Unusual cause of lethal pulmonary aspergillosis in patients with chronic obstructive pulmonary disease.

Abstract

Two patients admitted to two different medical wards of our institution following respiratory decompensation of chronic obstructive pulmonary disease (COPD) were subsequently transferred to the same room of the medical intensive care unit (ICU) and intubated. Both patients developed invasive pulmonary aspergillosis and died soon after. Because COPD itself is rarely associated with lethal pulmonary aspergillosis, both cases were reviewed, and a retrospective investigation was conducted. Both patients had repeated sputum cultures while on the medical ward before their admission to the ICU; none of the sample grew Aspergillus spp. A. fumigatus was found in tracheal aspirates of both patients from the first day of their intubation while in the ICU. The pulmonary condition of both patients worsened, and invasive aspergillosis was diagnosed by bronchoalveolar lavage. Despite therapy with amphotericin B, the patients died 16 and 22 d after intubation, respectively. Both deaths were attributed to pulmonary aspergillosis; autopsy confirmed a massive pneumonia of the five lobes due to A. fumigatus in one patient. Investigation revealed that an air filter had been replaced 30 h before the first patient was admitted to the room. Experimental air filter replacement performed 12 d after the second patient died revealed the presence of A. fumigatus on the surface of the filters as well as a 10-fold increase in room air fungal counts during the procedure. This study shows that exposure to high concentrations of airborne Aspergillus spp. related to air filter change was associated with fatal invasive aspergillosis in two mechanically ventilated patients. Such infection can be prevented by the establishment and application of guidelines for air filter replacement.

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

“…Therefore, the present authors propose IPA definitions in that population of patients (table 1) in an attempt to standardise definitions, and based on the published information [12,13,34,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54], which are summarised in table 2.…”

Invasive Aspergillosis in the Intensive Care Unit: Beyond the Typical Haematological Patient

“…Pittet described two patients who developed fatal IA in the ICU. In retrospect, high concentrations of airborne Aspergillus spores could be found, closely related to air filter change in the ICU [23]. Besides the airborne route, contaminated water has been implicated as a source of infection [24].…”

Air Conditioning Systems as Non-Infectious Health Hazards Inducing Acute Respiratory Symptoms

“…Recently, the appearance of the severe acute respiratory syndrome caused by a novel SARS coronavirus (SARS-CoV) highlighted the dangers of airborne infectious agents [1][2][3] In this respect, the legionella pneumophila associated pneumonia 4) , even in large public places such as the Picadilly Circus in London 5) or lethal pulmonary aspergillosis 6) have been reported. Therefore, to protect patients from air condition-transmitted nosocomial infections at intensive care units, operating theatres and other medical wards, air-filters should be checked and disinfected regularly.…”