The Clinical Characteristics, Therapeutic Outcome and Prognostic Factors for Invasive Pulmonary Aspergillosis: A Single-Center Experience and Review of the Literature
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Background: Despite advances in microbiological diagnosis and effective antifungal treatment,invasive pulmonary aspergillosis (IPA) is a still major cause of mortality in immunocompromised patients. Objective: The aim of this study is to analyze clinical characteristics, treatment outcome and prognostic factors for IPA. Methods: Between May 2003 and March 2011, we retrospectively studied all patients with IPA in our facility. Results: A total 37 cases were identified. Hematologic malignancies were the leading underlying disease for 27 (27/37, 73.0%) patients. Neutropenic period between the onset of neutropenia and the diagnosis of IPA was 15.0 days. The most common symptom was fever (35/37, 94.6%). The principal findings of chest computed tomography (CT) were segmental or air space consolidation (17/37, 45.9%)followed by halo sign (13/37, 35.1%), and ground-glass attenuation (11/37, 29.7%). Amphotericin B was the initial treatment for 36 (36/37, 97.3%) patients. Voriconazole was subsequently substituted for Amphotericin B in 25 (35/36, 97.2%) patients. The 30-day mortality rate was 24.3% (9/37). The 30-day mortality rate was associated with a failure to recover from neutropenia (p=0.048) or persistent fever during treatment (p=0.003). Two patients were lost to follow-up. Overall mortality was 62.9% (22/35). Conclusion: IPA remains a serious condition with failure to recover from neutropenia or persistent fever during treatment associated with a high 30-day mortality rate.
Abstract
Background: Despite advances in microbiological diagnosis and effective antifungal treatment,invasive pulmonary aspergillosis (IPA) is a still major cause of mortality in immunocompromised patients. Objective: The aim of this study is to analyze clinical characteristics, treatment outcome and prognostic factors for IPA. Methods: Between May 2003 and March 2011, we retrospectively studied all patients with IPA in our facility. Results: A total 37 cases were identified. Hematologic malignancies were the leading underlying disease for 27 (27/37, 73.0%) patients. Neutropenic period between the onset of neutropenia and the diagnosis of IPA was 15.0 days. The most common symptom was fever (35/37, 94.6%). The principal findings of chest computed tomography (CT) were segmental or air space consolidation (17/37, 45.9%)followed by halo sign (13/37, 35.1%), and ground-glass attenuation (11/37, 29.7%). Amphotericin B was the initial treatment for 36 (36/37, 97.3%) patients. Voriconazole was subsequently substituted for Amphotericin B in 25 (35/36, 97.2%) patients. The 30-day mortality rate was 24.3% (9/37). The 30-day mortality rate was associated with a failure to recover from neutropenia (p=0.048) or persistent fever during treatment (p=0.003). Two patients were lost to follow-up. Overall mortality was 62.9% (22/35). Conclusion: IPA remains a serious condition with failure to recover from neutropenia or persistent fever during treatment associated with a high 30-day mortality rate.
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