Epidemiology of invasive aspergillosis in France: a six-year multicentric survey in the Greater Paris area

Cornet, Muriel; Fleury, Laurent; Maslo, Caroline; Bernard, Jean‐François; Brücker, Gilles

doi:10.1053/jhin.2002.1258

Cited by 156 publications

(107 citation statements)

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“…attack rate) has been reported extensively in patients with various hematologic diseases. 3,4,7,14,[25][26][27] While IA increased in the 1980s-1990s in the general population, 2 no reduction in IA incidence has been observed in hematology patients. 3,28 In our study, the decrease in IA incidence could be explained by medical prophylaxis with posaconazole which has been used systematically in all patients with AML in induction chemotherapy since 2007 in our setting.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] The mortality rate usually exceeds 50% and can reach 90% in allogeneic hematopoietic stem cell transplantations recipients. 1,4,5 IA occurs mainly in immunosuppressed patients with prolonged neutropenia induced by chemotherapy and/or patients who undergo hematopoietic stem cell transplantation. 4,[6][7][8] IA prevention and treatment remain important issues.…”

Section: Introductionmentioning

confidence: 99%

“…1,4,5 IA occurs mainly in immunosuppressed patients with prolonged neutropenia induced by chemotherapy and/or patients who undergo hematopoietic stem cell transplantation. 4,[6][7][8] IA prevention and treatment remain important issues. Recently-observed improvement in survival 9 has been related to changes in clinical practices, and despite greater risk of aplasia, the prognosis of hematologic diseases has improved in recent years with more efficient chemotherapies.…”

Section: Introductionmentioning

confidence: 99%

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Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Nicolle¹,

Bénet²,

Thiébaut³

et al. 2011

Haematologica

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BackgroundThe study objectives were: 1) to report on invasive aspergillosis patients in a hematology department; and 2) to estimate its incidence according to the hematologic diagnosis. Design and MethodsA prospective survey of invasive aspergillosis cases was undertaken between January 2004 and December 2009 in the hematology department of a university hospital. Meetings with clinicians, mycologists and infection control practitioners were organized monthly to confirm suspected aspergillosis cases. Demographic characteristics, clinical and complementary examination results were recorded prospectively. Information on hospitalization was extracted from administrative databases. Invasive aspergillosis diagnosis followed the European Organization for Research and Treatment of Cancer criteria, and proven and probable IA cases were retained. A descriptive analysis was conducted with temporal trends of invasive aspergillosis incidence assessed by adjusted Poisson regression. ResultsOverall, 4,073 hospitalized patients (78,360 patient-days) were included in the study. In total, 127 (3.1%) patients presented invasive aspergillosis. The overall incidence was 1.6 per 1,000 patient-days (95% confidence interval: 1.4, 1.9) with a decrease of 16% per year (-1%, -28%). The incidence was 1.9 per 1,000 patient-days (1.5, 2.3) in acute myeloid leukemia patients with a decrease of 20% per year (-6%, -36%). Serum Aspergillus antigen was detected in 89 (71%) patients; 29 (23%) had positive cultures, and 118 (93%), abnormal lung CT scans. One-month mortality was 13%; 3-month mortality was 42%. Mortality tended to decrease between 2004 and 2009. ConclusionsInvasive aspergillosis incidence and mortality declined between 2004 and 2009. Knowledge of invasive aspergillosis characteristics and its clinical course should help to improve the management of these patients with severe disease.Key words: invasive aspergillosis, surveillance, hematologic disease, incidence, hospital. 2004 . Haematologica 2011 96(11):1685-1691. doi:10.3324/haematol.2011 Citation: Nicolle M-C, Bénet T, Thiebaut A, Bienvenu A-L, Voirin N, Duclos A, Sobh M, Cannas G, Thomas X, Nicolini F-E, De Monbrison F, Piens M-A, Picot S, Michallet M, and Vanhems P. Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Nicolle¹,

Bénet²,

Thiébaut³

et al. 2011

Haematologica

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“…Both have been implicated as risk factors; corticosteroids inhibit the function of pulmonary macrophages (Schorn et al, 1977). Atypically, the patient had slight neutrophil leukocytosis and not neutropenia (Cornet et al, 2002). Elevated neutrophil counts were previously reported in a 33-year-old woman with AIDS who had disseminated aspergillosis affecting the brain and spine (Martinez et al, 2009).…”

Section: Discussionmentioning

confidence: 75%

“…Aspergillus species are the most frequently isolated moulds among human immunodeficiency virus (HIV)-infected patients (Enoch et al, 2006), but invasive aspergillosis is very uncommon in this population (,1 %) (Cornet et al, 2002). Despite this low incidence, it is of particular importance because the case-fatality rate associated with disseminated infection or central nervous system (CNS) involvement is reported to be 88 % (Lin et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

