Loss to follow-up associated factors in patients with chronic pulmonary aspergillosis and its impact on the disease prognosis

Li, Shaoqiang; Li, Ya; Li, Zhengtu; Yang, Xin; Zhan, Yangqing; Li, Weilong; Yao, Lin; Ye, Feng

doi:10.3389/fpubh.2022.1026855

Cited by 2 publications

(1 citation statement)

References 27 publications

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“…In conclusion, the pathophysiology of CPA is complex, emphasizing the need for personalized medical care for each patient. 372 , 373 A thorough understanding of the characteristics of the causative fungi, epidemiology, pathogenesis, risk factors, diagnosis, treatment, and prognosis, as outlined in this review, is essential for optimal patient-tailored management. Although treatment options for CPA remain limited, the ongoing momentum in clinical trials, led by global organizations such as the Chronic Pulmonary Aspergillosis Network (CPAnet), is promising.…”

Section: Discussionmentioning

confidence: 99%

Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, treatment, and unresolved challenges

Tashiro,

Takazono,

Izumikawa

2024

Therapeutic Advances in Infection

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Chronic pulmonary aspergillosis (CPA) is a challenging respiratory infection caused by the environmental fungus Aspergillus. CPA has a poor prognosis, with reported 1-year mortality rates ranging from 7% to 32% and 5-year mortality rates ranging from 38% to 52%. A comprehensive understanding of the pathogen, pathophysiology, risk factors, diagnosis, surgery, hemoptysis treatment, pharmacological therapy, and prognosis is essential to manage CPA effectively. In particular, Aspergillus drug resistance and cryptic species pose significant challenges. CPA lacks tissue invasion and has specific features such as aspergilloma. The most critical risk factor for the development of CPA is pulmonary cavitation. Diagnostic approaches vary by CPA subtype, with computed tomography (CT) imaging and Aspergillus IgG antibodies being key. Treatment strategies include surgery, hemoptysis management, and antifungal therapy. Surgery is the curative option. However, reported postoperative mortality rates range from 0% to 5% and complications range from 11% to 63%. Simple aspergilloma generally has a low postoperative mortality rate, making surgery the first choice. Hemoptysis, observed in 50% of CPA patients, is a significant symptom and can be life-threatening. Bronchial artery embolization achieves hemostasis in 64% to 100% of cases, but 50% experience recurrent hemoptysis. The efficacy of antifungal therapy for CPA varies, with itraconazole reported to be 43–76%, voriconazole 32–80%, posaconazole 44–61%, isavuconazole 82.7%, echinocandins 42–77%, and liposomal amphotericin B 52–73%. Combinatorial treatments such as bronchoscopic triazole administration, inhalation, or direct injection of amphotericin B at the site of infection also show efficacy. A treatment duration of more than 6 months is recommended, with better efficacy reported for periods of more than 1 year. In anticipation of improvements in CPA management, ongoing advances in basic and clinical research are expected to contribute to the future of CPA management.

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Section: Discussionmentioning

confidence: 99%

Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, treatment, and unresolved challenges

Tashiro,

Takazono,

Izumikawa

2024

Therapeutic Advances in Infection

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Outpatient Follow-Up and Reconstructive Surgery Rates in Massive Burn Survivors: Investigating the Social Determinants

Valdez,

Sen,

Palmieri

et al. 2024

Journal of Burn Care &Amp; Research

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Burn care continues to improve and larger total body surface area (TBSA) burn survival is increasing. These survivors require more extensive care than smaller burns and are at higher risk for wound/scar related complications. Prior work has shown low rates of follow up for burn survivors linked to socioeconomic factors such as housing insecurity and substance use. There are limited studies that evaluate socioeconomic factors that contribute to follow up and reconstructive surgery rates in massively burned patients. Patients that survived to discharge with >50% TBSA burns and planned return to treating institution were included in the study. Univariate and multivariate analyses were performed on the data collected. Sixty-Five patients were included with an average TBSA of 63.1%. Fifty-three patients (81.5%) attended at least one follow up appointment with median of four follow-up appointments. Younger patients (33±9 vs 44±11; p=0.0006), patients with larger TBSA burns (65±13 vs 55±5%; p=0.02), those with private insurance and those without housing insecurity (1.8% vs 45.4%; p=0.003) were more likely to follow up. On multivariate regression analysis, patients with housing insecurity were independently associated with lack of follow up (OR: 0.009 CI: 0.00001-0.57). Thirty-five patients had at least one reconstructive surgery and 31 patients had reconstructive surgery after discharge. No patients with housing insecurity underwent reconstructive surgery. Follow up rates in massive burns were higher than reported for smaller TBSA burns and more than half received reconstructive surgery. Housing insecure patients should be targeted for improved follow up and access to reconstructive surgery.

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Loss to follow-up associated factors in patients with chronic pulmonary aspergillosis and its impact on the disease prognosis

Cited by 2 publications

References 27 publications

Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, treatment, and unresolved challenges

Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, treatment, and unresolved challenges

Outpatient Follow-Up and Reconstructive Surgery Rates in Massive Burn Survivors: Investigating the Social Determinants

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