A 10-year study reveals clinical and laboratory evidence for the ‘semi-invasive’ properties of chronic pulmonary aspergillosis (original) (raw)
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The importance of risk factors for the prediction of patients with invasive pulmonary aspergillosis
Revista da Associação Médica Brasileira
Invasive pulmonary aspergillosis (IPA) is a major challenge in the management of immunocompromised patients. Despite all the advances in diagnosis, it remains a problem. The purpose of our study was to investigate the risk factors associated with IPA seen in patients with hematological malignancies. Method: A total of 152 febrile neutropenia (FEN) patients with hematological malignancies aged over 18 years and receiving high-dose chemotherapy or stem cell transplant between January 1, 2010, and December 31, 2012 were included in the study. Sixty-five (65) cases with IPA according to the European Organization for the Research and Treatment of Cancer and Infectious Diseases Mycoses Study Group criteria were enrolled as the case group, while 87 patients without IPA development during concomitant monitoring were enrolled as the control group. Incidence of IPA was 21.4% (3/14) in patients receiving bone marrow transplant (allogeneic 2, autologous 1) and those cases were also added into the case group. The two groups were compared in terms of demographic, clinical and laboratory findings and risk factors associated with IPA investigated retrospectively. Results: Presence of relapse of primary disease, neutropenia for more than 3 weeks, presence of bacterial infection, and non-administration of antifungal prophylaxis were identified as risk factors associated with IPA. Conclusion: It may be possible to reduce the incidence of the disease by eliminating preventable risk factors. Predicting those risks would, per se, enable early diagnosis and treatment and, thus, the mortality rate of these patients would unquestionably decline.
Invasive Aspergillosis in Patients with Chronic Obstructive Pulmonary Diseases
Canadian Respiratory Journal, 2005
OBJECTIVES: To determine the outcomes, and clinical and therapeutic factors associated with the development of invasive pulmonary aspergillosis (IPA) in patients with obstructive pulmonary diseases.DESIGN: A case control study examining patients who developed IPA while hospitalized, and controls who were matched by year of hospitalization and type of obstructive lung disease.SETTING: A tertiary care university-affiliated respiratory hospital.PATIENTS: Twelve patients were identified who had developed nosocomial IPA. Each case was compared with four control patients: two with and two without Aspergillus colonization.RESULTS: Patients and control patients had similar demographic characteristics, comorbid illnesses and severity of underlying pulmonary disease. All cases required admission to the intensive care unit and eight patients (67%) died, whereas only 17% of control patients required admission to the intensive care unit and 7% died. The patients with IPA received significantly h...
The Clinical Respiratory Journal, 2014
IntroductionOur objective was to investigate characteristics risk factors and outcomes of patients with chronic pulmonary aspergillosis (CPA).MethodsThe Aspergillosis Committee prospectively collected Aspergillus notifications from January 2000 to December 2011. A retrospective analysis of data was performed.ResultsAmong 1614 notifications registered, 44 cases of CPA in non‐immunocompromised patients were identified. The median age was 65 years (Q1–Q3: 54–75), the median body mass index (BMI) was 20 kg/m2 (Q1–Q3: 16–22) and 15 had chronic obstructive pulmonary disease. All patients had a positive specific serum precipitin antibody titer. Radiological presentations were: cavitations [single n = 31 (70%); multiple n = 12 (27%)] containing mycetomas [n = 18 (41%)], consolidations [n = 19 (43%)], emphysema [n = 15 (34%)] and sequelae of mycobacterial infection [n = 10 (23%)]. The median duration of follow‐up was 30 months (Q1–Q3: 14–55). The median duration of antifungal treatment was 6...
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 in patients with chronic obstructive pulmonary disease
Multidisciplinary Respiratory Medicine, 2013
Background: Invasive pulmonary aspergillosis (IPA) is an infection often occurring in neutropenic patients and has high mortality rates. In recent years, it has been reported that the incidence of IPA has also increased in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study is to investigate the clinical and demographic characteristics and treatment responses of IPA in patients with COPD. Methods: Seventy-one patients with a positive culture of Aspergillus from lower respiratory tract samples were examined retrospectively. Eleven (15.4%) of these patients, affected with grade 3 or 4 COPD, had IPA. Results: Aspergillus hyphae were detected in lung biopsy in three (27.3%) out of 11 patients and defined as proven IPA; a pathological sample was not taken in the other eight (72.7%) patients, and these were defined as probable IPA. Aspergillus isolates were identified as six cases of Aspergillusfumigatus and three of Aspergillusniger in nine patients, while two isolates were not identified at species level. While five patients required intensive care unit admission, four of them received mechanical ventilation. The most common finding on chest X-ray and computed tomography (CT) (respectively 63.6%, 72.7%) was infiltration. Amphotericin B was the initial drug of choice in all patients and five patients were discharged with oral voriconazole after amphotericin B therapy. Six patients (54.5%) died before treatment was completed. Conclusions: IPA should be taken into account in the differential diagnosis particularly in patients with severe and very severe COPD presenting with dyspnea exacerbation, poor clinical status, and a new pulmonary infiltrate under treatment with broad-spectrum antibiotics and steroids.