Invasive Pulmonary Aspergillosis

Ledoux, Marie‐Pierre; Guffroy, Blandine; Nivoix, Yasmine; Simand, Célestine; Herbrecht, Raoul

doi:10.1055/s-0039-3401990

Cited by 77 publications

(67 citation statements)

References 217 publications

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“…Patients with neutropenia, treated with a long course of glucocorticoids (GC) or immunosuppressants, are extremely risky for IPA. 1 Increasing evidence suggests that patients with various comorbidities such as diabetes mellitus (DM), malnutrition, and chronic pulmonary disease are potential hosts for IPA. 2,3 Elderly patients are usually complicated with but not limited to the chronic medical conditions.…”

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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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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“…Meanwhile, fungal infection is a major infectious complication in immunocompromised patients. A prospective, observational study [20] found that the prevalence of IFI is 22.97% in persistent FN in children with acute leukemia. The most common isolated fungi is Aspergillussp., followed by Candidasp.…”

Section: Discussionmentioning

confidence: 99%

“…AmB lipid complex showed e cacy in the secondline therapy of IA in adults and children. The statements above are the guidelines for IA treatment from the Infectious Diseases Society of America, the European Conference on Leukemia, and the European Society of Clinical Microbiology and Infectious Diseases [20]. In clinical practice, the drug combination of treatment is best and most effective choice on speci c conditions.…”

Section: Discussionmentioning

confidence: 99%

Successful Engraftment of HLA-matched Peripheral Hematopoietic-stem-cell Transplantation for Severe Aplastic Anemia With Multidrug-resistant Bacterial and Fungal Infections

et al. 2020

Preprint

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Abstract Allogeneic hematopoietic-stem-cell transplantation (HSCT) is relatively challenging for the patients with serious infection and intensifying complications. Patients often lost the timing of HSCT due to the poor health status. We report a rare case of successful engraftment of HLA -matched peripheral hematopoietic stem cells for a 15-year-old girl with severe aplastic anemia (SAA), suffering multidrug-resistant (MDR) bacterial infection and fungal infections. With strong antibiotics and life support treatments, the patient received Cy + ATG precondition. The patient received cyclosporine A, methotrexate and mycophenolate for GVHD prophylaxis. Leukocyte and Platelet engraftment occurred on day + 15 and + 35 respectively. The patient’s blood routine test returned to normal on day + 72. The conditioning regimen was well tolerated by patient. Donor's engraftments were achieved successfully. The immunosuppressants were weaned off gradually. We hope this case's experience can be a reference for patients with SAA suffering severe infection on HSCT in future.

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“…The patient in this case also had invasive pulmonary aspergillosis, which begins with the inhalation of Aspergillus spores. 8 These spores are ubiquitous in both indoor air and outdoor air. They get into the air from household dust, soil, food, water, plants, flowers, decomposing plants, and building materials.…”

Section: -8mentioning

confidence: 99%

“…The patient had persistent diarrhea despite oral metronidazole therapy, suggesting the possibility of graft-versus-host disease, for which oral prednisone therapy was added to his regimen 7 weeks ago. Ileal and colonic biopsies showed no abnormalities, but biopsy culture was positive for adenovirus, 6 weeks ago, treated with a brief course of cidofovir and one dose of intravenous [2][3][4][5][6][7][8] Autops Case Rep (São Paulo). 2020 Oct-Dec;10(4):e2020191…”

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confidence: 99%

The grim reaper evading modern medicine: aspergillosis, adenovirus, and Hodgkin lymphoma

2020

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Illustrative cases of diseases that are difficult to suspect and diagnose can serve as useful reminders. Invasive pulmonary aspergillosis and adenovirus hepatitis are two such diseases, both revealed by autopsy in this case of Hodgkin lymphoma refractory to chemotherapy treated with allogeneic hematopoietic stem cell transplantation complicated by these two fatal infections. This patient was cured of Hodgkin lymphoma, Clostridioides difficile colitis and thrombotic thrombocytopenic purpura using the marvels of modern medicine. This case illustrates many features of aspergillosis and adenovirus hepatitis, shows the value of autopsy in revealing diagnoses, and illustrates the limits of modern medicine, which should serve as a mental spur in our efforts to advance medical science, to try to defeat the numerous demons of disease, who seem to keep outwitting us.

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Invasive Pulmonary Aspergillosis

Cited by 77 publications

References 217 publications

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

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

Successful Engraftment of HLA-matched Peripheral Hematopoietic-stem-cell Transplantation for Severe Aplastic Anemia With Multidrug-resistant Bacterial and Fungal Infections

The grim reaper evading modern medicine: aspergillosis, adenovirus, and Hodgkin lymphoma

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