Background: Invasive aspergillosis (IA) is an opportunistic infection that occurs mainly in patients with prolonged neutropenia, GVHD or severe immunosuppression. Data on IA in non-neutropenic patients are limited. Objective: To establish the frequency and clinical manifestations of IA, sub-acute and chronic pulmonary aspergillosis (CA), aspergilloma (AO), Aspergillus rhinosinusitis and disseminated aspergillosis (DA) in non-neutropenic patients reporting in 5 Swiss university hospitals. Methods: Inclusion criteria required the presence of signs and symptoms of infection and evidence for mold infection by histology, microscopy, culture or PCR from the affected site. All cases were reviewed by a Data Review Committee. Results: During the first year of the survey 60 patients were identified and 51 included in the analysis (mean age 58.8 y; 61% male). Infection was localized in 45 (88%); aspergillosis was proven in 35% of patients. Infections included: AO (included fungus balls in sinuses) 22 (43%), IA 18 (35%), (DA) 5 (10%), CA 5 (10%), undetermined 1 (2%). Primary site of infections were lung 30 (60%), sinus 12 (24%), bone 5 (9%), CNS 3 (6%), other sites 2%. The most frequent underlying conditions were corticosteroid treatment 27%, ICU stay 25%, any prior surgery 25%, solid organ transplantation (SOT) 16%, cancer 12%. A fumigatus was the most frequently isolated species (83%). Treatment consisted of surgical resection in 23 cases, antifungal therapy in 11 and a combination of the two in 13 (4 cases were diagnosed post-mortem). The overall mortality rate was 31% and was found to be higher in patients with DA (60%), IA (56%), and chronic aspergillosis (40%) than in the other patients. Conclusion: Aspergillus infection is not infrequent in non-neutropenic patients with underlying diseases such as corticosteroid treatment, ICU stay and SOT. Surgery alone was successful treatment in 57%.
Full conference title:
47th Interscience Conference on Antimicrobial agents and Chemotherapy
- ICAAC 47th