Invasive Pulmonary Aspergillosis with Disseminated Infection in Immunocompetent Patient (original) (raw)
Related papers
Fulminant invasive pulmonary aspergillosis in immunocompetent patients-a two-case report
Clinical Microbiology and Infection, 2003
Two cases of invasive aspergillosis (IA) in immunocompetent patients with a fulminant fatal outcome are reported. Both patients were elderly and had a history of chronic lung disease treated with prolonged inhaled corticosteroids and a short course of systemic corticosteroids. They presented with dyspnea and fever, their respiratory function deteriorated rapidly, and they died 7 days after admission. Aspergillus fumigatus was cultured from respiratory samples. IA was con®rmed in one case by necropsy that showed diffuse bilateral necrotizing pneumonitis and myocarditis. In the other case, IA diagnosis was established by thoracic CT scan plus detection of Aspergillus antigen in two blood samples. These two cases demonstrate that short-term corticosteroid therapy in immunocompetent patients with underlying chronic lung conditions is a risk factor for IA, and that its evolution can be fulminant.
Clinical Diagnosis of Invasive Pulmonary Aspergillosis in a Non-Neutropenic Critically Ill Patient
Respiratory Care, 2013
Real life diagnosis of invasive pulmonary aspergillosis in a non neutropenic critically ill patient Introduction : Invasive Pulmonary Aspergillosis (IPA) is a life threatening fungal infection that predominantly affects severely immunocompromised patients, particulary those with prolonged neutropenia or organ transplantation. 1 Definitions have been developed that facilitate the diagnosis of IPA in immunocompromised patients with cancer or hematologic malignancy. 2 More recently, publications explored IPA in non-immunocompromised patients in intensive care units (ICU). 3,4 In this specific setting, diagnosis of IPA is challenging for several reasons: it is a relatively uncommon condition, clinical presentation may be unspecific and mimick ventilator-associated pneumonia, specific radiological and microbiological findings may be delayed. To highlight the difficulties of IPA diagnosis in the ICU, we present the case of an 82-year-old ICU patient without immunosuppression affected by possible IPA. Case presentation An 82-year-old woman was referred to our intensive care unit (ICU) for septic shock and acute kidney injury due to acute peritonitis. Before the onset of the symptoms, she was in good health without any chronic medication and her past medical history was significant only for hypertension. She was a non-smoker. She underwent surgery and supportive care was initiated with broad spectrum antibiotics, vasopressor support, mechanical ventilation and intravenous hydrocortisone (200mg per day) treatment. Initial evolution was favorable, except RESPIRATORY CARE Paper in Press.
Internal and Emergency Medicine, 2021
Blot and colleagues have proposed putative invasive pulmonary aspergillosis (PIPA) definitions for troublesome diagnosis in suspected patients outside the classical criteria of immunosuppression. We retrospectively included in the study all admitted patients with an Aspergillus spp. positive culture within lower airway samples. Overall, Aspergillus spp. positivity in respiratory samples was 0.97 every 1000 hospital admissions (HA): 4.94 and 0.28/1000/HA, respectively, in intensive care units (ICUs) and medical wards (MW). 66.6% fulfilled PIPA criteria, and 33.4% were defined as colonized. 69.2% of PIPA diagnosis occurred in the ICU. Antifungal therapy was appropriate in 88.5% of subjects with PIPA and 37.5% of colonized, confirming the comparison between deads and lives. Patients with PIPA in the ICUs had more frequent COPD, sepsis or septic shock, acute kidney injury (AKI), needed more surgery, mechanical ventilation (MV), vasopressors, hemodialysis, blood or platelets transfusions...
Invasive pulmonary aspergillosis: A study of 39 cases at autopsy
Journal of postgraduate medicine
Aspergillus is a common cause of invasive mycosis, especially in immunocompromised or immunosuppressed individuals. To study the incidence of invasive pulmonary aspergillosis and evaluate the predisposing factors and clinico-pathological manifestations. Retrospective analysis of autopsy material from a tertiary care hospital. All autopsies performed over a 12-year period were reviewed and cases with invasive aspergillosis were analysed with respect to their clinical presentation, predisposing factors, gross and histological features, complications and causes of death. Among a total of 20475 autopsies performed in 12 years, 39 patients (0.19 %) had invasive pulmonary aspergillosis. There were 28 males and 11 females. Their ages ranged from five months to 67 years. Dyspnoea, fever, cough with mucopurulent expectoration, chest pain and haemoptysis were commonly encountered symptoms. Forty-one per cent of the patients had no respiratory symptoms. Fungal aetiology was not entertained cli...
