Corticosteroid-treated hosts, however, are more likely to have tissue damage and necrosis caused by a defective, but exuberant inflammatory reaction to Aspergillus hyphae in the lung, which could theoretically alter classic patterns of dissemination. Therefore, the changes in the predominant underlying immunosuppression likely contributed to the changing prevalence and pattern of IFIs observed at autopsy. Although invasive moulds continue to be the predominant IFIs in haematological malignancy patients, the prevalence of Aspergillus infections decreased substantially in the last 5 years whereas the frequency
of Mucorales infections increased slightly. The increase in mucormycosis relative to aspergillosis in this population has been partially attributed to the increased use of echinocandins and voriconazole, which have good activity against Aspergillus spp., PD0325901 but limited or no activity against Mucorales. However, decreased early mortality due to aspergillosis may allow patients to survive longer and accumulate risk factors (i.e. hyperglycaemia, iron overload) or increased environmental exposures that may favour the development of mucormycosis.[4-6, 28] Nevertheless, the increase in mucormycosis is concerning in light of the higher mortality rates in patients infected with non-Aspergillus
moulds including mucormycosis and fusariosis. More than half of the invasive mould infections in this autopsy survey were disseminated, STA-9090 chemical structure Interleukin-3 receptor accounting for the involvement of almost every organ in the autopsy examination. Beyond the sinopulmonary tract and central nervous system, moulds frequently disseminated to unusual sites such as the heart, gastrointestinal tract, liver, spleen and kidneys, which are considered to be common sites for dissemination of Candida infections.[18, 29] Indeed, our data suggest that over the last 10 years of the study, moulds were a more common cause of hepatosplenic lesions and infections involving the heart and kidneys
than yeast. The changes in invasive candidiasis at autopsy over the 20 year study period mirror the changing epidemiology that has been described in multiple studies,[1, 3, 11, 30, 31] namely a decrease in disseminated and hepatosplenic infections following the introduction and widespread use of fluconazole prophylaxis in the haematologic malignancy population. Candida invasion of the lung was frequently reported at autopsy in our patients despite the rare clinical occurrence of Candida pneumonia. It is not clear whether this dissemination to the lung represents true infection represents true infection, or is an artifact of respiratory colonisation or post-mortem seeding.