Invasive pulmonary aspergillosis is a frequent complication in patients with severe fever with thrombocytopenia syndrome: A retrospective study

Abstract Sixteen of 45 patients with severe fever with thrombocytopenia (36%) were admitted to an intensive care unit; 9 (56%) developed invasive pulmonary aspergillosis (IPA) within a median of 8 days (range, 2–11). Mortality was higher in the IPA vs non-IPA patients and in those without vs with antifungal therapy.

Download Full-text

1707. Invasive Pulmonary Aspergillosis in Patients with Severe Fever with Thrombocytopenia Syndrome

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1571 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S625-S626

Author(s):

Seongman Bae ◽

Jiwon Jung ◽

Min Jae Kim ◽

Eunbeen Cho ◽

Mi Young Kim ◽

...

Keyword(s):

Tertiary Care ◽

Fatal Outcome ◽

Invasive Pulmonary Aspergillosis ◽

Rank Test ◽

Care Hospital ◽

Pulmonary Aspergillosis ◽

Corticosteroid Administration ◽

Log Rank Test ◽

Tick Borne Disease ◽

Severe Fever

Abstract Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease often accompanied by immune catastrophic course and subsequent fatal outcome. More than 90% of patients with SFTS had leukopenia and about one-third of those need the admission of intensive care unit (ICU) during the hospital course. So, there has been growing concern about the complications such as invasive pulmonary aspergillosis (IPA) in critical SFTS patients. We thus investigate the incidence and clinical characteristics of IPA in patients with SFTS. Methods All patients who were confirmed as SFTS in a tertiary care hospital, Seoul, South Korea, between January 2013 and October 2018 were enrolled. The modified AspICU algorithm was used to identify cases of putative invasive pulmonary aspergillosis (PIPA) and discriminate these invasive diseases from colonization. Results Of the 45 PCR-confirmed SFTS patients, 16 (36%) received ICU care. Of these 16 patients, 9 (56%) developed PIPA during hospitalization. The median duration from admission to the first evidence of PIPA was 8 days (range, 2–11 days). None of the PIPA cases met the revised EORTC/MSG criterion. Septic shock and corticosteroid administration preceded more frequently in PIPA group than non-PIPA group (100% vs. 19%, P < 0.0001 and 67% vs. 14%, P = 0.003, respectively). Patients complicated by PIPA showed significantly higher mortality than non-PIPA patients (44% vs. 8%, P = 0.048 by log-rank test). Mortality was lower in patients with PIPA who received antifungal treatment (17% [1/6]) than in those with PIPA who did not (100% [3/3]) (log-rank test, P = 0.002). Conclusion More than half of patients with SFTS in ICU were complicated by IPA during early hospital course. Cautious scrutiny for IPA in patients with SFTS followed by early appropriate antifungal therapy for IPA is needed. Disclosures All authors: No reported disclosures.

Download Full-text

Clinical features of fatal severe fever with thrombocytopenia syndrome that is complicated by invasive pulmonary aspergillosis

Journal of Infection and Chemotherapy ◽

10.1016/j.jiac.2018.01.005 ◽

2018 ◽

Vol 24 (6) ◽

pp. 422-427 ◽

Cited By ~ 3

Author(s):

Xiancheng Chen ◽

Zhuxi Yu ◽

Yajun Qian ◽

Danjiang Dong ◽

Yingying Hao ◽

...

Keyword(s):

Clinical Features ◽

Invasive Pulmonary Aspergillosis ◽

Pulmonary Aspergillosis ◽

Severe Fever

Download Full-text

The limited role of serum galactomannan assay in screening for invasive pulmonary aspergillosis in allogeneic stem cell transplantation recipients on micafungin prophylaxis: a retrospective study

Blood Research ◽

10.5045/br.2017.52.4.300 ◽

2017 ◽

Vol 52 (4) ◽

pp. 300 ◽

Cited By ~ 3

Author(s):

Ryul Kim ◽

Youngil Koh ◽

Dong-Yeop Shin ◽

Pyoeng Gyun Choe ◽

Nam Joong Kim ◽

...

Keyword(s):

Stem Cell ◽

Retrospective Study ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Allogeneic Stem Cell Transplantation ◽

Invasive Pulmonary Aspergillosis ◽

Pulmonary Aspergillosis ◽

Limited Role

Download Full-text

Early-Warning Immune Predictors for Invasive Pulmonary Aspergillosis in Severe Patients With Severe Fever With Thrombocytopenia Syndrome

Frontiers in Immunology ◽

10.3389/fimmu.2021.576640 ◽

2021 ◽

Vol 12 ◽

Author(s):

Lifen Hu ◽

Qinxiang Kong ◽

Chengcheng Yue ◽

Xihai Xu ◽

Lingling Xia ◽

...

