Invasive fungal tracheobronchitis in mechanically ventilated critically ill patients: underlying conditions, diagnosis, and outcomes

Abstract

BackgroundInvasive fungal tracheobronchitis (IFT) is a severe form of pulmonary fungal infection that is not limited to immunocompromised patients. Although respiratory failure is a crucial predictor of death, information regarding IFT in critically ill patients is limited.MethodsIn this retrospective, multicenter, observational study, we enrolled adults diagnosed as having IFT who had been admitted to the intensive care unit between January 2007 and December 2015. Their demographics, clinical imaging data, bronchoscopic and histopathological findings, and outcomes were recorded.Results This study included 31 patients who had been diagnosed as having IFT, comprising 24 men and 7 women with a mean age of 64.7 ± 13.7 years. All patients developed respiratory failure and received mechanical ventilation before diagnosis. Eighteen (58.1%) patients had diabetes mellitus, and 12 (38.7%) had chronic lung disease. Four (12.9%) patients had hematologic disease, and none of the patients had neutropenia. Twenty-five (80.6%) patients were diagnosed as having proven IFT, and the remaining patients had probable IFT. Aspergillus spp. (61.3%) were the most common pathogenic species, followed by Mucorales (25.8%) and Candida spp. (6.5%). The diagnoses in six (19.4%) patients were confirmed only through bronchial biopsy and histopathological examination, whereas their cultures of bronchoalveolar lavage fluid were negative for fungi. The overall in-hospital mortality rate was 93.5%.ConclusionsIFT in critically ill patients results in a high mortality rate. Diabetes mellitus is the most prevalent underlying disease, followed by chronic lung disease. In addition to Aspergillus spp., Mucorales is another crucial pathogenic species. Bronchial lesion biopsy is the key diagnostic strategy.

Comparison of clinical manifestation, diagnosis and outcomes of invasive pulmonary aspergillosis and pulmonary mucormycosis

“…In recent decades, we found that not only immunocompromised patients were susceptible to fungal infections, diabetes mellitus, chronic lung diseases may also experience invasive fungal infections [4].…”

“…This study included 47 IPA ( 34 proven IPA and 13 probable IPA) and 22 PM patients (21 with proven PM and one with probable PM, Figure 1). Among these patients, 19 IPA patients and eight PM patients were reported in our published article [4]. There were four patients having concomitant IPA and PM, of which three were categorized as PM and one as IPA by histopathology.…”

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

“…In that study, the success rate in the isavuconazole group was 60.3% vs. 71.1% in the caspofungin group [81]. A pooled analysis was performed of patient-level data from seven randomized antifungal treatment trials, using 30-day mortality as the primary endpoint [55].…”

“…[80] identified during the last decade including COPD, liver failure, cirrhosis, and post-H1N1 influenza [27,28]. The diversity of patients and risk factors complicates diagnostic and therapeutic procedures while the available data in critically ill patients are extremely limited.…”

Sequence Base Identification of Respiratory Mucormycosis

“…In critically ill adult patients admitted to the intensive care units during 2007 to 2015, mucormycosis was responsible for 25.8% of fungal infections (5). The mortality rate of infections was extremely high and was reported as 38% to 100% in immunocompromised patients, such as those with hematologic malignancy and hematopoietic stem cell transplantation, and transplant recipients (6)(7)(8)(9)(10).…”