Given the limited utility of current diagnostic approaches, autopsy series

remain a key source of information for understanding the changing epidemiology of IFI in immunocompromised patient populations. Moreover, autopsy series provide a unique opportunity to explore trends of organ involvement by IFI. This may be especially relevant considering the pharmacokinetic limitations of some of the newer antifungal agents selleck kinase inhibitor that have low or undetectable concentrations in some organs that are a common site of metastatic seeding with Candida or moulds.[15] In a previous study, we reported epidemiological and microbiological characteristics of IFIs identified in the autopsy examination of patients with haematological malignancies at our institution during the period from 1989 to 2003.[9] In this study, we expanded our previous observations by examining patterns of organ involvement by IFIs as well as fungal species and immunosuppression-specific patterns associated with fungal dissemination over a 20-year period. The objective was to

gain insight into how temporal trends in immunosuppression risk and antifungal exposure influence the epidemiology of IFI at autopsy HSP inhibitor in haematological malignancy patients. Patients with haematological malignancies were identified who underwent autopsy examination at The University of Texas M. D. Anderson Cancer Center from January 1989, through August 2008. Autopsy and medical records were reviewed for demographic and cancer treatment information, including: the type and status of the underlying malignancy; the type and date of HSCT (if applicable); risk factors for IFIs [e.g. severe neutropenia, Grade III–IV graft-vs.-host disease (GvHD), receipt of a significant dose of corticosteroids]; human immunodeficiency virus infection status; the presence of intercurrent bacterial or viral infections; and the type of antifungal prophylaxis administered. In addition, data were collected on the

fungal species identified in cultures from sterile sites, histopathological characteristics of organ involvement by IFIs, whether isothipendyl IFI contributed to death, and whether IFI was suspected ante mortem. The EORTC/MSG criteria were applied for the ante mortem diagnosis of IFIs.[16] A diagnosis of disseminated IFI required the involvement of two or more non-contiguous organs at autopsy. Mixed IFI was defined as the presence of more than one fungal morphotype (e.g. yeast and moulds) by histopathological examination, or the growth of two or more fungal pathogens in cultures drawn from a sterile site. Severe neutropenia was defined as a neutrophil count <100 mm−3 for more than 10 days. Significant corticosteroid use was defined as the use of a systemic corticosteroid at a cumulative dose equivalent to ≥600 mg of prednisone during the month prior to diagnosis of IFI. The date of death was considered the date of diagnosis if the infection was not detected ante mortem.