Invasive pulmonary aspergillosis: comparative analysis in cancer patients with underlying haematologic malignancies versus solid tumours

Dib, Rita Wilson; Khalil, Melissa; Fares, Johny; Hachem, Ray; Jiang, Ying; Dandachi, Dima; Chaftari, Anne-Marie; Raad, Issam

doi:10.1016/j.jhin.2019.09.020

Cited by 19 publications

(22 citation statements)

References 23 publications

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“…In patients with hematological malignancy, the overall mortality within 12 weeks after IPA diagnosis is reported to be 40.1%. 14 In the current study, the mortality of IPA in the elderly patients is close to that in the severe immunocompromised population. The overall mortality in critically ill elderly patients with IPA is extremely high (82.9%), exceeding that in the general population (77%).…”

Section: Discussionsupporting

confidence: 54%

<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: Discussionsupporting

confidence: 54%

<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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“…We often use corticosteroid to reduce symptoms in the palliative care of patients with solid tumors, and in many of these attempts, the corticosteroid can be effective [23][24][25]. However, the overall picture of adverse events from corticosteroid is not fully clarified, and it is also noted that the implementation of antifungal prophylaxis is low in solid tumors compared to hematologic malignancies [26]. The prognosis of IPA is extremely poor, and clinicians need to discuss with patients whether to provide prophylaxis when using corticosteroid or to conduct surveillance for the early detection of IPA.…”

Section: Discussionmentioning

confidence: 99%

A patient with hepatocellular carcinoma who developed invasive pulmonary aspergillosis after corticosteroid treatment

Sato

Yamada

Nishizawa

et al. 2021

Preprint

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“…12,13 It is also proven to be effective in treating fungal infections in patients with solid pulmonary tumors. 14 Adjusting the variconazole dose can be challenging, especially in patients with compromised liver function and patients with hematopoietic cell transplant. 15,16 Fortunately, in this case report, the patient was free of any predisposing factors affecting the immune system.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Maxillary Aspergillosis with Unusual Clinical and Imaging Presentations

Jan

Jadu

2020

The Journal of Contemporary Dental Practice

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Aim:The aim of the present study was to present a case of maxillary aspergillosis with unusual clinical presentation and imaging findings. Background: The range of lesions and conditions that affect the maxillary sinus is wide and vast. This necessitates a dynamic multidisciplinary approach for proper diagnosis and effective management. Case description: We present an unusual case of maxillary aspergillosis that mimicked apical periodontitis and was most consistent with lymphoma from the diagnostic imaging perspective. Histopathology, however, established the correct diagnosis; appropriate management commenced promptly. Conclusion: It is imperative that maxillary aspergillosis be diagnosed and managed properly and promptly to improve prognosis. Advanced imaging is required, but it plays an adjunct role to histopathology. Long-term follow-up is also necessary to ensure complete resolution of the infection. Clinical significance: Correlating clinical and imaging findings is a crucial step and any inconsistencies should be resolved promptly so as not to delay adequate management. Histopathology often serves to dispute any inconsistencies and allows the establishment of a proper diagnosis.

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Invasive pulmonary aspergillosis: comparative analysis in cancer patients with underlying haematologic malignancies versus solid tumours

Cited by 19 publications

References 23 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>

A patient with hepatocellular carcinoma who developed invasive pulmonary aspergillosis after corticosteroid treatment

A Case Report of Maxillary Aspergillosis with Unusual Clinical and Imaging Presentations

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