glabrata (24%), C. tropicalis (15%), C. krusei (13%) and C. parapsilosis (3%). Multiple Candida infections ranged between 3% and 15% of all autopsy cases with documented yeast infection whereas non-Candida yeast and yeast-like find more species (i.e. Trichosporon,

Rhodoturula, Saccharomyces cerevesiae) occurred in 4–10% of cases during the 20 year period. Interestingly, infections caused by Candida species with variable (C. glabrata) or non-susceptibility (C. krusei) to fluconazole decreased in the final 5 years of the study, whereas C. albicans and C. tropicalis infections increased. The pattern of organ involvement by IFIs differed depending on the fungal pathogen and type of underlying immunosuppression. Candida spp. were frequently detected by both culture and histopathology in the lung (79%), blood (37%), gastrointestinal tract (35%), kidney (34%),

liver (20%) and spleen (19%). Patterns of organ involvement did not differ significantly, Y-27632 mw however, among the isolated species. Patients with persistent neutropenia were more likely to have invasion of the kidney (P = 0.02) and heart (P = 0.02) compared with non-neutropenic patients. High-dose corticosteroid therapy did not appear to predispose to a specific pattern of organ involvement. The lungs were the most common site of infection for moulds, occurring in more than 90% of all infections. Aspergillus infections most frequently affected the lung (92%), central nervous system TCL (25%), heart (24%), kidney (15%) and gastrointestinal tract (15%). Aspergillus spp. were rarely (4%) isolated from blood cultures, and nearly all of the positive cultures were caused by A. terreus (60%) or A. flavus (40%). Compared with Aspergillus spp., Mucorales were more likely to be associated with invasion of the sinuses (23% vs. 5%, P = 0.007). Fusarium spp. were isolated frequently from the heart (63%), kidney (50%), spleen (50%) and bloodstream (40%). We also compared patterns of organ dissemination over the study period for the four most common monomicrobial infections detected at autopsy among patients with haematological malignancies. Significant reductions in

Candida dissemination to the spleen, kidney, heart, gastrointestinal tract and liver were observed over the 20 year study period, although Candida spp. dissemination to the liver rebounded back to a percentage observed in earlier periods of the study by 2004–2008 (Fig. 2). After 2003, moulds accounted for the majority of infections identified at autopsy in four of these five organs including the spleen, kidney, heart and gastrointestinal tract. To our knowledge, this is the largest single-institution study of autopsy proven IFI in patients with haematological malignancies spanning two decades. Collectively, these autopsy data support the findings of recent epidemiological surveys that have documented a declining prevalence of IFIs and associated mortality in this high-risk population.