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Clinical Approach for Invasive Fungal Disease Explored

Diagnosing neutropenia-induced complication may not require microbiologic surveillance

WEDNESDAY, Oct. 21 (HealthDay News) -- A clinically driven approach to neutropenia-induced invasive fungal disease (IFD) can expedite diagnosis and reduce unnecessary antifungal treatment compared to standard empirical and preemptive strategies, according to a study published online Oct. 19 in the Journal of Clinical Oncology.

Corrado Girmenia, M.D., of the University of Rome, and colleagues evaluated 220 neutropenia episodes in 146 patients. The subjects all underwent baseline workup of blood cultures and other examinations. If symptoms persisted for four days, an intensive three-day workup of serum galactomannan, chest computed tomography, and other examinations were conducted. Patients diagnosed with IFD or with persistent neutropenic fever received antifungal therapy.

Of the total of 220 neutropenia episodes, the researchers note that two cases of IFD were diagnosed in the basic workup and 47 in the intensive workup. Antifungal therapy was given to 48 patients diagnosed with IFD and a single patient received empirical antifungal therapy (one patient died without treatment). Intensive workup was necessary in 40 percent of neutropenia episodes, and there was a 43 percent reduction in antifungal treatments compared to the standard empirical approach. At three-month follow-up, no previously undetected IFD was discovered.

"In summary, we implemented a clinically driven antifungal approach without microbiologic surveillance, alternative to empirical and preemptive strategies. This diagnostic algorithm in chemotherapy-induced neutropenia offers effective antifungal control, although non-Aspergillus infections may be a problem," the authors write. "Randomized trials comparing empirical versus diagnostic driven -- preemptive and clinically driven -- antifungal strategies with a predefined diagnostic workup are warranted to demonstrate differences in terms of survival and costs."

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