Pulmonary Fungal Diseases in Immunocompetent Hosts: A Single-Center Retrospective Analysis of 35 Subjects

Yan, Xiaopei; Feng, Zhang; Kong, Hui; Wang, Yanli; Zhao, Xinyun; Liu, Wenrui; Wang, ZaiLiang; Xie, Weiping

doi:10.1007/s11046-016-9999-1

Cited by 8 publications

(6 citation statements)

References 43 publications

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“…Another theory is that the higher haemoglobin values could suggest that there is less angioinvasion and haemorrhage at the time of surgery indicative of an infection that is less aggressive and more easily‐controlled. Similar to multiple prior studies, our study found significantly shorter survival times in patients with neutropenia …”

Section: Discussionsupporting

confidence: 91%

“…Mucormycosis, formerly known as zygomycosis, is an ominous and highly lethal opportunistic fungal infection principally affecting immunocompromised patients . Patients with haematologic malignancies and those who have undergone haematopoietic cell transplantation (HCT) are most frequently affected, but mucormycosis has also been described in patients with solid organ transplants, diabetes mellitus (DM), iron chelation or taking high‐dose corticosteroids; more rarely, persons with no identified immunocompromising conditions have been affected . This has been, and is continuing to become, increasingly relevant as there has been a notable recent shift in the epidemiology of invasive fungal infections (IFIs) from Aspergillus to Mucorales and other non‐ Aspergillus moulds …”

Section: Introductionmentioning

confidence: 99%

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Cut it out! Thoracic surgeon’s approach to pulmonary mucormycosis and the role of surgical resection in survival

Multani

Reveron-Thornton

Garvert

et al. 2019

Mycoses

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Background: Mucormycosis portends a poor prognosis with mortality rates ranging from 50% to 70% in pulmonary mucormycosis (PM) and up to 95% in disseminated disease. However, detailed outcomes data have been lacking. It remains unknown how to identify patients who would benefit from surgical resection. Objectives:We present our experience with patients undergoing surgical resection for PM, including an analysis of factors affecting postoperative survival. We also describe a thoracic surgeon's approach through illustrative cases. Patients/Methods: We conducted a single-centre retrospective study of all adult patients with PM who received antifungal therapy and underwent surgical resection or who Results: Twelve patients received antifungal therapy and underwent surgical resection and 13 patients received antifungal therapy alone. From infection onset to death (or right-censoring if still alive), patients who underwent surgical resection had a median survival of 406 days (mean, 561.3; range, 22-2510), and patients who received antifungal therapy alone had a median survival of 28 days (mean, 66.7; range, 8-447).In patients who underwent surgical resection, median postoperative survival time was 154 days (range, 11-2495), in-hospital mortality was 16.7%, and 1-year mortality was 50.0%. Age, primary disease, ASA status, extrapulmonary dissemination, laterality, multilobar involvement, number of lesions, largest lesion size, platelet count, surgical approach, type of resection or extent of resection were not significantly associated with postoperative survival. Conclusions:Surgical resection significantly increases survival and should be strongly considered for selected patients with PM.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Cut it out! Thoracic surgeon’s approach to pulmonary mucormycosis and the role of surgical resection in survival

Multani

Reveron-Thornton

Garvert

et al. 2019

Mycoses

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“… 30 – 34 The observation of hypoalbuminemia as an independent prognostic factor for mortality is in agreement with previous studies. 15 , 33 The association of hypoalbuminemia with poor treatment outcomes could be explained by its impact on pharmacokinetics of antifungal drugs shown in a recent study suggesting that hypoalbuminemia can increase unbound voriconazole concentrations in plasma, thereby increasing drug elimination and attenuating its therapeutic effects. 35 These findings suggest a need to correct or seek and treat the causes of hypoalbuminemia in patients with PFIs.…”

Section: Discussionmentioning

confidence: 99%

New insights into the clinical characteristics and prognostic factors of pulmonary fungal infections from a retrospective study in Southwestern China

