Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome

Abstract

We describe a large series of patients with chronic obstructive pulmonary disease (COPD) and probable invasive pulmonary aspergillosis (IPA), and the risk factors and incidence of the disease in patients with isolation of Aspergillus from lower respiratory tract samples. From 2000 to 2007, we retrospectively studied all patients admitted with COPD and isolation of Aspergillus (239; 16.3/1000 admissions). Multivariate logistic regression and survival curves were used. Fifty-three patients had probable IPA (3.6 cases of IPA per 1000 COPD admissions). IPA affects at least 22.1% of patients with COPD and isolation of Aspergillus in culture. In 33 of the 53 patients with probable IPA, serum galactomannan was determined; in 14 (42.4%) of these, the result was positive. Five variables were independent predictors of IPA with statistical significance: admission to the intensive-care unit, chronic heart failure, antibiotic treatment received in the 3 months prior to admission, the accumulated dosage of corticosteroids equivalent to >700 mg prednisone received in the 3 months prior to admission, and the similar accumulated dosage of corticosteroids received from admission to the first clinical isolation of Aspergillus. Multivariate analysis gave an area under the curve of 0.925 (95% CI 0.888-0.962; p <0.001). The overall mean survival of the cohort was 64.1% (28.3% for IPA patients and 75.2% for non-IPA patients). The median number of days of survival was 48 (95% CI 33.07-62.92). However, we found statistically significant differences between patients with IPA (29 days; 95% CI 20.59-37.40) and patients without IPA (86 days; 95% CI 61.13-110.86) (log rank, p <0.001).

Invasive Aspergillosis in Intensive Care Unit Patients in Iran

“…However neutropenia was reported as the main predisposing factor for IA but patients with COPD have emerged to be at particular risk for IA (10,15,25,30). Because of long-term corticosteroid use by COPD patients, which has significant impact on the distribution and function of neutrophils, macrophages, and lymphocytes, COPD can be considered as one of the main predisposing factors for IA.…”

Utility of a serum Aspergillusgalactomannan assay in diagnosis of invasive pulmonary Aspergillosis in HIV/AIDS patients: a prospective analysis

“…[20,21] Typically, a definite diagnosis is rarely established and diagnosis frequently relies on a combination of clinical features and radiological abnormalities in a patient with high-risk predisposing conditions. While an accurate diagnosis relies on histopathology, a lung biopsy is seldom performed and even in cases where it is feasible the diagnostic accuracy rarely exceeds 80%, more so in event of false negative results due to failure of the invasive method to reach the area infected by Aspergillus species.…”

An update of clinical characteristics and imaging findings of pulmonary aspergillosis

“…In the recent years, the number of studies has been reported that the incidence of IPA is gradually increasing in nonneutropenic immunocompetent COPD and critically ill patients in ICU [52,53] . In COPD patients ciliary activity impairment, immunosuppression due to alveolar macrophage and neutrophil inhibition in those treated with steroids and also receiving broad-spectrum antibiotics, play an important role in the development of IPA [54] .…”