Invasive Tracheobronchial Aspergillosis in Critically III Patients with Severe Influenza A Clinical Trial
- 1 September 2020
- journal article
- research article
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 202 (5), 708-716
- https://doi.org/10.1164/rccm.201910-1931OC
Abstract
Rationale: Invasive tracheobronchial aspergillosis (ITBA) is an uncommon but severe clinical form of invasive pulmonary aspergillosis in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. Objectives: To analyze the diagnostic and prognostic differences between tracheobronchial aspergillosis and pulmonary aspergillosis without tracheobronchial lesions among patients admitted to the ICU with severe influenza. Methods: This retrospective, observational study included critically ill patients with influenza associated with pulmonary aspergillosis from three hospital ICUs between 2010 and 2019. Patient characteristics and clinical and mycologic data at admission and during ICU stay were collected in a database to evaluate variables in the two groups. Measurements and Main Results: Thirty-five patients admitted to the ICU with severe influenza and pulmonary aspergillosis were included. Ten patients were included in the group with ITBA (n = 10 of 35; 28.6%), and 25 patients were included in the group without ITBA. The group with ITBA comprised more patients with active smoking, diabetes mellitus, and higher severity scores (Simplified Acute Physiology Score II). Ninety-day mortality rates in the groups with and without ITBA were 90% and 44%, respectively (P = 0.02). Moreover, significantly higher serum 1,3-beta-D-glucan and galactomannan and BAL fluid galactomannan concentrations were observed in the group with ITBA compared with the group without ITBA (P < 0.0001, P = 0.003, and P = 0.008, respectively). Conclusions: ITBA was associated with higher severity scores, mortality, and serum and BAL fluid galactomannan and 1,3-beta-D-glucan concentrations than invasive pulmonary aspergillosis without tracheobronchial lesions. ITBA should be systematically researched by bronchoscopic examination in ICU patients with concomitant pulmonary aspergillosis and influenza.This publication has 33 references indexed in Scilit:
- Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort studyThe Lancet Respiratory Medicine, 2018
- Influenza-associated Aspergillosis in Critically Ill PatientsAmerican Journal of Respiratory and Critical Care Medicine, 2017
- Severe ARDS in a critically ill influenza patient with invasive pulmonary aspergillosisIntensive Care Medicine, 2016
- Invasive Aspergillosis Associated With Severe Influenza InfectionsOpen Forum Infectious Diseases, 2016
- Aspergillus TracheobronchitisMedicine, 2012
- Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcomeClinical Microbiology & Infection, 2010
- Treatment of Aspergillosis: Clinical Practice Guidelines of the Infectious Diseases Society of AmericaClinical Infectious Diseases, 2008
- Invasive Aspergillosis in Critically Ill Patients without MalignancyAmerican Journal of Respiratory and Critical Care Medicine, 2004
- Ulcerative and Plaque-Like Tracheobronchitis Due to Infection with Aspergillus in Patients with AIDSClinical Infectious Diseases, 1993
- Ulcerative Tracheobronchitis after Lung Transplantation: A New Form of Invasive AspergillosisAmerican Review of Respiratory Disease, 1991