Invasive aspergillosis in nonneutropenic patients：risk factors，clinical features and outcome_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 CHEN Ruiying , JIN Jianjun , OUYANG Songyun , SUN Peizong

Department of Respiratory Medicine，The First Affiliated Hospital of Zhengzhou University.Zhengzhou，He’nan，450052，China Corresponding author：CHEN Rui-ying，E-mail：ring923@126.com;

Corresponding author：

CHEN Ruiying, Email: ring923@126.com

Keywords：

Invasive aspergillosis; Nonneutropenic; Risk factors：Outcome

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Objective To investigate the risk factors，clinical features and outcome of invasive aspergillosis（IA） in nonneutropenic patients.Methods Fifty-four patients with IA at the First Affiliated Hospital of Zhengzhou University from Jan 2001 to Dec 2006 were analyzed retrospectively.According to the definitions of EORTC/MSG，proven diagnosis was made in 9 cases，probable diagnosis in 30 cases and possible diagnosis in 15 cases.Results In the neutropenic group（n=24），hematological malignancies were the major underlying conditions（n=20）.In nonneutropenic group（n=30），the main underlying condition was steroid-treated COPD（n=11）.Fever，dyspnea，cough，chest pain and haemoptysis were commonly symptoms.Thoracic computed tomography showed that segmental consolidation occurred more frequently in neutropenic patients，whereas diffuse nodules more frequently in nonneutropenic patients.Nodules or consolidation with evidence of cavity lesion had a higher sensitivity than the halo sign or air crescent sign in both groups.The total mortality of IA was 72.2%.The mortality of nonneutropenic group was higher than that of neutropenic group（83.3% vs 58.3%，P=0.042）.Multivariate analysis showed that secondary central nerves system IA and delayed diagnosis were associated with poor outcome of IA.Conclusion There were high incidence and mortality of IA among nonneutropenic patients，especially those with COPD treated with long-term corticosteroids.

Citation： CHEN Ruiying,JIN Jianjun,OUYANG Songyun,SUN Peizong. Invasive aspergillosis in nonneutropenic patients：risk factors，clinical features and outcome. Chinese Journal of Respiratory and Critical Care Medicine, 2008, 08(3): 169-173. doi: Copy

1.	Vaideeswar P，Prasad S，Deshpande JR，et al.Invasive pulmonary aspergillosis：A study of 39 cases at autopsy.J Postgrad Med，2004，50：21-26.
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5.	Ascioglu S，Rex JH，de Pauw B，et al.Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants：an international consensus.Clin Infect Dis，2002，34：7-14.
6.	朱小敏，周新.侵袭性肺曲霉病的诊断与治疗.中国呼吸与危重监护杂志，2005，4：316-320.
7.	Allam MF，Del Castillo AS，Diaz-Molina C，et al.Invasive pulmonary aspergillosis：identification of risk factors.Scand J Infect Dis，2002，34：819-822.
8.	Bulpa PA，Dive AM，Garrino MG，et al.Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis：benefits of intensive care? Intensive Care Med，2001，27：59-67.
9.	Rello J，Esandi ME，Mariscal D，et al.Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease：report of eight cases and review.Clin Infect Dis，1998，26：1473-1475.
10.	Garcés Jarque JM，Terradas Robledo R，Alvarez-Lerma F，et al.Lung aspergillosis.Role of the corticoids as associated risk factor in the patient with chronic bronchitis.Rev Clin Esp，2003，203：472-474.
11.	陈瑞英，孙培宗，靳建军，等.原发性侵袭性肺曲霉病四例分析.中国呼吸与危重监护杂志，2007，6，385-387.
12.	Clancy CJ，Nguyen MH.Acute community-acquired pneumonia due to Aspergillus in presumably immunocompetent hosts：clues for recognition of a rare but fatal disease.Chest，1998，114：629-634.
13.	Denning DW：Aspergillus species.In Principles and Practice of Infectious Disease Edited by：Mandell G，Douglas J，Bennett D.Philadelphia：Churchill Livingstone：2000：2675-2685.
14.	Yu VL，Muder RR，Poorsattar A.Significance of isolation of Aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergillosis.Results from a three-year prospective study.Am J Med，1986，81：249-254.

1. Vaideeswar P，Prasad S，Deshpande JR，et al.Invasive pulmonary aspergillosis：A study of 39 cases at autopsy.J Postgrad Med，2004，50：21-26.
2. Patterson TF，Kirkpatrick WR，White M，et al.Invasive aspergillosis.Disease spectrum，treatment practices，and outcome.13 Aspergillus Study Group.Medicine（Baltimore），2000，79：250-260.
3. Ader F，Nseir S，Le Berre R，et al.Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease：an emerging fungal pathogen.Clin Microbiol Infect，2005，11：427-429.
4. Denning DW.Aspergillosis in “nonimmunocompromised” critically ill patients.Am J Respir Crit Care Med，2004，170：580-581.
5. Ascioglu S，Rex JH，de Pauw B，et al.Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants：an international consensus.Clin Infect Dis，2002，34：7-14.
6. 朱小敏，周新.侵袭性肺曲霉病的诊断与治疗.中国呼吸与危重监护杂志，2005，4：316-320.
7. Allam MF，Del Castillo AS，Diaz-Molina C，et al.Invasive pulmonary aspergillosis：identification of risk factors.Scand J Infect Dis，2002，34：819-822.
8. Bulpa PA，Dive AM，Garrino MG，et al.Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis：benefits of intensive care? Intensive Care Med，2001，27：59-67.
9. Rello J，Esandi ME，Mariscal D，et al.Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease：report of eight cases and review.Clin Infect Dis，1998，26：1473-1475.
10. Garcés Jarque JM，Terradas Robledo R，Alvarez-Lerma F，et al.Lung aspergillosis.Role of the corticoids as associated risk factor in the patient with chronic bronchitis.Rev Clin Esp，2003，203：472-474.
11. 陈瑞英，孙培宗，靳建军，等.原发性侵袭性肺曲霉病四例分析.中国呼吸与危重监护杂志，2007，6，385-387.
12. Clancy CJ，Nguyen MH.Acute community-acquired pneumonia due to Aspergillus in presumably immunocompetent hosts：clues for recognition of a rare but fatal disease.Chest，1998，114：629-634.
13. Denning DW：Aspergillus species.In Principles and Practice of Infectious Disease Edited by：Mandell G，Douglas J，Bennett D.Philadelphia：Churchill Livingstone：2000：2675-2685.
14. Yu VL，Muder RR，Poorsattar A.Significance of isolation of Aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergillosis.Results from a three-year prospective study.Am J Med，1986，81：249-254.

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