Clinical characteristics and outcomes of invasive Lomentospora prolificans infections: Analysis of patients in the FungiScope® registry

Jeffrey D. Jenks; Danila Seidel; Oliver A. Cornely; Sharon Chen; Sebastiaan van Hal; Carol Kauffman; Marisa H. Miceli; Melina Heinemann; Martin Christner; Alfredo Jover Sáenz; Alexander Burchardt; Björn Kemmerling; Raoul Herbrecht; Joerg Steinmann; Shmuel Shoham; Sandra Gräber; Livio Pagano; Dries Deeren; Monica A. Slavin; Martin Hoenigl

doi:10.1111/myc.13067

Clinical characteristics and outcomes of invasive Lomentospora prolificans infections: Analysis of patients in the FungiScope^® registry

Jeffrey D. Jenks, Danila Seidel, Oliver A. Cornely, Sharon Chen, Sebastiaan van Hal, Carol Kauffman, Marisa H. Miceli, Melina Heinemann, Martin Christner, Alfredo Jover Sáenz, Alexander Burchardt, Björn Kemmerling, Raoul Herbrecht, Joerg Steinmann, Shmuel Shoham, Sandra Gräber, Livio Pagano, Dries Deeren, Monica A. Slavin, Martin Hoenigl

School of Medicine

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

Objectives: Invasive fungal infections caused by Lomentospora prolificans are associated with very high mortality rates and can be challenging to treat given pan-drug resistance to available antifungal agents. The objective of this study was to describe the clinical presentation and outcomes in a cohort of patients with invasive L prolificans infections. Methods: We performed a retrospective review of medical records of patients with invasive L prolificans infection in the FungiScope^® registry of rare invasive fungal infections. Patients diagnosed between 01 January 2008 and 09 September 2019 were included in for analysis. Results: The analysis included 41 patients with invasive L prolificans infection from eight different countries. Haematological/oncological malignancies were the most frequent underlying disease (66%), disseminated infection was frequent (61%), and the lung was the most commonly involved organ (44%). Most infections (59%) were breakthrough infections. Progression/deterioration/treatment failure was observed in 23/40 (58%) of patients receiving antifungal therapy. In total, 21/41 (51%) patients, and 77% of patients with underlying haematological/oncological malignancy, had a fatal outcome attributed to invasive fungal infection. Combination antifungal therapy was frequent (24/40) and associated with improved survival. In particular, treatment regimens including terbinafine were significantly associated with higher treatment success at final assessment (P =.012), with a positive trend observed for treatment regimens that included voriconazole (P =.054). Conclusions: Lomentospora prolificans infections were associated with mortality rates of 77% and above in patients with underlying haematological/oncological malignancies and those with disseminated infections. While combination therapy is the preferred option for now, the hope lies with novel antifungals currently under development.

Original language	English (US)
Pages (from-to)	437-442
Number of pages	6
Journal	Mycoses
Volume	63
Issue number	5
DOIs	https://doi.org/10.1111/myc.13067
State	Published - May 1 2020

Keywords

Lomentospora prolificans
clinical presentation
fungal infections
outcomes
treatment

ASJC Scopus subject areas

Dermatology
Infectious Diseases

Access to Document

10.1111/myc.13067

Cite this

Jenks, J. D., Seidel, D., Cornely, O. A., Chen, S., van Hal, S., Kauffman, C., Miceli, M. H., Heinemann, M., Christner, M., Jover Sáenz, A., Burchardt, A., Kemmerling, B., Herbrecht, R., Steinmann, J., Shoham, S., Gräber, S., Pagano, L., Deeren, D., Slavin, M. A., & Hoenigl, M. (2020). Clinical characteristics and outcomes of invasive Lomentospora prolificans infections: Analysis of patients in the FungiScope^® registry. Mycoses, 63(5), 437-442. https://doi.org/10.1111/myc.13067

Jenks, JD, Seidel, D, Cornely, OA, Chen, S, van Hal, S, Kauffman, C, Miceli, MH, Heinemann, M, Christner, M, Jover Sáenz, A, Burchardt, A, Kemmerling, B, Herbrecht, R, Steinmann, J, Shoham, S, Gräber, S, Pagano, L, Deeren, D, Slavin, MA & Hoenigl, M 2020, 'Clinical characteristics and outcomes of invasive Lomentospora prolificans infections: Analysis of patients in the FungiScope^® registry', Mycoses, vol. 63, no. 5, pp. 437-442. https://doi.org/10.1111/myc.13067

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title = "Clinical characteristics and outcomes of invasive Lomentospora prolificans infections: Analysis of patients in the FungiScope{\textregistered} registry",

abstract = "Objectives: Invasive fungal infections caused by Lomentospora prolificans are associated with very high mortality rates and can be challenging to treat given pan-drug resistance to available antifungal agents. The objective of this study was to describe the clinical presentation and outcomes in a cohort of patients with invasive L prolificans infections. Methods: We performed a retrospective review of medical records of patients with invasive L prolificans infection in the FungiScope{\textregistered} registry of rare invasive fungal infections. Patients diagnosed between 01 January 2008 and 09 September 2019 were included in for analysis. Results: The analysis included 41 patients with invasive L prolificans infection from eight different countries. Haematological/oncological malignancies were the most frequent underlying disease (66%), disseminated infection was frequent (61%), and the lung was the most commonly involved organ (44%). Most infections (59%) were breakthrough infections. Progression/deterioration/treatment failure was observed in 23/40 (58%) of patients receiving antifungal therapy. In total, 21/41 (51%) patients, and 77% of patients with underlying haematological/oncological malignancy, had a fatal outcome attributed to invasive fungal infection. Combination antifungal therapy was frequent (24/40) and associated with improved survival. In particular, treatment regimens including terbinafine were significantly associated with higher treatment success at final assessment (P =.012), with a positive trend observed for treatment regimens that included voriconazole (P =.054). Conclusions: Lomentospora prolificans infections were associated with mortality rates of 77% and above in patients with underlying haematological/oncological malignancies and those with disseminated infections. While combination therapy is the preferred option for now, the hope lies with novel antifungals currently under development.",