A rare, fatal case of invasive spinal aspergillosis in an antiretroviral-naïve, HIV-infected man with pre-existing lung colonization

Rossouw

Goedhals

Merwe

et al. 2011

Journal of Medical Microbiology

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Infection of the central nervous system (CNS) is a rare but devastating complication of invasive aspergillosis. We report a case of invasive aspergillosis with spinal involvement in a human immunodeficiency virus (HIV)-infected patient without neutropenia. A 42-year-old, antiretroviralnaïve, HIV-infected man presented with progressive weakness in the lower limbs and urinary and faecal incontinence for 2 weeks. The patient had been prescribed broad-spectrum antibiotics and prednisone. He had upper motor neuron signs and a sensory level at T1, with accompanying neck stiffness on flexion. Magnetic resonance imaging revealed diffuse abnormal signals of the vertebral bodies in the lower cervical and thoracic areas, with cord compression in the C2 and C3 region and signal distortions of the T2 and T3 vertebral bodies. Chest X-ray and computerized tomography demonstrated post-tuberculous apical cavities with suspected fungal colonization. Histopathology of an extradural spinal lesion at T1/T2 suggested invasive aspergillosis. The patient was started on fluconazole in response to the histopathological evidence of Aspergillus infection, but died within 3 weeks. Post-mortem analysis of the biopsy sample by PCR identified the infectious agent as Aspergillus fumigatus. Atypically, his CD4 + T-cell count was 239 cells mm "3 and he had no evidence of neutropenia. Invasive aspergillosis should be considered as part of the differential diagnosis among HIV-infected patients with non-specific, focal CNS symptoms, even among those without classical risk factors such as neutropenia, and aggressive antifungal therapy should be instituted as early as possible. IntroductionAspergillus species are the most frequently isolated moulds among human immunodeficiency virus (HIV)-infected patients (Enoch et al., 2006), but invasive aspergillosis is very uncommon in this population (,1 %) (Cornet et al., 2002). Despite this low incidence, it is of particular importance because the case-fatality rate associated with disseminated infection or central nervous system (CNS) involvement is reported to be 88 % (Lin et al., 2001). Among HIV-infected persons, invasive aspergillosis usually occurs in patients with a CD4 + T-cell count of ,50 cells mm 23 and in those with neutropenia or on corticosteroids (Mylonakis et al., 1998). However, CNS aspergillosis has also been described in immunocompetent patients and following epidural steroid injections (Haran & Chandy, 1993; Larson Kolbe et al., 2007;Saigal et al., 2004;Sundaram et al., 2006). Aspergillosis generally affects the lungs, but can also spread to other organs, including the CNS. Based on a large, randomized-controlled trial, the drug of choice for invasive aspergillosis is voriconazole (Herbrecht et al., 2002). However, a diagnosis of invasive aspergillosis is often only made post-mortem, and a definitive diagnosis requires both microscopic analysis of tissue and identification of the organism by culture (Walsh et al., 2008).Aspergillus infection in the CNS is rare, but appears to be becoming mo...

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Clinical characteristics of 45 patients with invasive pulmonary aspergillosis

Jiang

et al. 2009

Cancer

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Objective To examine the impact of distraction on the retention of rehearsed information in patients with fibromyalgia syndrome (FMS). Methods Data refer to the neurocognitive examination of 134 patients (91 with FMS and 43 control subjects) presenting with memory loss. Four neurocognitive measures free of distraction, along with 2 measures with added distraction, were completed. Differences in the retention of rehearsed and unrehearsed information with a source of distraction present were calculated. Results Patients with FMS showed normal cognitive functioning on verbal memory tests free of distraction. Adding a source of distraction caused unrefreshed information to be lost at a disproportionate rate in patients with FMS. Over 87% of patients with FMS scored in the impaired range on a task of unrehearsed verbal memory. Adding a source of distraction to well‐rehearsed information produced a normal rate of recall in FMS. Conclusion Rehearsal mechanisms are intact in patients with FMS and play beneficial roles in managing interference from a source of distraction. In the absence of rehearsal, a source of distraction added to unrefreshed information signals a remarkable level of cognitive deficit in FMS that goes undetected by conventionally relied‐upon neurocognitive measures. We present a theory to promote understanding of the cognitive deficit of people with FMS based on reduced speed of lexical activation and poor recall after distraction.

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Epidemiology of invasive aspergillosis in France: a six-year multicentric survey in the Greater Paris area

Cited by 156 publications

References 45 publications

Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

A rare, fatal case of invasive spinal aspergillosis in an antiretroviral-naïve, HIV-infected man with pre-existing lung colonization

Clinical characteristics of 45 patients with invasive pulmonary aspergillosis

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