The significance of rare non-fumigatus Aspergillus species as a cause of invasive aspergillosis (IA) has not been studied extensively. We evaluated the significance of positive respiratory cultures (BAL and sputum) for A. versicolor at our institution from 01/2000 to 01/2002. Forty-eight cultures positive for this rare mold were identified. Fifteen cases (31%) met the criteria for probable invasive pulmonary aspergillosis (IPA) according to the definitions set forth by the MSG/EORTC. Fourteen patients had hematological malignancy as underlying disease, and one patient had a solid tumor with BMT. Possible predisposing factors for IA were; BMT in 8 patients [53% 4 matchedunrelated, and 4 matched-related donor transplants], neutropenia in 7 patients (47%), steroids in 9 patients (60%), and GVHD in 2 patients (13%). Twelve of these 15 patients had positive respiratory cultures for A. versicolor in conjunction with other respiratory pathogens; 3 mold, 7 with yeast, 6 bacterial, 3 viral, and 1 with PCP. Seven (43%) patients received antifungal prophylaxis known to be active against Aspergillus spp,including amphotericin B lipid formulations, voriconazole, itraconazole and caspofungin. Nine patients (60%) were treated with combination antifungal therapy (including two or more of the following drugs; Amphotericin B Lipid formulations, caspofungin, itraconazole, posaconazole, and voriconazole). The remaining 6 patients received single drug therapy (3 with amphotericin B lipid formulations and voriconazole, itraconazole, or posaconazole, one patient each). The duration of treatment was 182 days (range 5-164 days). Eleven patients died (73%) despite antifungal treatment. IPA due to A. versicolor significantly contributed to their demise, in 91% of the cases. In conclusion, the presence of a positive respiratory culture for A. versicolor is associated with a poor outcome in patients with hematological malignancy. A. versicolor should be considered as a potential opportunistic mycosis in immunocompromised hosts.
Full conference title:
41st Annual Meeting Infectious Diseases Society of America
- Infectious Diseases Society of America 41st