Introduction Methods The epidemiology of IMD in IC patients varies

Introduction Methods The epidemiology of IMD in IC patients varies

M. Cecilia Dignani, MD [email protected], Phone: +54 9 11 64651021
FAX: +54 11 5901 3203 www.remiin.com
164
DIGNANI MC1, CHILLER T2, DAVEL G3, ROSSI S4, VALLEDOR A5, GUERRINI G6, PEREYRA ML7, ROCCIA ROSSI I8, JORDAN R9, HERRERA F10, LABORDE A11, VILA A12, PERETTI H13, ZARATE A14, BAJALEE A2, HEVIA A3, REFOJO N3, REMIIN GROUP (Registro Micosis Invasoras) 1REMIIN (Registro Micosis Invasoras)*, Buenos Aires, ARGENTINA; 2Mycology Branch, CDC, Atlanta, USA; 3ANLIS, Buenos Aires, ARGENTINA; 4CDR, Buenos Aires, ARGENTINA; 5Htal. Italiano, Buenos Aires, ARGENTINA; 6Htal. Rossi, La Plata, ARGENTINA; 7Htal. Austral, Pilar, ARGENTINA; 8Htal. San Martín, La Plata, ARGENTINA; 9Htal. Británico, Buenos Aires, ARGENTINA; 10CEMIC, Buenos Aires, ARGENTINA; 11FUNDALEU, Buenos Aires, ARGENTINA; 12Htal. Italiano, Mendoza, ARGENTINA; 13Sanatorio Británico, Rosario, ARGENTINA; 14Htal. Privado de Córdoba, Córdoba, ARGENTINA.
Introduction
The epidemiology of IMD in IC patients varies in different institutions and countries, mainly due to: 1) the patient history of antifungal
treatments (AFT), 2) geography, and, 3) institutional reservoirs. A multicenter national registry for IMD (REMIIN, Registro Micosis
Invasoras) was created in February 2010 to understand the Argentinean epidemiology of IMD. Preliminary results are presented.
Methods
The criteria to be enrolled in the REMIIN were: 1) non‐HIV immunesuppression, 2) probable or proven IMD (EORTC/MSG 2008), 3)
signed informed consent, and 4) recent IMD (less than 3 months after the end of the AFT). Clinical data of patients were obtained using
a web based electronic case report form. Digital images of CT were sent to a referral radiology center (CDR). Molds were sent to the
National Mycology Referral Center (ANLIS) to be identified according to their phenotypic features (growth rate and macroscopic and
microscopic morphology). Aspergillus antigen tests (GM) were performed locally at each center.
Results
From 3/2010 to 2/2012, 48 patients from 11 centers were enrolled. Median age was 47 (6‐77) years old and 69% were males.
Underlying diseases included hematological malignancies (40), solid organ trasplantation (6, 4 renal, 2 liver), CGD (1) and
immunosuppression due to steroid treatment (1). Hematopoietic stem cell transplantation (HSCT) was received by 7 patients (2/7
autologous). Fifty percent of IMD were documented and 50% were probable. The diagnoses were made by culture (36), pathology
(13), or GM (10). In 14 (29%) patients more than one mycology test was positive. In 34 (71%) only one test was diagnostic (26
culture, 5 GM, 3 pathology). The organisms causing IMD are shown in the table. Treatment and outcome data are available for 44
patients. Initial antifungal treatments (AFTs) were Liposomal Amphotericin B (17), Voriconazole (14), deoxycholate Amphotericin B
(6), Anidulafungin (2) Caspofungin (1), Itraconazole (1), and Posaconazole (1). Combination AFT was given to 2 patients. Survival was
89% on day 30 of AFTs and 43% at a median follow up of 176 days (12‐1224). At 6 weeks of AFTs 30 (68%) had a partial (18) or
complete (12) response.
Extention of the IMD
Disseminated
Localized
25%
Conclusions
75%
Preliminary data from the first multicenter registry of IMD in IC patients in Argentina showed that the most common etiological agents
were Aspergillus spp. followed by Fusarium spp. and Zygomycetes. These results are comparable to those seen in the northern
hemisphere.
*REMIIN Group: Other members (alphabetical order): Abiega, Claudio; Abrantes, Rubén; Afeltra Javier; Agorio Iris; Aguilera, Karina; Altclas, Javier; Amigot, Susana; Ardizzoli,
Karina; Barcán, Laura; Bonvehí, Pablo; Calmaggi, Aníbal; Carballo, Viviana; Cassata, Andrea; Chavez, Maria Laura; Christín, Martín; Cohen, Guillermo; Córdoba, Susana; Costantini,
Patricia; Damiano Cristina; De Paz, Mariana; Desmery. Pablo; Edat, Liliana; Efron, Ernesto David; Fernández, Julián; Flyn, Luis Pedro; Freuler, Cristina; Gajo Gane, Andrea; Garcia
Damiano, Cristina; Girardi, Laura; Giudice, Nancy; Giusiano, Gustavo; Greco, Graciela; Guerra, Alejandra; Guzzi, Leda; Hevia, Alejandra; Isla, Guillermina; Lapadula, Pablo; Lluesma
Goalons, Moira; Lopez Mora Joaquina;Lopez Papucci, Santiago; Maldonado, Ivana; Maurich, Silvia; Méndez, Tania; Mestroni, Silvana; Molinos, Juan; Nenna, Andrea; Otero,
Estefania; Ottino, Anabel; Pagella, Hugo; Peyrani, Paula; Pineda, Gloria; Ponessa, Adriana; Pryluka, Daniel; Quirós, Rodolfo; Relloso, Silvia; Roccia Rossi, Inés; Rosso, Amadeo;
Rotryng, Flavio; Salgueira, Claudia; Santos, Patricia; Sarkis, Claudia; Sorge, Adriana; Sosa, María de los Ángeles; Temporiti, Elena; Tiraboschi, Nora; Tisi Bañas, Matías; Verbanaz,
Sergio; Vitale, Roxana; Vratnica, Claudia; Ybarra, Viviana.
This study was supported by an Investigator Initiated Reserach Grant given by Pfizer.