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

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.

scholarly journals 1147. Short Course of Voriconazole Therapy as a Risk Factor for Relapse of Invasive Pulmonary Aspergillosis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S600-S601
Author(s):  
Dong Hoon Shin ◽  
Seung-Jin Yoo ◽  
Jongtak Jung ◽  
Kang Il Jun ◽  
Hyungjin Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Tertiary Care ◽  
Invasive Pulmonary Aspergillosis ◽  
Care Hospital ◽  
Pulmonary Aspergillosis ◽  
Treatment Termination ◽  
Duration Of Therapy ◽  
Short Course ◽  
Life Threatening

Abstract Background Invasive pulmonary aspergillosis (IPA) is a life-threatening opportunistic infection which usually occurs in immunocompromised patients. Recommended duration of voriconazole therapy is a minimum of 6-12 weeks for IPA, despite the lack of any firm evidence. In addition, risk factors for relapse of IPA are still unclear. Here, we explored risk factors for IPA relapse after initial treatment. Methods All patients with proven or probable IPA who had finished voriconazole treatment between 2005 and 2019 in a tertiary-care hospital were reviewed. IPA relapse was defined as re-diagnosis of proven or probable IPA at the same site within 1 year after treatment termination. Short course of voriconazole treatment was defined as a treatment less than 9 weeks, which is a median of the recommended minimum duration of therapy from the Infectious Disease Society of America. The radiological response was defined as a reduction in IPA burden by more than 50% on chest computed tomography (CT). Results Of 87 patients who had completed voriconazole treatment, 14 (16.1%) experienced IPA relapse. Multivariable Cox regression identified that short voriconazole treatment duration (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.1–12.3; P=0.033) and radiological non-response (aHR, 4.6; 95% CI, 1.2–17.5; P=0.026) were independently associated with relapse of IPA after adjusting for several clinical risk factors. Conclusion Less improvement in CT, and short duration of voriconazole therapy were the independent risk factors for relapse after treatment of IPA. Longer duration of therapy should be considered for those at higher risk of relapse. Disclosures All Authors: No reported disclosures

scholarly journals Dynamic monitor of CT scan within short interval in invasive pulmonary aspergillosis for nonneutropenic patients: a retrospective analysis in two centers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fei Chen ◽  
Yonghong Zhong ◽  
Na Li ◽  
Huijie Wang ◽  
Yanbin Tan ◽  
...  
Keyword(s):  
Ct Scan ◽  
Respiratory Diseases ◽  
Short Interval ◽  
Invasive Pulmonary Aspergillosis ◽  
Host Factors ◽  
Antifungal Treatment ◽  
Ct Scans ◽  
Pulmonary Aspergillosis ◽  
European Organization ◽  
Life Threatening

Abstract Background In nonneutropenic patients with underlying respiratory diseases (URD), invasive pulmonary aspergillosis (IPA) is a life-threatening disease. Yet establishing early diagnosis in those patients remains quite a challenge. Methods A retrospective series of nonneutropenic patients with probable or proven IPA were reviewed from January 2014 to May 2018 in Department of Respiratory Medicine of two Chinese hospitals. Those patients were suspected of IPA and underwent lung computed tomography (CT) scans twice within 5–21 days. The items required for IPA diagnosis were assessed by their host factors, mycological findings and CT scans according to the European Organization for Research and Treatment of Cancer (EORTC) and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG) criteria (EORTC/MSG criteria). Results Together with the risk factors, mycological findings and nonspecific radiological signs on first CT, ten patients were suspected of IPA. With the appearance of cavities on second CT scan in the following days, all patients met the criteria of probable or possible IPA. Except one patient who refused antifungal treatment, nine patients received timely antifungal treatment and recovered well. One of the nine treated IPA cases was further confirmed by pathology, one was confirmed by biopsy. Conclusions Dynamic monitor of CT scan provided specific image evidences for IPA diagnosis. This novel finding might provide a noninvasive and efficient strategy in IPA diagnosis with URD.

scholarly journals Short course of voriconazole therapy as a risk factor for relapse of invasive pulmonary aspergillosis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Dong Hoon Shin ◽  
Seung-Jin Yoo ◽  
Kang Il Jun ◽  
Hyungjin Kim ◽  
Chang Kyung Kang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Tertiary Care ◽  
Invasive Pulmonary Aspergillosis ◽  
Care Hospital ◽  
Pulmonary Aspergillosis ◽  
Treatment Termination ◽  
Duration Of Therapy ◽  
Short Course ◽  
Radiological Response

Abstract To investigate associations of the duration of voriconazole treatment and radiological response with relapse of invasive pulmonary aspergillosis (IPA) in immunocompromised patients, we explored the risk factors for IPA relapse after successful initial treatment. All patients with proven or probable IPA who had finished voriconazole treatment between 2005 and 2019 in a tertiary-care hospital were reviewed. IPA relapse was defined as re-diagnosis of proven or probable IPA at the same site within 1 year after treatment termination. Short course of voriconazole treatment was defined as a treatment less than 9 weeks, which is a median of the recommended minimum duration of therapy from the Infectious Disease Society of America. The radiological response was defined as a reduction in IPA burden by more than 50% on chest computed tomography. Of 87 patients who had completed voriconazole treatment, 14 (16.1%) experienced IPA relapse. Multivariable Cox regression identified that short voriconazole treatment duration (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.1–12.3; P = 0.033) and radiological non-response (aHR, 4.6; 95% CI, 1.2–17.5; P = 0.026) were independently associated with relapse of IPA after adjusting for several clinical risk factors. Longer duration of therapy should be considered for those at higher risk of relapse.

Invasive Pulmonary Aspergillosis: Identification of Risk Factors

2002 ◽  
Vol 34 (11) ◽  
pp. 819-822 ◽  
Author(s):  
Mohamed Farouk Allam ◽  
Amparo Serrano del Castillo ◽  
Carmen Díaz-Molina ◽  
Rafael Fernández-Crehuet Navajas
Keyword(s):  
Risk Factors ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis

scholarly journals Invasive nosocomial pulmonary aspergillosis: risk factors and hospital building works

1987 ◽  
Vol 99 (2) ◽  
pp. 407-412 ◽  
Author(s):  
M. Perraud ◽  
M. A. Piens ◽  
N. Nicoloyannis ◽  
P. Girard ◽  
M. Sepetjan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Epidemiological Study ◽  
Fungal Spores ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis ◽  
Protective Measures ◽  
Insulation Materials ◽  
Acoustic Insulation ◽  
Hospital Building ◽  
Set Up

SUMMARYA retrospective epidemiological study of 22 observations of invasive pulmonary aspergillosis, of which 18 were fatal, occurring over a period of 30 months, implicated certain building sites within the hospital. The building works were responsible for the diffusion into the atmosphere of fungal spores from normally closed reservoirs, notably false ceilings, fibrous thermal and/or acoustic insulation materials and roller-blind casings. The results of our study permit us to suggest that protective measures should be set up or that immunodepressed patients are evacuated when such works are to be carried out in an in-patient establishment.

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