Clinical manifestations and outcomes of pulmonary aspergillosis: experience from Pakistan

Iqbal, Nousheen; Irfan, Muhammad; Zubairi, Ali Bin Sarwar; Jabeen, Kauser; Awan, Safia; Khan, Jibran

doi:10.1136/bmjresp-2016-000155

Cited by 32 publications

(38 citation statements)

References 28 publications

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“…Underlying comorbidities may affect the outcome of patients with IA. Previous studies have demonstrated that bone marrow transplantation, diabetes and neutropenia are associated with an increased risk of mortality [ 1 , 16 , 19 ]. In the present study, bone marrow transplantation was the only comorbidity found to be predictive of mortality.…”

Section: Discussionmentioning

confidence: 99%

“…However, previous studies have been inconsistent in identifying prognostic factors. A single center study of IA by Hsiue et al reported that steroid use correlated with poorer survival [ 15 ], while Iqbal et al found no significant association between steroid exposure and morality in Pakistani patients with IPA [ 16 ]. The latter authors identified respiratory failure, DM, and longer length of hospital stay to be independent factors that predicted poor outcome.…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcome and prognostic factors associated with invasive pulmonary aspergillosis: An 11-year follow-up report from Taiwan

et al. 2017

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BackgroundInvasive pulmonary aspergillosis (IPA) has high mortality rate but prognostic factors are not well established. The aim of our study was to evaluate the trend in in-hospital mortality over a period of 11 years and identify factors affecting the clinical outcomes of patients with IPA.MethodWe conducted a nationwide inpatient population study using data from the Taiwan National Health Insurance Research Database. A total of 407 IPA patients from 2002 to 2012 were included in the study. Differences in demographics, comorbidities, and treatment were evaluated between in-hospital death group and survival group. Multivariate analysis was also performed to identify risk factors for mortality.ResultMale patients represented 63.14% of the patients (n = 257) and the mean age was 53.15 ± 20.93 years. Hematological cancer (n = 216, 53.07%) and diabetes mellitus (n = 75, 18.43%) were the most common underlying conditions. The overall case fatality rate was 30.22% with female slightly higher then male (32.67% versus 28.79%). The in-hospital case fatality rate increased since 2002 and peaked in 2006. It then declined over time with an in-hospital mortality of 25% in 2012. The in-hospital death group had a higher intubation rate (p<0.0001), a longer ICU stay (p = 0.0062), higher percentages of DM (p = 0.0412) and COPD (p = 0.0178), and a lower percentage of hematological cancer (p = 0.0079) as compared to survivor. The in-hospital death group was more likely to have steroid treatment (p<0.0001), develop acute renal failure (p<0.0001) and other infectious diseases (p = 0.0008) during hospitalization. Multivariate analysis identified female gender, older age (≥ 65 years old), intubation, bone marrow transplantation, acute renal failure, other infectious diseases and steroid use as predictive factors for mortality.ConclusionThe present study shows the trend in mortality among patients with IPA over an 11-year period. Female gender, older age, intubation, bone marrow transplantation, acute renal failure, other infectious diseases and steroid use were identified as risk factors for mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical outcome and prognostic factors associated with invasive pulmonary aspergillosis: An 11-year follow-up report from Taiwan

et al. 2017

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“…The number of patients registered with AKUH and diagnosed with aspergillosis (according to ICD-09), in 2015, were 49 (21) . Hence, using this population, one hundred and fourteen non-duplicate Aspergillus isolates were sampled to detect a hypothesized frequency of triazole resistance of 1.7 + 1% at 95% level of confidence.…”

Section: Interpretation Of Results: Breakpoints For Mold Testing Havementioning

confidence: 99%

Screening for triazole resistance in clinically significant Aspergillus species; report from Pakistan