Invasive Aspergillosis in the Intensive Care Unit
Clinical Infectious Diseases, 2007
Data regarding the incidence of invasive aspergillosis (IA) in the intensive care unit (ICU) are scarce, and the incidence varies. An incidence of 5.8% in a medical ICU has been reported. The majority of patients did not have a hematological malignancy, and conditions such as chronic obstructive pulmonary disease and liver failure became recognized as risk factors. Diagnosis of IA remains difficult. Mechanical ventilation makes it difficult to interpret clinical signs, and radiological diagnoses are clouded by underlying lung pathologies. The significance of a positive respiratory culture result is greatly uncertain, because cultures of respiratory specimens have low sensitivity (50%) and specificity (20%-70%, depending on whether the patient is immunocompromised). The use of serologic markers has never been validated in an ICU population. Limited experience with the detection of galactomannan in bronchoalveolar lavage fluid specimens has yielded promising results. Because of a delay in the diagnosis of IA, the mortality rate exceeds 50%. Recently, our therapeutic armamentarium against IA has improved. Data concerning the safety and efficacy of new antifungal agents in the ICU setting, however, are lacking.
Invasive Pulmonary Aspergillosis in an (Apparently) Immunocompetent Patient
Cureus, 2020
Invasive pulmonary aspergillosis (IPA) is an opportunistic infection that usually threatens immunocompromised patients. However, there are some reports of IPA in immunocompetent patients without the obvious classic risk factors. We present the case of an 82-year-old woman with a prior medical history of chronic obstructive pulmonary disease (COPD) and a recent short-term corticosteroid regimen for an acute exacerbation. She was admitted with dyspnoea, cough, and pleuritic pain and was diagnosed with pneumonia. Clinical deterioration occurred, and a diagnosis of IPA was made. She received treatment with voriconazole but died 14 days after admission. This case highlights the importance of considering IPA among the possible causes of infection in this population. Prompt institution of appropriate antifungal therapy is paramount for the management of this condition.
Pulmonary Aspergillosis: A Clinical Note
International Journal of Current Pharmaceutical Research
Aspergillosis is a mycotic sickness ordinarily brought about by Aspergillus fumigatus, a saprophytic and universal airborne growth. Obtrusive aspiratory aspergillosis happens essentially in patients with serious immunodeficiency. The meaning of this contamination has decisively expanded with developing quantities of patients with impeded insusceptible state related with the administration of danger, organ transplantation, immune system and fiery circumstances; fundamentally sick patients and those with constant obstructive aspiratory infection seem, by all accounts, to be at an expanded gamble. Persistent pneumonic aspergillosis influences patients without clear resistant split the difference, yet with a fundamental lung condition like COPD or sarcoidosis, earlier or simultaneous TB or non-tuberculous mycobacterial illness. Aspergillus bronchitis might be liable for tenacious respiratory side effects in patients with Aspergillus identified more than once in sputum without proof of p...
Journal of Preventive Medicine and Hygiene, 2013
Summary Introduction. Invasive aspergillosis (IA) is an important cause of morbidity and mortality in immunocompromised patients. During recent years, a rising incidence of IA in Intensive Care Unit (ICU) patients has been reported. The patterns of IA related infection may differ according to the type of underlying disease. Unfortunately little is known about the characteristics of IA in ICU patients. In the present study we assessed IA related clinical and bronchoscopy findings in ICU patients. Materials and methods. This study was performed at the ICU units in Sari and Babul, Mazandaran from August 2009 through September 2010. We analysed 43 ICU patients with underlying predisposing conditions for IA. Bronchoalveolar lavage (BAL) samples were collected by bronchoscope twice a weekly. The samples were analyzed by direct microscopic examination, culture and non-culture based diagnostic methods. Patients were assigned a probable or possible diagnosis of IA according to the consensus ...