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Aspergillus tracheobronchitis: report of 8 cases and review of the literature.
MedLine Citation:
PMID:  22932790     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
ABSTRACT: Aspergillus tracheobronchitis (AT) is an infrequent but severe form of invasive pulmonary aspergillosis in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We reviewed 8 cases of AT diagnosed in our tertiary care center during an 18-year period, as well as 148 cases previously reported in the English literature from 1985 to July 2011. The demographic, clinical, imaging, bronchoscopic, and outcome characteristics of every eligible patient were excerpted, and predictors of inhospital mortality were identified by logistic regression. Solid organ transplantation (SOT) (44.2%), hematologic malignancy (21.2%), neutropenia (18.7%), and chronic obstructive pulmonary disease (15.4%) were the most common underlying conditions reported. Most cases occurred in patients receiving long-term corticosteroid treatment (71.8%) or chemotherapy (25.0%). Fever and respiratory complaints (cough, dyspnea, stridor, or wheezing) were the most frequent symptoms; one-third of patients developed acute respiratory distress at presentation, and 15.1% were asymptomatic at the time of diagnosis. Initial imaging studies were not informative in 47.4% of the cases. Aspergillus fumigatus was the predominant species (74.4%). The pseudomembranous form was the most commonly observed (31.9% of cases) and was more frequent in neutropenic patients (p = 0.007), whereas ulcerative AT (31.2%) was associated with SOT (p = 0.001). The most frequent antifungal monotherapy regimens were amphotericin B deoxycholate (23.1%) and itraconazole (18.6%), whereas combined therapy was administered in 35.9% of the cases. Overall inhospital mortality was 39.1%, with neutropenia (odds ratio [OR], 20.47; p < 0.001) and acute respiratory distress at presentation (OR, 9.54; p = 0.002) as independent prognostic factors. Our pooled analysis of the literature shows that AT remains a rare opportunistic infection with a nonspecific presentation and a variable course depending on the nature of the predisposing factor.
Authors:
Mario Fernández-Ruiz; José Tiago Silva; Rafael San-Juan; Begoña de Dios; Ricardo García-Luján; Francisco López-Medrano; Manuel Lizasoain; José María Aguado
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Medicine     Volume:  91     ISSN:  1536-5964     ISO Abbreviation:  Medicine (Baltimore)     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-07     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985248R     Medline TA:  Medicine (Baltimore)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  261-73     Citation Subset:  AIM; IM    
Affiliation:
From the Unit of Infectious Diseases (MFR, RSJ, BdD, FLM, ML, JMA), Instituto de Investigación Hospital "12 de Octubre" (i+12), and Department of Pneumology (RGL), Hospital Universitario "12 de Octubre," Madrid; and Department of Internal Medicine (JTS), Hospital Infanta Cristina, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain.
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