Keyword(s):

Risk Factors ◽

T Cells ◽

Early Warning ◽

Invasive Pulmonary Aspergillosis ◽

Antifungal Treatment ◽

Characteristic Analysis ◽

Pulmonary Aspergillosis ◽

Cell Counts ◽

Tnf Α ◽

Severe Fever

Aspergillus-related disease was confirmed to be associated with immune disorders in patients, severe patients with severe fever with thrombocytopenia syndrome (SFTS) infected by novel phlebovirus were confirmed to have severe immune damage including cellular immunosuppression and cytokine storms. Secondary invasive pulmonary aspergillosis (IPA) in severe SFTS patients can increase fatality rate. This study investigated early-warning predictive factors of secondary IPA in severe SFTS patients. Receiver operating characteristic analysis was used to assess the value of immune parameters to predict IPA in SFTS patients. The cut-off values of CD4+ and CD8+ T-cell counts to predict IPA were 68 and 111 cells/mm3, with sensitivities of 82.6% and 72%, and specificities of 56.7% and 83.3%, respectively. Cut-off values of IL-6, TNF-α, IL-8, and IL-10 to predict IPA incidence in critically ill SFTS patients were 99 pg/mL, 63 pg/mL, 120 pg/mL, and 111 pg/mL, with sensitivities of 90.0%, 86.7%, 83.3% and 90.0% and specificities of 80.4%, 71.7%, 82.6% and 65.2%, respectively. Lower CD4+ and CD8+ T-cells counts, higher levels of IL-6, TNF-α, IL-8 and IL-10, higher incidence of pancreatic and renal damage, early antibacterial therapy of carbapenems, and intensive care unit admission were risk factors of IPA in SFTS patients. Multivariate logistic regression analysis indicated counts of CD4+ T-cells <68 cells/mm3 combined with CD8+ T-cells <111 cells/mm3 (odds ratio [OR] 0.218, 95% confidence interval [CI] 0.059–0.803, p=0.022), IL-6 >99 pg/ml combined with IL-10 >111 pg/ml (OR 17.614, 95% CI 2.319–133.769, p=0.006), and brain natriuretic peptide level >500 pg/ml (OR 13.681, 95% CI 1.994–93.871, p=0.008) were independent risk factors for IPA in SFTS patients. The mortality in the IPA group was significantly higher than in the non-IPA group (p=0.001). Early antifungal treatment of IPA patients was significantly associated with improved survival (log-rank, p=0.022). Early diagnosis of IPA and antifungal treatment can improve the prognosis of SFTS patients. Besides, we speculate SFTS may be as a host factor for IPA.

Download Full-text

Severe fever with thrombocytopenia syndrome (SFTS) associated with invasive pulmonary Aspergillosis in a patient with a low CD4+ T-cell count: A case report

International Journal of Critical Illness and Injury Science ◽

10.4103/ijciis.ijciis_96_19 ◽

2020 ◽

Vol 10 (5) ◽

pp. 53

Author(s):

JeongRae Yoo ◽

Miyeon Kim ◽

SangTaek Heo ◽

GilMyeong Seong ◽

KeunHwa Lee

Keyword(s):

Case Report ◽

T Cell ◽

Cell Count ◽

Invasive Pulmonary Aspergillosis ◽

Cd4 T Cell ◽

Pulmonary Aspergillosis ◽

Severe Fever ◽

Cd4 T Cell Count

Download Full-text

Severe Fever with Thrombocytopenia Syndrome Accompanied by Invasive Pulmonary Aspergillosis: An Autopsy Case

Viruses ◽

10.3390/v13061086 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1086

Author(s):

Kosho Iwao ◽

Takeshi Kawaguchi ◽

Masatoshi Kimura ◽

Chihiro Iwao ◽

Mao Rikitake ◽

...

Keyword(s):

Blood Test ◽

Multiorgan Failure ◽

Invasive Pulmonary Aspergillosis ◽

Autopsy Case ◽

Chain Reaction ◽

Pulmonary Aspergillosis ◽

Consciousness Disorder ◽

Polymerase Chain ◽

The University ◽

Severe Fever

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tickborne infectious disease in China, Korea, and Japan caused by the SFTS virus (SFTSV). SFTS has a high mortality rate due to multiorgan failure. Recently, there are several reports on SFTS patients with mycosis. Here, we report a middle-aged Japanese SFTS patient with invasive pulmonary aspergillosis (IPA) revealed by an autopsy. A 61-year-old man with hypertension working in forestry was bitten by a tick and developed fever, diarrhea, and anorexia in 2 days. On day 4, consciousness disorder was appearing, and the patient was transferred to the University of Miyazaki Hospital. A blood test showed leukocytopenia, thrombocytopenia, as well as elevated levels of alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase. The SFTSV gene was detected in serum using a reverse-transcription polymerase chain reaction. On day 5, respiratory failure appeared and progressed rapidly, and on day 7, the patient died. An autopsy was performed that revealed hemophagocytosis in the bone marrow and bleeding of several organs. IPA was observed in lung specimens. SFTSV infection may be a risk factor for developing IPA. Early diagnosis and treatment of IPA may be important in patients with SFTS.

Download Full-text