Differences in Clinical Characteristics of Invasive Tracheobronchial Aspergillosis according to the Presence of Invasive Pulmonary Aspergillosis

Abstract

Introduction:The association of invasive tracheobronchial aspergillosis (ITBA) with invasive pulmonary aspergillosis (IPA) is not well-established. We aimed to compare clinical characteristics between patients who exhibited ITBA with IPA and those who exhibited isolated ITBA (iITBA) and to evaluate the usefulness of serum or bronchial galactomannan (GM) tests in diagnosing ITBA.Methods: This retrospective single-center case-control study was conducted over a period of four years. Fifteen patients were enrolled after the confirmation of the presence of ITBA using bronchoscopy-guided biopsy (iITBA = 7 vs. ITBA+IPA = 8). Clinical characteristics of patients and results of serum or bronchial GM test were compared between the two groups.Mortality was assessed through 6-month follow-up data. Results:The ITBA+IPA group showed a higher prevalence of hematologic malignancy (75% vs 14%; P = 0.029), greater number of patients with multiple bronchial ulcers (75% vs. 14%; P = 0.029), lower platelet counts (63,000/μL vs. 229,000/μL; P < 0.001), and significantly higher mortality (63% vs. 0%; P = 0.026) than the iITBA group. In the ITBA+IPA group, 57% of patients tested positive for serum GM assay, whereas in the iITBA group, patients tested negative (P = 0.070). The bronchial GM level was high in both the iITBA and ITBA+IPA groups, but there was no significant difference between groups. Conclusions:Patients with ITBA+IPA had a greater number of hematologic malignancies with lower platelet counts and worse prognoses than did those with iITBA. Bronchoscopic findings and bronchial GM test results were more useful than serum GM test results for diagnosing ITBA.