stem cell transplantation and those undergoing biopsy for follow-up of skin malignancies were excluded. 

Results: 38 patients with bacterial and 30 with fungal infections were studied. Two patients with mixed infections were excluded. The most common bacterial pathogens isolated were Staphyloccocus aureus and aerobic gram negative rods. The most common fungal organisms isolated were Candida and Fusarium sp. (25% and 18.8% of all fungal lesions, respectively), followed by the mucorales, Aspergillus sp. and black molds. The most common Candida species was C. tropicalis, followed by C. parapsillosis, C. glabrata and C. krusei. Except two patients with positive blood cultures for Fusarium, one with disseminated Scedosporium, and two patients with positive cultures from bronchoalveolar lavage (one Aspergillus, one Mucor), 70.5% (12/17) of all molds were identified by skin biopsy alone. Patients with fungal infections were more likely to have neutropenia (ANC<500/µL, P=0.048; ANC<100, P=0.008), monocytopenia (AMC<100/µL, P=0.026), and a maculopapular or pustular rash (P=0.009). In multivariate analysis, an ANC<100 was the only predictor of a fungal infection (OR 3.45, 95% CI 1.26-9.41).

Conclusion: In leukemic patients with new skin lesions of an infectious aetiology, profound neutropenia (ANC<100/ µL) was the only significant predictor of invasive fungal over bacterial skin and soft tissue infections. Candida tropicalis and Fusarium were the most frequent fungal pathogens. In the assessment of patients with leukemia and a new skin eruption, skin biopsy is a helpful tool for identifying culprit pathogens, especially invasive molds.

Dimitrios Farmakiotis, MD, Baylor College of Medicine, Houston, TX, Ana M. Ciurea, MD, MD Anderson Cancer Center, Houston, TX and Dimitrios P. Kontoyiannis, MD, UT MD Anderson Cancer Center, Houston, TX


D. Farmakiotis, None

A. M. Ciurea, None

D. P. Kontoyiannis, None

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