Invasive aspergillesis in immunocompromised patients

Abstract


Aim. To analyse results of treatment of invasive aspergillesis in immunocompromised patients for
2000-2002.
Material and methods. The study was made of patients who, when treated with antibiotics, exhibited
foci in the lungs typical for invasive aspergillesis. Aspergillus were detected in the sputum, bronchoalveolar
lavage, bronchial wash-ups, aspergilla antigen (galactomannan) was detected in the blood.
Results. Invasive aspergillesis was diagnosed in 25 patients. 13 (52%) patients were treated with adjuvant
glucocorticoids. 19 (76%) patients had neutropenia. All the patients had fever. Foci in the lungs
were in 24 patients. Aspergillus were detected in 15 patients, a positive antigen galactomannan in 7 patients.
A. Fumigatus, A flavus, A. Niger occurred in 67, 26.5 and 6.5% patients, respectively. All the patients
received amphotericin В (median of the treatment reached 38 days, total dose 880-3500 mg). In
5 patients amphotericin В was replaced for liposomal amphotericin В because of high creatinine. 7 patients
continued with itraconasol in a dose 400-600mg/day. The foci were removed in 3 patients. The
cure was achieved in 12 patients, 13 patients died (cause of death - respiratory insufficiency).
Conclusion. Lethality in invasive aspergillesis in immunocompromised patients remains high - 52%.
Cultural detection of mycelial fungi was, as a rule, delayed. Early diagnosis of the disease requires
monitoring of the aspergilla antigen in the blood and computer tomography of the chest especially in
fever persisting in the treatment of wide-spectrum antibiotics.

References

  1. Denning D. W. Invasive aspergillosis. Clin. Infec. Dis. 1998; 26: 781-805.
  2. Meis J. Nonculture diagnostic methods for invasive aspergillosis. In: 39'" ICAAC. Sanfrancisco; 1999. Abstr. 495.
  3. Caillot D., Casasnovas O., Bernard A. et al. Improved management of invasive aspergillosis in neutropenic patients using early thoracic computed tomographic scan and surgery. J. Clin. Oncol. 1997; 15: 139-147.
  4. Agape P., Doermann F., Weill F. et al. Evaluation of aspergillus antigen detection in sera by ELISA for diagnosis of invasive aspergillosis. In: 39th ICAAC. 1999. Abstr. 2115.
  5. Caillot D., Thiebaut A., Cuisenier B. et al. Serial detection of Aspergillus antigenemia in neutropenic patients at risk of invasive pulmonary aspergillosis. Results of a prospective multicenter study. In: 40"' ICAAC. Toronto; 2000. Abstr. 1416.
  6. Becker M. J., Lugtenburg E. J., Cornelissen J. J. et al. Galactomannan detection in CT-based broncho-alveolar lavage fluid has a high positive predicting value for diagnosing invasive pulmonary aspergillosis in neutropenic patients. In: 42"d ICAAC. San Diego; 2002. Abstr. M-906.
  7. Ascioglu S., Rex J., de Pauw B. et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin, lnfec. Dis. 2002; 34: 7-14.
  8. Boutboul F., Alberti C., Leblanc T. et al. Invasive aspergillosis in allogeneic stem cell transplant recipients: increasing antigenemia is associated with progressive disease. Ibid. 939-943.
  9. Caillot D., Mannone L., Cuisenier В., Couaillier J. Role of early diagnosis and aggressive surgery in the management of invasive pulmonare aspergillosis in neutropenic patients. Clin. Microbiol. Infect. 2001; 7: 54-61.
  10. Eriksson V., Seifert В., Schaffiner A. Comparison of effects of amphotericin В deoxycholate infused over 4 or 24 hours: randomised controlled trial. Br. Med. J. 2001; 322: 1-6.
  11. Walsh Т., Goodman J., Pappas P. et al. Safety, tolerance and pharmacokinetics of high-dose Liposomal Amphotericin В (AmBisome) in patients infected with Aspergillus species and other filamentous fungi: maximum tolerated dose study. Antimicrob. Agents Chemother. 2001; 18: 3487-3496.
  12. Herbrecht R., Denning D., Patterson T. et al. Voriconazole versus Amphotericin В for primary therapy of invasive aspergillosis. N. Engl. J. Med. 2002; 347: 408-415.
  13. Maertens J., Raad I., Sable C. et al. Multicenter, noncomparative study to evaluate safety of Caspofungin in adults with invasive aspergillosis refractory or intolerant to Amphotericin В (AMВ), AMB Lipid Formulations or Azoles. In: 40th ICAAC. Toronto; 2000. Abstr. 1103.
  14. Yeghen Т., Kibbler C., Prentice H. et al. Management of invasive pulmonary aspergillosis in hematology patients: a review of consecutive cases at single institution. Clin. Infect. Dis. 2000; 31:859-868.

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Copyright (c) 2020 Klyasova G.A., Petrova N.A., Galstyan G.M., Gotman L.N., Vishnevskaya E.S., Sysoeva E.P., Khoroshko N.D., Mikhailova E.A., Parovichnikova E.N., Isaev V.G., Ustinova E.N., Kremenetskaya A.M., Kravchenko S.K., Glasko E.N., Kaplanskaya I.В., Vernyuk M.A., Krasnova E.O., Shavlokhov S.V., Ryzhko V.V., Savchenko V.G.

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