New insights into the clinical characteristics and prognostic factors of pulmonary fungal infections from a retrospective study in Southwestern China

Li, Peng; Xu, Zhiping; Huo, Zhenyu; Long, Rodney; Ma, Liang

doi:10.2147/idr.s157030

Cited by 8 publications

(9 citation statements)

References 32 publications

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“…In addition, chronic inflammation induced by hyperglycemia increases the consumption of hematopoietic materials. Hypoalbuminemia is associated with infection and increases mortality. Diabetes decreases the synthetic rate of serum albumin, and increases the transcapillary escape of albumin from the vascular to the interstitial compartment.…”

Section: Discussionmentioning

confidence: 99%

Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors

Lao

Jin

et al. 2019

J of Diabetes Invest

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Aims/Introduction: A retrospective study was carried out to investigate the clinical characteristics and associated factors for invasive fungal disease in patients with type 2 diabetes mellitus. Materials and Methods: Demographic and clinical data were recorded. Associated factors were analyzed by logistic regression analysis. Results: Invasive fungal disease was diagnosed in 120 patients with type 2 diabetes mellitus (prevalence, 0.4%). Yeast infection (56/120, 46.7%), including candidiasis (31/56, 55.4%) and cryptococcosis (25/56, 44.6%), was the most common. The urinary tract was mainly involved in candidiasis (12/31, 38.7%). More than half of the cryptococcosis (16/25, 64.0%) presented as pneumonia. Mold infection accounted for 40.8% of the cases, and predominantly involved the lung (34/49, 69.4%). A total of 15 (12.5%) patients had mixed fungal infection. Candida albicans (24/111, 21.6%), Cryptococcus neoformans (19/111, 17.1%) and Aspergillus fumigatus (14/111, 12.6%) were the leading agents. Co-infection occurred in 58 (48.3%) patients, mainly presenting as pneumonia caused by Gram-negative bacteria.The inpatient mortality rate of invasive fungal disease was 23.3% (28/120). Glycated hemoglobin levels were higher in non-survivors than survivors (8.8 -2.5 vs 7.7 -2.1%, P = 0.02). Anemia (adjusted odds ratio, 3.50, 95% confidence interval 1.95-6.27, P < 0.001), hypoalbuminemia (adjusted odds ratio, 5.42, 95% confidence interval 3.14-9.36, P < 0.001) and elevated serum creatinine (adjusted odds ratio, 2.08, 95% confidence interval 1.07-4.04, P = 0.03) were associated with invasive fungal disease in type 2 diabetes mellitus patients. Conclusions: Invasive fungal disease is a life-threatening complication in type 2 diabetes mellitus patients. C. a albicans, C. neoformans, and A. fumigatus are the leading agents. Prolonged hyperglycemia results in unfavorable outcomes. Correction of anemia and hypoalbuminemia might improve prognosis.

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Section: Discussionmentioning

confidence: 99%

Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors

Lao

Jin

et al. 2019

J of Diabetes Invest

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“…The mortality of IPA increases with age. 6 Many factors contribute to the high mortality of IPA. Of note, co-infections with other pathogens are remarkable.…”

Section: Introductionmentioning

confidence: 99%

<p>Clinical Features and Co-Infections in Invasive Pulmonary Aspergillosis in Elderly Patients</p>

Lao¹,

Zhang²,

Zhang³

et al. 2020

IDR

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Introduction: Invasive pulmonary aspergillosis (IPA) is a potentially lethal opportunistic infection. Old age is one of the important risk factors of IPA. However, data regarding the clinical characteristics and prognostic factors of elderly patients with IPA are limited, with data regarding co-infection of other bacteria or fungi even scarcer. Methods: We performed a retrospective study of elderly patients (aged≥60) with IPA diagnosed in the First Affiliated Hospital of Sun Yat-sen University from January 2000 to December 2019. Data collection included demographic characteristics, premorbid conditions, underlying diseases, clinical manifestations, therapeutic procedures, and pathogenic detection. Associated factors were analyzed by logistic regression analysis. Results: A total of 97 elderly patients (75 males, 22 females) with IPA were included. The all-cause mortality rate was 36.1% (35/97). Body mass index (BMI) (adjusted odds ratio (OR) 1.27, 95% confidence interval (CI) 1.08-1.50, P=0.01), solid organ malignancy (adjusted OR 5.37, 95% CI 1.35-21.33, P=0.02), and co-infections (adjusted OR 5.73, 95% CI 1.40-23.51, P=0.02) were associated with mortality in the elderly patients with IPA. Nearly, 76.3% (74/97) of the patients developed co-infections. Most of the infections (55/74, 74.3%) involved the lung. A total of 77 strains of bacteria were isolated, and Gramnegative bacteria (63/77, 81.3%) were predominant. Patients with co-infections are older (72.3±7.6 vs 67.4±7.4, P=0.04), prone to admit to the intensive care unit (ICU) (59.5% vs 26.1%, P=0.01), and present lymphopenia (60.8% vs 26.1%, P=0.004). In multivariate analysis, ICU admission (adjusted OR 4.57, 95% CI 1.53-13.67, P=0.01), and lymphopenia (adjusted OR 4.82, 95% CI 1.62-14.38, P=0.01) were significantly associated with coinfection in the elderly patients with IPA. Conclusion: IPA is a fatal disease in the elderly population. Co-infection is closely associated with mortality. Lymphopenia could be an indicator for co-infection in the elderly patients with IPA.

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“…Empirical therapy is recommended for unidentified pathogen and broad-spectrum anti-infective drugs with fewer side effects can be useful in this circumstance. The efficacy of voriconazole and caspofungin against candida and aspergillus was shown to be comparable to that of amphotericin B with fewer unexpected side effects [16][17][18]. In our case, caspofungin was chosen because of its low hepatotoxicity [19].…”

Section: Discussionmentioning

confidence: 85%

Fungal pneumonia manifesting as cavitary lesions in a critically ill elderly patient

Yang

Wang

et al. 2019

J Infect Dev Ctries

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Elderly patients with fungal pneumonia experience higher mortality and are more likely to be misdiagnosed. The diagnosis and treatment of fungal pneumonia in elderly patients is challenging. We herein present a clinical case of pulmonary fungal infection (PFI) manifesting as cavitary lesions in an 85-year-old male with multiple organ failure. Broad-spectrum antibiotics showed unsatisfactory result in this case. Computed tomography (CT) of the chest showed multiple pulmonary cavities with gas-fluid levels in the right upper and middle lobe, and patchy blurred shadows in the lower lobe. The diagnosis of fungal pneumonia was made after ruling out other causes of fever. The patient showed good response to anti-fungal treatment. Physicians must consider the possibility of fungal pneumonia in elderly patients who do not respond to antibiotic treatment after exclusion of immune response, tumor, tuberculosis, and other systemic infections.

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New insights into the clinical characteristics and prognostic factors of pulmonary fungal infections from a retrospective study in Southwestern China

Cited by 8 publications

References 32 publications

Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors

Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors

<p>Clinical Features and Co-Infections in Invasive Pulmonary Aspergillosis in Elderly Patients</p>

Fungal pneumonia manifesting as cavitary lesions in a critically ill elderly patient

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