DEEP MYCOSES ACCOMPANYING HEMATOLOGICAL N EOPLASIAS - A POSTMORTEM ANALYSIS OF 1,053 PATIENTS

Background: Mycoses are common complications of haematological neoplas ias. For successful antimycotic treatment, a knowledge of preferential underlying disease, frequency, species and site of the mycosis is of importance. Patients and methods: Postmortem material comprising clini cal data, autopsy protocols and histological sections obtained between 1976 and 1990 from 1,053 patients with leukaemia and malignant lympho mas following anti-neoplastic therapy was analysed retrospectively. Re sults: Autopsy revealed systemic mycoses in 184 patients (17.5%). Betw een 1976 and 1990, the incidence of fungal infections increased from 1 2% to 30%, most being found in acute leukaemia (24%). Myeloproliferati ve syndrome (18%), non-Hodgkin's lymphomas (16%), Hodgkin's disease (1 0%) and plasmocytoma (2.5%) were less frequently associated with mycos es. With no preference for any particular malignancy in evidence, aspe rgillosis predominated at histology (85 cases), while candidosis occur red in 75 cases. A combination of two mycoses (aspergillosis and candi dosis) (14 patients), zygomycosis (eight patients) and cryptococcosis (two patients) were much less common. While aspergillosis caused mostl y pulmonary (81 cases) and cerebral (18 cases) infections, candidosis most frequently affected the GI tract (83 cases). The fungal infection was regarded as the main cause of death in some 76% of the cases. An analysis of bone marrow of patients with mycosis (184 cases) revealed la predominance of hypoplasia (54%) over tumour infiltration (34%) and normal bone marrow (12%). In malignancies with no mycoses (869 cases) in contrast, hypoplasia was significantly less common (19%) than infi ltration (59%) or normal bone marrow (22%) (p < 0.001). Conclusion: Th e incidence of mycoses in haematological neoplasias in our post mortem series has continued to increase. Bone marrow hypoplasia in particula r predisposes to fungal infection. The lungs are the organs of predile ction, and aspergillosis is likely to be the infection presenting.