Characterization of deep fungal infections in patients with non–HIV-associated immunosuppression: A systematic review
DOI:
https://doi.org/10.5281/zenodo.21544032Keywords:
invasive fungal infections, immunosuppression, organ transplantation, candidemia, aspergillosis, mucormycosisAbstract
Introduction: Invasive fungal infections (IFI) are a significant cause of morbidity and mortality in patients with non–HIV-associated immunosuppression, an expanding population that includes transplant recipients and oncohematologic patients.
Objective: To characterize the epidemiology, predominant etiologic agents, risk factors, clinical presentation and outcomes of IFI in these specific populations.
Methods: A comprehensive systematic review was conducted following the PRISMA 2020 statement guidelines. PubMed/MEDLINE and SciELO were searched to identify observational studies published between January 2015 and October 2025. Methodological quality was assessed using the Newcastle–Ottawa Scale (NOS).
Results: Twelve primary studies were included (10 cohorts and 2 case–control studies) covering a total of 26,433 patients. Predominant etiologic agents were Candida spp. (with notable emergence of non-albicans species), Aspergillus spp. and fungi of the order Mucorales. Main risk factors identified included prolonged neutropenia (>10 days), high-dose corticosteroid use and cytomegalovirus (CMV) coinfection or reactivation. Reported overall mortality ranged from 26% to 50%, and was significantly higher in mucormycosis cases associated with delayed diagnosis.
Conclusions: IFI constitute a serious complication with a clear epidemiological transition toward azole-resistant species. Early diagnosis based on biomarkers and clinical suspicion, together with aggressive multidisciplinary management, are critical determinants for improving survival.
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Copyright (c) 2026 Emily Heck Casa, Laísa Fernandes Dal Ponte, Lionel De Melo Moreno, Julia Werneck Da Silva Rocha, Manuela Da Costa Pellin, Lucas Gabriel Fagundes, Victor Hugo De Oliveira Gouveia, Andrea Paola Britos Gómez (Autor/a)
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