Profile and classification of invasive fungal disease in patients with haematologic malignancies using microscopy, culture, biomarkers and polymerase chain reaction.

BACKGROUND

Invasive fungal diseases (IFDs) are significant causes of morbidity and mortality in patients with haematologic malignancies (HM). This study aimed to classify IFD using integrated diagnostic methods according to European Organization for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) criteria.

METHODS

A prospective observational study was conducted in 100 adult HM patients not on antifungal prophylaxis. Diagnosis included microscopy, culture, galactomannan (GM) enzyme-linked immunosorbent assay (ELISA), Candida mannan immunoglobulin M (IgM) lateral flow assay (LFA), Aspergillus IgM assay, cryptococcal antigen LFA, (1,3)-β-D-glucan (BDG) assay and panfungal polymerase chain reaction (PCR), along with high-resolution computed tomography (HRCT).

RESULTS

Probable IFD was observed in 51%, possible in 24%, proven in 12% and no IFD in 13%. Acute leukaemia predominated, with invasive aspergillosis (IA) and candidiasis being the most common infections. Fever was the most frequent presentation, while respiratory symptoms were associated with invasive aspergillosis. PCR showed the highest sensitivity (88.8%), followed by BDG (87.3%). Microscopy and culture were positive in 25% cases, Aspergillus fumigatus being the most common isolate. HRCT was normal in 56%, with ground-glass opacities and consolidation as the most frequent abnormalities.

CONCLUSION

Integrated diagnostic approaches improve classification and early detection of IFD in HM patients and support timely antifungal management.