Li¹,

Huo³

et al. 2018

IDR

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BackgroundDespite increasing incidence of pulmonary fungal infections (PFIs) worldwide, the clinical characteristics and prognostic factors remain poorly understood. The goal of this study was to investigate the clinical features, laboratory findings, and outcomes of hospitalized patients diagnosed with PFIs.MethodsWe retrospectively enrolled 123 patients at a university hospital in Southwestern China between February 2014 and May 2016, who were diagnosed with PFIs based on clinical presentations and laboratory tests including fungal culture and pathological examination. Medical records were reviewed and analyzed. Prognostic factor associated with mortality was evaluated by multivariate regression analysis.ResultsOf the 123 PFI patients enrolled, the mean age was 67 years with 72% of them being males. In addition to common clinical features reported previously, these patients exhibited distinct characteristics, with the elderly accounting for 79% of all cases, and with prolonged hospitalization being the most prevalent risk factor (74%) and chronic obstructive pulmonary disease (COPD) being the most common underlying disease (45%). Invasive operation was significantly more frequently involved in patients with unfavorable treatment responses than in patients with favorable responses (45.6 vs 7.4%, P=0.000). By multivariate regression analysis, invasive operation (odds ratio [OR]: 5.736, 95% confidence interval [CI]: 2.008–16.389, P=0.001) and hypoalbuminemia (OR: 3.936, 95% CI: 1.325–11.696, P=0.014) were independent prognostic factors of mortality in PFIs.ConclusionThis study provides new insights into the clinical characteristics and prognostic factors of PFIs and highlights the necessity to be aware of PFIs in patients with COPD and patients receiving invasive operation in order to improve clinical management of these patients.

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“…Chronic pulmonary aspergillosis has been increasingly reported in patients with underlying respiratory disorders, such as COPD, cavitary pulmonary tuberculosis, and bronchiectasis, and in patients given glucocorticoids or immunosuppressants (Garnacho-Montero et al, 2005; Wichmann and Kluge, 2013; Denning et al, 2015; Yan et al, 2016). Because of the relatively intact immune system, these patients often display atypical symptoms coupled with non-standard imaging results, making the early diagnosis difficult.…”

Section: Introductionmentioning

confidence: 99%

Role of the Aspergillus-Specific IgG and IgM Test in the Diagnosis and Follow-Up of Chronic Pulmonary Aspergillosis

Rui

Zhou

et al. 2019

Front. Microbiol.

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Background Chronic pulmonary aspergillosis (CPA) has a high rate of misdiagnosis and has been reported to have an increasing rate of morbidity and mortality. In this article, we assessed the serum Aspergillus -specific IgG and IgM test in the diagnosis of patients with CPA. Methods A prospective study was conducted from January 2016 to July 2017 in Nanjing Jinling Hospital. Serum samples were collected from CPA patients (178 sera, 82 patients) and from non-aspergillosis patients (125 sera) with community-acquired pneumonia (CAP), active tuberculosis, bronchiectasis or lung tumors. Additionally, we included a control group of healthy patients(50 sera). Aspergillus -specific antibody detection was performed using a Dynamiker ELISA kit, and the results were compared with the value of galactomannan (GM) in bronchoalveolar lavage fluid (BALF). Results The sensitivity and specificity of the Aspergillus -specific IgG antibody in the diagnosis of CPA were 84.1 and 89.6%, respectively. These values were slightly higher compared to those obtained for the sensitivity and specificity using the BALF GM test (79.1 and 84.2%, respectively). However, the sensitivity and specificity of Aspergillus -specific IgM antibody were only 43.9 and 87.2%, respectively. Moreover, the positive rate of IgG in patients with subacute invasive aspergillosis (SAIA) was 87%, compared to the positive rates of IgG in CPA patients sick for 3–6 months (80.0%), 6–9 months (81.8%) and ≥9 months (80.0%). Meanwhile, the positive rate of IgM in SAIA patients was 63%, compared to the positive rate of IgM in CPA patients sick for 3–6 months (46.7%), 6–9 months (0%) and ≥9 months (0%), respectively. Furthermore, serum IgG levels decreased gradually in the majority of CPA patients who showed positive response to antifungal therapy, and IgG levels increased in two CPA patients when their disease worsened. Conclusion A serum Aspergillus -specific IgG test is a valuable tool for the diagnosis of CPA and SAIA, while an Aspergillus -specific IgM test is only modestly specific for the diagnosis of SAIA. Overall, the variation trend of Aspergillus -specific IgG levels may reflect the therapeutic effectiveness in the long-term follow-up of CPA.

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Pulmonary Fungal Diseases in Immunocompetent Hosts: A Single-Center Retrospective Analysis of 35 Subjects

Abstract: Pulmonary fungal disease in immunocompetent patients, with Aspergillus as the most common identified species, had a prognosis that was influenced by the level of serum albumin.

Cited by 8 publications

References 43 publications

Cut it out! Thoracic surgeon’s approach to pulmonary mucormycosis and the role of surgical resection in survival

Cut it out! Thoracic surgeon’s approach to pulmonary mucormycosis and the role of surgical resection in survival

New insights into the clinical characteristics and prognostic factors of pulmonary fungal infections from a retrospective study in Southwestern China

Role of the Aspergillus-Specific IgG and IgM Test in the Diagnosis and Follow-Up of Chronic Pulmonary Aspergillosis

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