The importance of risk factors for the prediction of patients with invasive pulmonary aspergillosis

Abstract

Objective: Invasive pulmonary aspergillosis (IPA) is a major challenge in the management of immunocompromised patients. Despite all the advances in diagnosis, it remains a problem. The purpose of our study was to investigate the risk factors associated with IPA seen in patients with hematological malignancies. Method: A total of 152 febrile neutropenia (FEN) patients with hematological malignancies aged over 18 years and receiving high-dose chemotherapy or stem cell transplant between January 1, 2010, and December 31, 2012 were included in the study. Sixty-five (65) cases with IPA according to the European Organization for the Research and Treatment of Cancer and Infectious Diseases Mycoses Study Group criteria were enrolled as the case group, while 87 patients without IPA development during concomitant monitoring were enrolled as the control group. Incidence of IPA was 21.4% (3/14) in patients receiving bone marrow transplant (allogeneic 2, autologous 1) and those cases were also added into the case group. The two groups were compared in terms of demographic, clinical and laboratory findings and risk factors associated with IPA investigated retrospectively. Results: Presence of relapse of primary disease, neutropenia for more than 3 weeks, presence of bacterial infection, and non-administration of antifungal prophylaxis were identified as risk factors associated with IPA. Conclusion: It may be possible to reduce the incidence of the disease by eliminating preventable risk factors. Predicting those risks would, per se, enable early diagnosis and treatment and, thus, the mortality rate of these patients would unquestionably decline.

Infectious complications in patients with acute leukemia according to the duration of neutropenia

“…Влияниепродолжительностигранулоцитопениинача-стотуинвазивныхмикозовбылодоказанов1984г.вработе S. L. Gerson и соавт. [7], включавшей 70 больных острыми лейкозами, у которых, начиная с 22-го дня гранулоцитопении,вероятностьразвитияИАувеличи-валасьежедневнона4,3%,ак34-муднюгранулоцито-пениипревысила70%.Этазависимостьбылаподтверждена и в ряде современных исследований [8][9]. Так, вработе,опубликованнойв2009г.,больныеОМЛиинвазивныммикозом(n=11)статистическизначимочаще, чембольныебезэтойинфекции(n=33),имели«глубокую»(гранулоцитоввкровименее100 / мм 3…”

“…70%,p=0,04)иболеепродолжительнуюгранулоцитопению(26днейпротив15дней,p=0,002) [8].Вдругом исследованииубольныхгемобластозамииИА(n=65) всравнениисгруппойконтроля(n=87)такжепреобладала регистрация глубокой гранулоцитопении (90,8% против2,3%)длительностьюболее3нед(92,3%против 49,4%), p <0,001 [9]. В рамках этого исследования примногофакторноманализенезависимымпредиктором развитияИАсталоналичиегранулоцитопениидлитель-ностьюболее3нед(отношениешансов7,01;p=0,002).…”

CYP2C19 Genotyping Plus Therapeutic Drug Monitoring Dependent Voriconazole Treatment for Invasive Pulmonary Aspergillosis in a Patient with Liver Failure

“…Early recognition of IPA and prompt antifungal treatment in patient with liver failure may improve the outcome. As noted previously, treatment with glucocorticoid (GC) is established to be a risk factor for IPA, [2] by inhibiting the anti-fungal immune responses of the host. Currently, the Infectious Diseases Society of America (IDSA) recommended voriconazole as the primary agent for treatment of IPA.…”

Potential value of serum Aspergillus IgG antibody detection in the diagnosis of invasive and chronic pulmonary aspergillosis in non-agranulocytic patients

“…Furthermore, invasive pulmonary aspergillosis (IPA) has become a common type of severe pneumonia with the highest mortality, and one of the important reasons the is difficulty in diagnosis [6]. In addition, patients with agranulocytosis are predominant among those with IPA, and relevant international guidelines for diagnosis and treatment also focus on them [7].…”