The significance of isolation of saprophytic molds

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1: Cancer. 2004 Jan 1;100(1):165-72. Related Articles, Links

The significance of isolation of saprophytic molds from the lower

respiratory tract in patients with cancer.

Lionakis MS, Kontoyiannis DP.

Department of Infectious Diseases, Infection Control and Employee

Health, The University of Texas M. D. Cancer Center,

Houston, Texas 77030, USA.

BACKGROUND: Invasive infections caused by molds other than

Aspergillus, Fusarium, and Zygomycetes have been reported

sporadically in patients with leukemia and allogeneic bone marrow

transplantation (BMT). However, the significance of lower

respiratory tract cultures that are positive for these saprophytic

molds in an unselected population of patients with cancer remains

unclear. METHODS: The authors evaluated the significance of

respiratory specimens positive for saprophytic molds in patients

with cancer using the criteria set by the European Organization for

Research and Treatment of Cancer (EORTC)/Mycoses Study Group (MSG).

They included the diagnostic category of indeterminate pulmonary

invasive mold infection (IMI) for cases that met the criteria for

probable IMI but had other pathogens concomitantly isolated from the

respiratory tract. RESULTS: Eighty-five cases with at least 1

positive culture were identified in 79 patients. Two cases were

proven IMI, 29 were indeterminate IMI, 5 were possible IMI, and 49

were no IMI. All 38 cases from patients with solid tumors

represented colonization compared with only 11 of the 47 cases (23%)

from high-risk patients (P < 0.0001). The positive predictive value

(PPV) of cultures was 0% in patients with solid tumors and ranged

from 4.3% to 76.6%, depending on the analytic model used, in high-

risk patients with leukemia and recipients of BMT. Cultures positive

for Scedosporium spp. had a higher PPV (9.1-100%) than did cultures

positive for non- Scedosporium spp. (2.8- 69.4%). CONCLUSIONS:

Adjustments of the EORTC/MSG criteria may be required for the

diagnosis of invasive infections caused by saprophytic molds,

especially non-Scedosporium spp., in patients with cancer. Copyright

2003 American Cancer Society.

PMID: 14692037 [PubMed - indexed for MEDLINE]