Invasive Fungal Infections in Acute Haematological Malignancies: A Cross-sectional Study

Introduction: Fungal infections are common complications of acute haematological malignancies i.e. acute myeloid and acute lymphoblastic leukaemia. The cells in these two groups are different morphologically and immunologically. Hence, the interaction with the different types of fungi may vary.

Aim: To identify the acute leukaemia cases and fungal infection among myeloid and lymphoid groups and to find out association of types of invasive fungal infection according to cell line affected.

Materials and Methods: A cross-sectional observational hospital-based prospective study was conducted in a risk group of acute haematological malignancy over a period of six months from July 2021 to December 2021 in a tertiary care Hospital, Medical College, Kolkata, West Bengal, India. Study tools were questionnaire based on European Organisation for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria, clinical reports and standard laboratory procedures were practiced in Microbiology laboratory. The data was entered in excel spreadsheet and analysed using Statistical Package for the Social Sciences (SPSS) 28.0 version.

Results: A total of 24 cases of Invasive Fungal Infections (IFI) were observed, out of the 78 patients included in the study. This corresponds to an IFI prevalence of 30.77%. Patients with proven IFI constituted 8 (33.33%), probable IFI accounted for 15 (62.5%) where as those with possible IFI accounted for 1 (4.2%) of total IFI cases. There were age and sex wise variation in IFI. The prevalence of IFI was found to be higher in Acute Myeloid Leukaemia (AML) (48.5%) patients as compared to Acute Lymphoblastic Leukaemia (ALL) (19.14%). Of all AML patients, invasive candidiasis was the most common type followed by aspergillosis. In ALL patients, invasive candidiasis also constituted 44.44% followed by dematiaceous mycosis, followed by aspergillosis.

Conclusion: AML patients suffer more from IFI than ALL ones. Invasive non albicans candidiasis affected both types, but more incidence was seen in AML affected group. Aspergillus spp. affected lungs of both groups, but dematiaceous fungi were isolated only from ALL affected paediatric patients and in samples other than pulmonary or blood sample.