Purpose: The clinical spectrum of aspergillosis and pulmonary aspergillosis varies from the colonisation of the organism to the presence of aspergilloma or an allergic response. There is limited data available on the clinical manifestations and outcome of pulmonary aspergillosis from Kerala, India.
Methods: To determine the clinical manifestations and outcome of pulmonary aspergillosis in a tertiary care hospital, a retrospective study was conducted from 2011 to 2015 in patients admitted with pulmonary aspergillosis.
Results: Of the 100 cases with provisional diagnosis of aspergillosis 49 met the inclusion criteria. The mean age was 45±15.7 years, 48 (69.6%) were men and 21 (30.4%) had diabetes mellitus (DM). The average length of hospital stay (LOS) was 10.61±9.08 days. Aspergillus fumigatus was the most common (42.0%), followed by Aspergillus flavus (28.9%). More than one third of patients previously had tuberculosis (TB) (39.13%). The commonest pulmonary manifestation was chronic pulmonary aspergillosis (CPA) 47 (68.1%) followed by invasive pulmonary aspergillosis (IPA) 12 (17.4%) and subacute invasive aspergillosis (SAIA) 8 (11.6%). Surgical excision was performed in 28 patients (40.57%). Intensive care unit admission was required for 18 patients (26.08%). Case fatality rate was 14/69 (20.3%). DM, mean LOS and hypoxic respiratory failure were identified as independent risk factors of mortality on multivariate analysis.
Conclusion: A. fumigatus was the most frequent species found especially in patients with prior TB. Diabetes, hypoxic respiratory failure and increased LOS were independent predictors of poor outcomes. Overall patients had good outcome with CPA compared with SAIA and IPA.
Full conference title:
- AAA 8th (2018)