keywords = "Lomentospora prolificans, clinical presentation, fungal infections, outcomes, treatment",

author = "Jenks, {Jeffrey D.} and Danila Seidel and Cornely, {Oliver A.} and Sharon Chen and {van Hal}, Sebastiaan and Carol Kauffman and Miceli, {Marisa H.} and Melina Heinemann and Martin Christner and {Jover S{\'a}enz}, Alfredo and Alexander Burchardt and Bj{\"o}rn Kemmerling and Raoul Herbrecht and Joerg Steinmann and Shmuel Shoham and Sandra Gr{\"a}ber and Livio Pagano and Dries Deeren and Slavin, {Monica A.} and Martin Hoenigl",

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year = "2020",

month = may,

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doi = "10.1111/myc.13067",

language = "English (US)",

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T1 - Clinical characteristics and outcomes of invasive Lomentospora prolificans infections

T2 - Analysis of patients in the FungiScope® registry

AU - Jenks, Jeffrey D.

AU - Seidel, Danila

AU - Cornely, Oliver A.

AU - Chen, Sharon

AU - van Hal, Sebastiaan

AU - Kauffman, Carol

AU - Miceli, Marisa H.

AU - Heinemann, Melina

AU - Christner, Martin

AU - Jover Sáenz, Alfredo

AU - Burchardt, Alexander

AU - Kemmerling, Björn

AU - Herbrecht, Raoul

AU - Steinmann, Joerg

AU - Shoham, Shmuel

AU - Gräber, Sandra

AU - Pagano, Livio

AU - Deeren, Dries

AU - Slavin, Monica A.

AU - Hoenigl, Martin

PY - 2020/5/1

Y1 - 2020/5/1

N2 - Objectives: Invasive fungal infections caused by Lomentospora prolificans are associated with very high mortality rates and can be challenging to treat given pan-drug resistance to available antifungal agents. The objective of this study was to describe the clinical presentation and outcomes in a cohort of patients with invasive L prolificans infections. Methods: We performed a retrospective review of medical records of patients with invasive L prolificans infection in the FungiScope® registry of rare invasive fungal infections. Patients diagnosed between 01 January 2008 and 09 September 2019 were included in for analysis. Results: The analysis included 41 patients with invasive L prolificans infection from eight different countries. Haematological/oncological malignancies were the most frequent underlying disease (66%), disseminated infection was frequent (61%), and the lung was the most commonly involved organ (44%). Most infections (59%) were breakthrough infections. Progression/deterioration/treatment failure was observed in 23/40 (58%) of patients receiving antifungal therapy. In total, 21/41 (51%) patients, and 77% of patients with underlying haematological/oncological malignancy, had a fatal outcome attributed to invasive fungal infection. Combination antifungal therapy was frequent (24/40) and associated with improved survival. In particular, treatment regimens including terbinafine were significantly associated with higher treatment success at final assessment (P =.012), with a positive trend observed for treatment regimens that included voriconazole (P =.054). Conclusions: Lomentospora prolificans infections were associated with mortality rates of 77% and above in patients with underlying haematological/oncological malignancies and those with disseminated infections. While combination therapy is the preferred option for now, the hope lies with novel antifungals currently under development.

AB - Objectives: Invasive fungal infections caused by Lomentospora prolificans are associated with very high mortality rates and can be challenging to treat given pan-drug resistance to available antifungal agents. The objective of this study was to describe the clinical presentation and outcomes in a cohort of patients with invasive L prolificans infections. Methods: We performed a retrospective review of medical records of patients with invasive L prolificans infection in the FungiScope® registry of rare invasive fungal infections. Patients diagnosed between 01 January 2008 and 09 September 2019 were included in for analysis. Results: The analysis included 41 patients with invasive L prolificans infection from eight different countries. Haematological/oncological malignancies were the most frequent underlying disease (66%), disseminated infection was frequent (61%), and the lung was the most commonly involved organ (44%). Most infections (59%) were breakthrough infections. Progression/deterioration/treatment failure was observed in 23/40 (58%) of patients receiving antifungal therapy. In total, 21/41 (51%) patients, and 77% of patients with underlying haematological/oncological malignancy, had a fatal outcome attributed to invasive fungal infection. Combination antifungal therapy was frequent (24/40) and associated with improved survival. In particular, treatment regimens including terbinafine were significantly associated with higher treatment success at final assessment (P =.012), with a positive trend observed for treatment regimens that included voriconazole (P =.054). Conclusions: Lomentospora prolificans infections were associated with mortality rates of 77% and above in patients with underlying haematological/oncological malignancies and those with disseminated infections. While combination therapy is the preferred option for now, the hope lies with novel antifungals currently under development.

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