Invasive aspergillosis in Saint Petersburg, Russia: analysis of 445 proven and probable cases

Ref ID: 19410

Author:

N. N. Klimko,1 O. V. Shadrivova,1 S. N. Khostelidi,1 E. A.
Desyatik,1 Y. V. Borzova,1 A. G. Volkova,2 M. O. Popova,2
I. S. Zjuzgin,3 O. S. Ruzhinskaya,3 S. M. Ignatyeva,1 T. S.
Bogomolova,1 L. S. Zubarovskaya2 and B. V. Afanasyev2

Author address:

1I. Metchnikov North-Western State Medical University, St.
Petersburg, Russian Federation; 2R. Gorbacheva Memorial
Institute of Children Hematology and Transplantation, St.
Petersburg, Russian Federation and 3Leningrad Regional Clinical
Hospital,

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Objective Analysis of demographic parameters, underlying diseases,
risk factors, aetiology, clinical features, treatment and survival rates
in patients with invasive aspergillosis (IA) in Saint Petersburg,
Russia.
Materials and methods Prospective study in 1998-2013 yy. We
used criteria EORTS/MSG, 2008 for the diagnosis of proven and
probable IA. For identification of prognostic factors multifactorial
analysis was used.
Results We observed 445 patients with proven (7%) and probable
(93%) IA from 15 hospitals in St. Petersburg, 356 adults (80%) and
89 children (20%). The average age of patients was 36 years (range
1-83), males – 55%, females – 45%. Main underlying diseases were
hematological malignancies (88%): acute myeloid leukemia – 30%,
acute lymphoblastic leukemia – 22%, non-Hodgkin lymphoma – 10%,
Hodgkin lymphoma – 7%, chronic lymphocytic leukemia, chronic
myeloid leukemia, and multiple myeloma – 4% each, myelodysplastic
syndrome – 3%, aplastic anemia – 2%, and other hemoblastosis – 2%.
Non-hematological underlying diseases were: COPD – 2,5%, oncologi-
cal malignancies – 2%, chronic sinusitis – 2%, drug-induced agranu-
locytosis – 1,5%, chronic renal failure – 1%, connective tissue
diseases – 1%, tuberculosis 0,5%, immunodeficiencies – 0,5%, other –
1%. The risk factors: prolonged neutropenia – 64%, steroid therapy –
45%, allogeneic hematopoietic stem cells transplantation – 28%, graft
versus host disease – 18%, surgery – 6%, organ transplantation – 1%.
The main sites of infection were lungs – 86%, sinuses – 12%, cen-
tral nervous system – 4%. Two or more organs were affected in 6%
of patients.
Galactomannan test in serum or bronchoalveolar lavage fluid
(BAL) was positive in 62% cases. Direct microscopy of BAL or spu-
tum was positive in 20% of cases. Aspergillus spp. were isolated in
culture in 31% cases. The main aetiological agents were: A.fumigatus
– 42%, A.niger – 33%, A.flavus – 21%, A.versicolor – 2%, A.nidulans –
1%, and A.terreus – 1%. Mixed Aspergillus infection was found in
12% cases.
Antifungal therapy was received by 98% patients: voriconazole –
55%, amphotericin B deoxycholate – 34%, itraconazole – 29%, caspo-
fungin – 17%, posaconazole – 5%. Two and more antifungal drugs
were used for 62% patients, surgery – 4%.
Overall survival rate in twelve weeks was 83%. Positive prognostic
factors of 12th week survival were antifungal treatment with vorico-
nazole (p = 0.03) and secondary antifungal prophylaxis
(p = 0.0003).
Conclusion IA mainly develops in hematological patients (88%).
The main underlying diseases were acute myeloid leukemia (30%)
and acute lymphoblastic leukemia (22%). Aetiological agents were:
A.fumigatus (42%), A.niger (33%), A.flavus (21%). Lung involvement
develops in most cases of IA (86%). Twelve week overall survival
was 83%. Positive prognostic factors of 12th week survival were
treatment with voriconazole and secondary antifungal prophylaxis.

Abstract Number: p165

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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