Invasive Aspergillosis Caused By Aspergillus Non-Fumigatus In Children And Adults After Hematopoietic Stem Cell Transplantation (Hsct) & Chemotherapy

Aspergillus fumigatus is the most common etiologic agent of invasive aspergillosis (IA) reported in severely immunocompromised patients. Aspergillosis caused by non-fumigatus Aspergillus species is poorly studied. We design the retrospective study in order to investigate the epidemiology of IA caused by Aspergillus non-fumigatus as a single agent in large cohort of patients after HSCT and chemotherapy from 2013 to 2018 in CIC725. During the observation period 30 patients with IA caused by Aspergillus non-fumigatus were identified and included into analysis. The median age was 26 (3-60) y.o., males – 53%. The median follow up time was 10 months; for survivors – 17,5 months. A. non-fumigatus IA was more common diagnosed in allo-HSCT recipients (90%) then after chemotherapy (10%). Most of the patients at the moment of IA diagnosed received antifungal prophylaxis with fluconazole (83%) or echinocandins (6,7%). Breakthrough IA (prophylaxis with voriconazole – 2, posaconazole – 1) was diagnosed in 10% of patients. Etiology agents were Aspergillus niger – 60%, A. flavus – 34%, A. glaucus – 3%, and A. terreus – 3%. The main sites of infection were lungs (80%), paranasal sinuses (10%), or combination lungs and paranasal sinuses (10%). A. non-fumigatus IA developed in combination with bacterial or other fungal infections in 20% (n=6). The median time of onset of A. non-fumigatus IA after allo-HSCT was 155 (19-922) days. Antifungal therapy was used in all patients: voriconazole – 73,3%, lipid amphotericin B – 6,7%, posaconazole – 6,7%, combination therapy – 13,3%. A. non-fumigatus IA developed on the background of acute graft-versus-host diseases (GVHD) grade 2-3 + glucocorticoids therapy (25%) and CMV reactivation (19%). Overall survival at 12 weeks from the diagnosis of A. non-fumigatus IA was 83,3%. Death could be attributed to IA was registered in one case. Aspergillus non-fumigatus IA affected allo-HSCT recipients (90%). Aspergillus niger was the main etiology agent. Aspergillus non-fumigatus IA was a late complication and developed on the background of CMV reactivation and acute GVHD. Overall survival at 12 weeks from the IA diagnosis was 83,3%.