Invasive Aspergillosis in Critically Ill Patients without Malignancy

Abstract

Using criteria designed for invasive aspergillosis (IA) in patients with cancer, we aimed to determine the impact of IA in patients without malignancy in a medical intensive care unit (ICU). In this retrospective study, 127 patients out of 1,850 admissions (6.9%) hospitalized between 2000 and 2003 had microbiological or histopathologic evidence of Aspergillus during their ICU stay. There were 89 cases (70%) without hematologic malignancy. These patients were classified as proven IA (n = 30), probable IA (n = 37), possible IA (n = 2), or colonization (n = 20). In these patients, mean SAPS II score was 52 with a predicted mortality of 48%. The observed mortality was 80% (n = 71). Mortality of the proven and the probable IA was 97 and 87%, respectively. Postmortem examination was done in 46 out of 71 patients, and 27 autopsies (59%) showed hyphael invasion with Aspergillus. Aspergillus infections occurred in five critically ill patients with proven IA who did not have any predisposing factors according to the currently available definitions. Three of these patients had Child C liver cirrhosis. IA is an emerging and devastating infectious disease in patients in the ICU without malignancy. In those patients, host criteria for probable fungal infections should probably be adapted.

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

“…It has been suggested that late IA diagnosis could lead to poor prognosis. 32 In our study, continuous effort was made by the medical staff to diagnose IA as early as possible. Indeed, serum Aspergillus antigen was tested two times/week during patient aplasia.…”

Corticosteroids in severe pneumonia: Table 1—

“…Indeed, the potential for harmful side-effects due to GC treatment in these patients and the rebound effects that their tapering can cause in the evolution of the inflammatory process are the subject of intense debate [35]. The prolonged use of GCs can alter the phagocytic action of macrophages and alveolar granulocytes, which can facilitate the acquisition of severe bacterial and opportunistic infections [36]. Several studies involving patients with sepsis and ARDS have suggested that high-dose GCs increase the risk of secondary infections [37][38][39]; however, a meta-analysis of moderate-dose GCs for sepsis did not substantiate this observation [40].…”

Evaluation of Risk Factors for Invasive Pulmonary Aspergillosis and Detection of Diagnostic Values of Galactomannan and PCR Methods in Bronchoalveolar Lavage Samples From Non-Neutropenic Intensive Care Unit Patients

“…Özgül olmayan klinik ve radyolojik bulgular ve kolonizasyon-enfeksiyon ayrımının güçlükle yapılabildiği pozitif kültür sonuçları erken tanı konulmasını zorlaştırmaktadır [8][9][10] . İPA için altın standart tanı testi kabul edilen histopatolojik inceleme, YB hastalarının büyük çoğunluğunda yapılamamaktadır 11 . Bu durum, yeni tanı yöntemlerinin kullanıldığı klinik çalışmalara gereksinimi artırmaktadır.…”

“…Nötropenik hastalarda serum GM antijeninin tekrarlayan ölçümleri İPA tanısında kullanılmakla birlikte, ancak nötropenik olmayan hastalarda serum GM ölçümünün duyarlılık ve özgüllüğü düşüktür [12][13][14][15] . Bu olgularda, bronkoalveoler (BAL) sıvısında GM antijeninin saptanmasının İPA tanısındaki duyarlılığı daha yüksektir ve klinik çalışmalardaki önemi giderek artmaktadır 11 .…”