Moin¹,

Farooqi²,

Jabeen³

et al. 2019

Preprint

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Background: Burden of aspergillosis is reported to be significant from developing countries including those in South Asia. The estimated burden in Pakistan is also high on the background of tuberculosis and chronic lung diseases. There is concern for management of aspergillosis with the emergence of azole resistant Aspergillus species in neighbouring countries in Central and South Asia. Hence the aim of this study was to screen significant Aspergillus species isolates at the Microbiology Section of Aga Khan Clinical Laboratories, Pakistan, for triazole resistance. Methods: A descriptive cross-sectional study, conducted at the Aga Khan University Laboratories, Karachi, from September 2016-May 2019. One hundred and fourteen, clinically significant Aspergillus isolates [A. fumigatus (38; 33.3%), A. flavus (64; 56.1%), A. niger (9; 7.9%) A. terreus (3; 2.6%)] were included. The clinical spectrum ranged from invasive aspergillosis (IA) (n=25; 21.9%), chronic pulmonary aspergillosis (CPA) (n=58; 50.9%), allergic bronchopulmonary aspergillosis (ABPA) (n=4; 3.5%), severe asthma with fungal sensitization (SAFS) (n=4; 3.5%), saprophytic tracheobronchial aspergillosis (n=23; 20.2%). Screening for triazole resistance was performed by antifungal agar screening method. The minimum inhibitory concentration (MIC) of 41 representative isolates were tested and interpreted according to the Clinical and Laboratory Standards Institute broth microdilution method. Results: All the isolates were triazole-susceptible on agar screening. MICs of three azole antifungals for 41 tested isolates were found to be ≤1 ml/L; all isolates tested were categorized as triazole-susceptible, including 4 isolates from patients previously on triazole therapy for more than two weeks. The minimum inhibitory concentration required to inhibit the growth of 90% organisms (MIC90) of itraconazole, voriconazole and posaconazole of the representative Aspergillus isolates was 1 mg/L, 1 mg/L and 0.5 mg/L, respectively. Conclusion: Triazole resistance could not be detected amongst clinical Aspergillus isolates from the South of Pakistan. However, environmental strains remain to be tested for a holistic assessment of the situation. This study will set precedence for future periodic antifungal resistance surveillance in our region on Aspergillus isolates. Keywords: Aspergillosis, Aspergullus flavus, Aspergullus fumigatus, Aspergullus niger, Aspergullus terreus, itraconazole, voriconazole and posaconazole.

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“…The number of patients registered with AKUH and diagnosed with aspergillosis (according to ICD-09), in 2015, were 49 (22) . Hence, using this population, one hundred and fourteen non-duplicate Aspergillus isolates were sampled to detect a hypothesized frequency of triazole resistance of 1.7+1% at 95% level of confidence.…”

Section: Sample Sizementioning

confidence: 99%

Screening for triazole resistance in clinically significant Aspergillus species; report from Pakistan

Moin¹,

Farooqi²,

Jabeen³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Burden of aspergillosis is reported to be significant from developing countries including those in South Asia. The estimated burden in Pakistan is also high on the background of tuberculosis and chronic lung diseases. There is concern for management of aspergillosis with the emergence of azole resistant Aspergillus species in neighbouring countries in Central and South Asia. Hence the aim of this study was to screen significant Aspergillus species isolates at the Microbiology Section of Aga Khan Clinical Laboratories, Pakistan, for triazole resistance. Methods: A descriptive cross-sectional study, conducted at the Aga Khan University Laboratories, Karachi, from September 2016-May 2019. One hundred and fourteen, clinically significant Aspergillus isolates [ A. fumigatus (38; 33.3%), A. flavus (64; 56.1%), A. niger (9; 7.9%) A. terreus (3; 2.6%)] were included. The clinical spectrum ranged from invasive aspergillosis (IA) (n=25; 21.9%), chronic pulmonary aspergillosis (CPA) (n=58; 50.9%), allergic bronchopulmonary aspergillosis (ABPA) (n=4; 3.5%), severe asthma with fungal sensitization (SAFS) (n=4; 3.5%), saprophytic tracheobronchial aspergillosis (n=23; 20.2%). Screening for triazole resistance was performed by antifungal agar screening method. The minimum inhibitory concentration (MIC) of itraconazole, voriconazole and posaconazole against 41 isolates, a subset of the collection, were tested and interpreted according to the Clinical and Laboratory Standards Institute broth microdilution method. Results: All the isolates were triazole-susceptible on agar screening. MICs of all three azole antifungals for 41 tested isolates were found to be ≤1 ml/L; all isolates tested were categorized as triazole-susceptible, including 4 isolates from patients previously on triazole therapy for more than two weeks. Conclusion: Triazole resistance could not be detected amongst clinical Aspergillus isolates from Karachi. However, environmental strains remain to be tested for a holistic assessment of the situation. This study will set precedence for future periodic antifungal resistance surveillance in our region on Aspergillus isolates. Keywords: Aspergillosis, Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger, Aspergillus terreus, itraconazole, voriconazole and posaconazole.

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Clinical manifestations and outcomes of pulmonary aspergillosis: experience from Pakistan

Cited by 32 publications

References 28 publications

Clinical outcome and prognostic factors associated with invasive pulmonary aspergillosis: An 11-year follow-up report from Taiwan

Clinical outcome and prognostic factors associated with invasive pulmonary aspergillosis: An 11-year follow-up report from Taiwan

Screening for triazole resistance in clinically significant Aspergillus species; report from Pakistan

Screening for triazole resistance in clinically significant Aspergillus species; report from Pakistan

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