Fungal empyema thoracis in cancer patients

Masayuki Nigo, Macarena R. Vial, Jose M. Munita, Ying Jiang, Jeffrey Tarrand, Carlos A. Jimenez, Dimitrios P. Kontoyiannis

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Objectives: Fungal empyema thoracis (FET) is a rare life-threatening infection. We sought to describe the clinical characteristics of FET in a large academic cancer center. Methods: We conducted a retrospective chart review of all cancer patients who had a fungal isolate from the pleural fluid culture between 1/2005 and 8/2013. Results: A total of 106 fungal isolates were identified in 97 patients. Yeasts accounted for 62% of the isolates whereas 38% were identified as molds. The most frequent pathogens were Candida spp. (58%) and Aspergillus spp. (12%). All patients with Aspergillus and 83% with Candida met criteria for proven fungal disease. Compared to the Aspergillus group, Candida FET was associated with recent abdominal or thoracic surgical procedures (44% vs. 0%, p = 0.01). Overall, 6-week mortality was high, with no significant differences between Candida and Aspergillus (31% vs. 45%, respectively [p = 0.48]). Only 1 out of 11 patients with uncommon molds died at 6 weeks, despite only 2 of them received appropriate antifungal therapy. Conclusions: Development of FET carries a high mortality in cancer patients. A history of a recent surgical procedure is a risk factor for FET due to Candida. Isolation of uncommon molds is likely to represent a contamination of the pleural fluid.

Original languageEnglish (US)
Pages (from-to)615-621
Number of pages7
JournalJournal of Infection
Volume72
Issue number5
DOIs
StatePublished - May 1 2016

Keywords

  • Cancer
  • Empyema
  • Fungal empyema
  • Invasive fungal infection

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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