Invasive aspergillus infections in hospitalized patients with chronic lung disease

Abstract

Background: Although invasive pulmonary aspergillosis (IPA) is more prevalent in immuno compromised patients, critical care clinicians need to be aware of the occurrence of I PA in the nontraditional host, such as a patient with chronic lung disease. The purpose of this study was to describe the I PA patient with chronic lung disease and compare the data with that of immuno compromised patients. Methods: The records of 351 patients with Aspergillus were evaluated in this single-center, retrospective study for evidence and outcomes of IPA. The outcomes of 57 patients with chronic lung disease and 56 immuno compromised patients were compared. Patients with chronic lung disease were defined by one of the following descriptive terms: emphysema, asthma, idiopathic lung disease, bronchitis, bronchiectasis, sarcoid, or pulmonary leukostasis. Results: Baseline demographics were similar between the two groups. Patients with chronic lung disease were primarily defined by emphysema (61%) and asthma (18%), and immuno compromised patients primarily had malignancies (27%) and bone marrow transplants (14%). A higher proportion of patients with chronic lung disease had a diagnosis of IPA by bronchoalveolar lavage versus the immuno compromised group (P, 0.03). The major risk factors for IPA were found to be steroid use in the chronic lung disease group and neutropenia and prior surgical procedures in the immuno compromised group. Overall, 53% and 69% of chronic lung disease and immuno compromised patients were cured (P = 0.14); 55% of chronic lung patients and 47% of immuno compromised patients survived one month (P = 0.75). Conclusion: Nontraditional patients with IPA, such as those with chronic lung disease, have outcomes and mortality similar to that in the more traditional immuno compromised population. © 2013 Wessolossky et al, publisher and licensee Dove Medical Press Ltd.