Deep-Seated Mycoses in Hematopoietic Disorders

We examined infections complicated by hematopoietic disorders and found that 141 autopsied cases from 1980 through 1991, infections accounted for nearly 50% of the deaths. Forty-four cases of 70 lethal infections were caused by deep-seated mycoses, including 30 cases of aspergillosis and 8 cases of candidiasis. In the annual profile of causes of death, the incidence of aspergillosis and bacterial infection has remained unchanged, while candidiasis, cytomegalovirus infection and Pneumocystis carinii pneumonia have decreased since 1985. To evaluate the clinical effects of G-CSF, we also reviewed granulocytopenic episodes (≦500μl) and/or febril episodes (38°C≦; more than 3 days) in 200 cases of hematopoietic disorders from hospital records. A total of 241 episodes were analyzed, excluding 22 episodes of aplastic anemia because of a prolonged period, and G-CSF was used in 36 episodes. The incidence of apparent infection was 86.2% in the G-CSF (+) group, and 68.3% in the G-CSF (-) group. Moreover, episodes in the G-CSF(+) group were accompanied by more severe infections such as sepsis (27.8%) or pneumonia (22.2%) than those of G-CSF (-), 7.3% and 8.8%, respectively. There was one death from systemic candidiasis in the G-CSF(+) group, and two of candidiasis and four of aspergillosis in the G-CSF(-) group. Despite high incidence and severity of the infections, the overall lethal rate of the G-CSF (+) group was lower than that of G-CSF (-) group, 11.1% and 16.1%, respectively.