tetano
Editor, Senior Moderator
Am J Respir Crit Care Med. 2020 May 14. doi: 10.1164/rccm.201910-1931OC. [Epub ahead of print]
Invasive Tracheobronchial Aspergillosis in Critically Ill Patients with Severe Influenza.
Nyga R[SUP]1[/SUP], Maizel J[SUP]2,[/SUP][SUP]3[/SUP], Nseir S[SUP]4,[/SUP][SUP]5[/SUP], Chouaki T[SUP]6[/SUP], Milic I[SUP]1[/SUP], Roger PA[SUP]1[/SUP], Van Grunderbeeck N[SUP]7[/SUP], Lemyza M[SUP]8[/SUP], Totet A[SUP]1[/SUP], Castelain S[SUP]1[/SUP], Slama M[SUP]9[/SUP], Dupont H[SUP]10,[/SUP][SUP]11[/SUP], Sendid B[SUP]12,[/SUP][SUP]13[/SUP], Zogheib E[SUP]10[/SUP].
Author information
Abstract
RATIONALE:
Invasive tracheobronchial aspergillosis (ITBA) is an uncommon, but severe clinical form of Invasive Pulmonary Aspergillosis (IPA) in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree.
OBJECTIVES:
To analyze diagnostic and prognostic differences between tracheobronchial aspergillosis and pulmonary aspergillosis without tracheobronchial lesions among patients admitted to the intensive care unit (ICU) with severe influenza.
METHODS:
This retrospective, observational study included critically ill patients with influenza associated with pulmonary aspergillosis from 3 hospital ICUs between 2010 and 2019. Patient characteristics, clinical and mycological 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 ITBA group (n=10/35; 28.6%) and 25 patients in the No ITBA group. The ITBA group comprised more patients with active smoking, diabetes mellitus and higher severity scores (SAPSII). Ninety-day mortality in the ITBA and No ITBA groups was 90% and 44% respectively (p=0.02). Moreover, significantly higher serum beta-D glucan and galactomannan, and broncho-alveolar lavage fluid (BALF) galactomannan levels were observed in the ITBA group compared to the No ITBA group (p<0.0001, p=0.003 and p=0.008, respectively).
CONCLUSIONS:
Invasive tracheobronchial aspergillosis was associated with higher severity scores, mortality, serum and BALF Galactomannan and Beta-D Glucan levels than IPA patients without tracheobronchial lesions. ITBA should be systematically researched by bronchoscopic examination in ICU patients with concomitant pulmonary aspergillosis and influenza.
KEYWORDS:
Aspergillosis; Influenza; Intensive care unit; galactomannan; β-1,3-D-Glucan
PMID:32407157DOI:10.1164/rccm.201910-1931OC
Invasive Tracheobronchial Aspergillosis in Critically Ill Patients with Severe Influenza.
Nyga R[SUP]1[/SUP], Maizel J[SUP]2,[/SUP][SUP]3[/SUP], Nseir S[SUP]4,[/SUP][SUP]5[/SUP], Chouaki T[SUP]6[/SUP], Milic I[SUP]1[/SUP], Roger PA[SUP]1[/SUP], Van Grunderbeeck N[SUP]7[/SUP], Lemyza M[SUP]8[/SUP], Totet A[SUP]1[/SUP], Castelain S[SUP]1[/SUP], Slama M[SUP]9[/SUP], Dupont H[SUP]10,[/SUP][SUP]11[/SUP], Sendid B[SUP]12,[/SUP][SUP]13[/SUP], Zogheib E[SUP]10[/SUP].
Author information
Abstract
RATIONALE:
Invasive tracheobronchial aspergillosis (ITBA) is an uncommon, but severe clinical form of Invasive Pulmonary Aspergillosis (IPA) in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree.
OBJECTIVES:
To analyze diagnostic and prognostic differences between tracheobronchial aspergillosis and pulmonary aspergillosis without tracheobronchial lesions among patients admitted to the intensive care unit (ICU) with severe influenza.
METHODS:
This retrospective, observational study included critically ill patients with influenza associated with pulmonary aspergillosis from 3 hospital ICUs between 2010 and 2019. Patient characteristics, clinical and mycological 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 ITBA group (n=10/35; 28.6%) and 25 patients in the No ITBA group. The ITBA group comprised more patients with active smoking, diabetes mellitus and higher severity scores (SAPSII). Ninety-day mortality in the ITBA and No ITBA groups was 90% and 44% respectively (p=0.02). Moreover, significantly higher serum beta-D glucan and galactomannan, and broncho-alveolar lavage fluid (BALF) galactomannan levels were observed in the ITBA group compared to the No ITBA group (p<0.0001, p=0.003 and p=0.008, respectively).
CONCLUSIONS:
Invasive tracheobronchial aspergillosis was associated with higher severity scores, mortality, serum and BALF Galactomannan and Beta-D Glucan levels than IPA patients without tracheobronchial lesions. ITBA should be systematically researched by bronchoscopic examination in ICU patients with concomitant pulmonary aspergillosis and influenza.
KEYWORDS:
Aspergillosis; Influenza; Intensive care unit; galactomannan; β-1,3-D-Glucan
PMID:32407157DOI:10.1164/rccm.201910-1931OC