Investigation of Candidemia Diagnosis by PCR Method in Febrile Neutropenic Patients with Hematological Malignancies Hematological Malignancies and Candidemia
Article Sidebar
Main Article Content
Abstract
Objective: Candidiasis" is the predominant fungal infection that occurs invasively and opportunistically in individuals with compromised immune systems. Febrile neutropenia patients receiving cytotoxic chemotherapy due to malignancy, especially acute leukemia and stem cell transplantation are at greater risk among many others. In this study, it was aimed to search for Candida DNA to make an early diagnosis by using PCR method
Materials & Method: This prospective study was conducted in Pediatric Hematology Transplantation Clinic of Akdeniz University. The study enrolled 78 patients with malignancies and candidiasis infection who were experiencing febrile neutropenia. The febrile neutropenic episodes were identified prospectively by monitoring the daily leukocyte counts and fever symptoms of the patients.
Results: Candida was grown in the blood cultures of seven (9%) of the febrile neutropenic patients included in the study. All of the breeding Candidas were C.albicans. The underlying primary diagnosis of 6 (85.7%) of the febrile neutropenic patients with reproduction was hematological malignancy, while the underlying primary diagnosis of one (12.5%) was solid malignancy (Neuroblastoma). PCR detected Candida DNA in 9% of Febrile Neutropenic patients. C.albicans was grown in the blood cultures of all patients with Candida DNA.
Conclusion: As a result, The conclusion drawn was that in cases where candidemia is suspected, particularly in febrile neutropenic patients with hematological malignancies who are immuno-compromised and at high risk of mortality, rapid and accurate diagnosis using Candida PCR with high sensitivity and specificity is necessary.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Accepted 2023-02-12
Published 2023-02-15
References
Rosa, R.G. and L.Z. Goldani, Cohort study of the impact of time to antibiotic administration on mortality in patients with febrile neutropenia. Antimicrob Agents Chemother, 2014. 58(7): p. 3799-803.
Greer, J.P., Wintrobe's clinical hematology. 3rd ed. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins Health; 2014
Swerdlow, S.H., Campo E., Pileri S.A., Harris N.L., Stein H., Siebert R., et al., The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood, 2016. 127(20): p. 2375-90.
Adamson, P., Bray F., Costantini A.S., Tao M.H., Weiderpass E., Roman E., Time trends in the registration of Hodgkin and non-Hodgkin lymphomas in Europe. Eur J Cancer, 2007. 43(2): p. 391-401.
Crawford, J., D.C. Dale, and G.H. Lyman, Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management. Cancer, 2004. 100(2): p. 228-37.
Hao, T., Li-Talley, M., Buck, A., Chen, WY. An emerging trend of rapid increase of leukemia but not all cancers in the aging population in the United States, Sci Rep 9, 2019. 12070 (2019).
Flowers, C.R., Seidenfeld J., Bow E.J., Karten C., Gleason C., Hawley D.K., et al., Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2013 Feb 20;31(6):794-810.
Arber D.A., Orazi A., Hasserjian R., Thiele J., Borowitz M.J., Le Beau M., et al., The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood. 2016 May 19;127(20):2391-405.
Freifeld, A.G., Bow E.J., Sepkowitz K.A., Boeckh M.J., Ito J., Mullen C.A., et al., Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of America. Clin Infect Dis, 2011. 52(4): p. e56-93.
Akova M., Paesmans M., Calandra T., Viscoli C., International Antimicrobial Therapy Group of the European Organization for Research and Treatment of Cancer, Clin Infect Dis. 2005 Jan 15;40(2):239-45.
Febril Nötropeni Çalışma Grubu Febril Nötropenik Hastalarda Tanı ve tedavi Klavuzu Flora 2004;9(1):5-28 http://www.floradergisi.org/managete/fu_folder/2004-01/2004-9-1-005-028.pdf December 20, 2022.
Loeffler J., Hebart H, Schumacher U, Reitze H, Einsele H., Comparison of different methods for extraction of DNA of fungal pathogens from cultures and blood, J Clin Microbiol. 1997 Dec;35(12):3311-2.
Baskaran, N.D., G.G. Gan, and K. Adeeba, Applying the Multinational Association for Supportive Care in Cancer risk scoring in predicting outcome of febrile neutropenia patients in a cohort of patients. Ann Hematol, 2008. 87(7): p. 563-9.
Kara Ali, R., Surme S., Balkan İ.İ., Salihoglu A., Ozdemir M.S., Ozdemir Y., et al., An eleven-year cohort of bloodstream infections in 552 febrile neutropenic patients: resistance profiles of Gram-negative bacteria as a predictor of mortality. Ann Hematol, 2020. 99(8): p. 1925-1932.
Işık N., Mills K. Using PCR and Real-Time PCR (LightCycler) for Diagnosis and Follow up of Invasive Fungal Infections in Turkish Journal of Haematology 2003, Volume 20, Number 2, Page(s) 63-68
Pagano, L., Antinori, A., Ammassari, A., Mele, L., Nosari, A., Melillo, Martino B, Sanguinetti M, Equitani F, Nobile F, Carotenuto M, Morra E, Morace G, Leone G. Retrospective study of candidemia in patients with hematological malignancies. Clinical features, risk factors and outcome of 76 episodes. European journal of haematology. 1999 Aug; 63(2), 77–85.
Zeichner Ostrosky L., Invasive Mycoses: Diagnostic Challenges. The American Journal of Medicine, 2012; 125, 14-24.
Dinubile MJ, Hille D, Sable CA, Kartsonis NA. Invasive candidiasis in cancer patients:observations from a randomized clinical trial. J Infect. 2005 Jun;50(5):443-9.
Viscoli C, Girmenia C, Marinus A, Collette L, Martino P, Vandercam B, Doyen C, Lebeau B, Spence D, Krcmery V, De Pauw B, Meunier F. Candidemia in cancer patients: a prospective, multicenter surveillance study by the Invasive Fungal Infection Group (IFIG) of the European Organization for Research and Treatment of Cancer (EORTC). Clin Infect Dis. 1999 May;28(5):1071-9.
Kett DH, Azoulay E, Echeverria PM, Vincent J-L. Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study. Critical care medicine. 2011;39(4):665-70.
Arjuna N.B Ellepola and Christine J. Morrison Laboratory Diagnosis of Invasive Candidiasis The Journal of Microbiology, February 2005, p.65-84
Ahn, S., Lee Y.S., Chun Y.H., Lim K.S., Kim W., Lee J.L., Predictive factors of bacteraemia in low-risk patients with febrile neutropenia. Emerg Med J, 2012. 29(9): p. 715-9.
Maaroufi Y, Heymans C, De Bruyne JM, Duchateau V, Rodriguez-Villalobos H, Aoun M, Crokaert F. Rapid detection of Candida albicans in clinical blood samples by using a TaqMan-based PCR assay. J Clin Microbiol. 2003 Jul;41(7):3293-8.
Kalkancı A,Kuştimur S,Güneş İ,Otlu B Nötropenik hastalarda invazif Candida infeksiyonunun polimeraz zincir reaksiyonu ile tanısı. İnfeksiyon Dergisi. 2003; 17(2): 171 - 174.
Cruciani M., Mengoli C., Loeffler J., Donnelly P., Barnes R., Jones B.L., Klingspor L., Morton O., Maertens J., Polymerase chain reaction blood tests for the diagnosis of invasive aspergillosis in immunocompromised people. Cochrane Database Syst Rev. Sep 7;9:CD009551.