The MSG conducted a hospital-based survey of aspergillosis involving twenty-four tertiary care centers to help in the evaluation of this major infectious disease. The entry point for patient evaluations included a positive Aspergillus culture in the microbiology laboratory during 1995 and then charts were reviewed. This design allowed for categorizations of invasion, colonization and contamination with Aspergillus. From 1421 positive cultures, there were 1024 patients reviewed with a mean age of 48.7 Â± 0.64 years. Forty-three percent of cultures represented colonization, 18% were considered contamination, and 17% were from an unknown status; only 22% of aspergillus cultures were found to be associated with infection. In those with infection, four types were represented: invasive disease (60%), chronic necrotizing aspergillosis (6%), aspergilloma (17%), allergic bronchopulmonary aspergillosis (17%). In 123 patients with invasive disease, the majority were male (67%) and white (77%). The most frequently reported underlying conditions were corticosteroid usage (55%), hematologic cancer (38%), underlying pulmonary disorder (32%), neutropenia (27%), stem cell transplant (20%), malnutrition (20%). Aspergillus fumigatus (68%) was the most common species to cause invasive disease but infection with A. flavus (13%), A. niger (6%), A. terreus (3%) and A. nidulans (1%) were observed. Most patients were treated with amphotericin B (71%) or itraconazole (37%). Mortality at 3 months with invasive disease was 48% and 28% of patients on amphotericin B and itraconazole, respectively. Three months after diagnosis of invasive disease, 60% of patients had died and death was directly attributable to this infection in 19%. In those found to be colonized with Aspergillus, 14% were dead within 3 months of initial cultures. In summary, most positive cultures for Aspergillus do not represent invasive disease. However, invasive aspergillosis is a disease of middle-aged adults with a variety of underlying diseases in which the long-term prognosis remains poor in the majority of cases.
Full conference title:
37th Annual Meeting of the Infectious Diseases Society of America (IDSA), November 18-21.
- IDSA 37th