Clinical Features, Treatment Outcome and Potential risk Factors for Recurrence Among Patients with Chronic Pulmonary Aspergillosis in a Resource-limited Setting: A Retrospective Observational Study.

IF 3.6 3区生物学 Q2 MYCOLOGY Mycopathologia Pub Date : 2024-08-22 DOI:10.1007/s11046-024-00884-9

Emine Aksoy, Elif Yildirim, Ipek Ozmen, Nermin Ozer Yilmaz, Ahmet Kursat Karaman, Huriye Takir, Fatma Ozbaki, Meltem Agca, Aysegul Berk

{"title":"Clinical Features, Treatment Outcome and Potential risk Factors for Recurrence Among Patients with Chronic Pulmonary Aspergillosis in a Resource-limited Setting: A Retrospective Observational Study.","authors":"Emine Aksoy, Elif Yildirim, Ipek Ozmen, Nermin Ozer Yilmaz, Ahmet Kursat Karaman, Huriye Takir, Fatma Ozbaki, Meltem Agca, Aysegul Berk","doi":"10.1007/s11046-024-00884-9","DOIUrl":null,"url":null,"abstract":"Objective: To evaluate the clinical characteristics and treatment outcomes of patients with chronic pulmonary aspergillosis (CPA) and to determine risk factors for disease recurrence.Methods: A total of 43 patients with CPA (mean ± SD age: 61.4 ± 10.5 years, 83.7% were males) were included in this retrospective study. Data on demographic, clinical and disease-related characteristics, galactomannan (GM) test positivity in bronchoalveolar lavage (BAL) samples, histopathological diagnosis, imaging (CT) findings and CPA forms, antifungal therapy, recurrence rate and time to recurrence were recorded.Results: Chronic obstructive pulmonary disease (COPD;76.7%) was the leading predisposing factor, and the aspergillus nodule (37.2%) was the most prevalent CPA form.GM test positivity was noted in 89.7% (35/39) of BAL samples. Median duration of voriconazole treatment was 180 days. CPA recurrence was noted in 14.0% of patients, while the comorbid tuberculosis sequela (66.7% vs. 16.2%, p = 0.02) and mild immunosuppressive disorder (100.0% vs. 51.4%, p = 0.032) were significantly more common in patients with recurrence vs. those without recurrence. Recurrence rate was 50.0% (3 of 6 patients) in patients with simple aspergilloma, and ranged from 0.0% to 25.0% in those with other CPA forms. Treatment duration and time to recurrence ranged 70-270 days and 1.1-37 months, respectively in simple aspergilloma, while they were ranged 150-180 days and 30-43.3 months, respectively in other CPA forms.Conclusions: Our findings indicate the importance of considering CPA in differential diagnosis in patients with predisposing conditions, and emphasize the tuberculosis sequela, immunosuppressive disorder and the certain CPA forms managed with shorter duration of antifungal therapy (i.e., simple aspergilloma) as the potential risk factors of CPA recurrence.","PeriodicalId":19017,"journal":{"name":"Mycopathologia","volume":"189 5","pages":"76"},"PeriodicalIF":3.6000,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Mycopathologia","FirstCategoryId":"99","ListUrlMain":"https://doi.org/10.1007/s11046-024-00884-9","RegionNum":3,"RegionCategory":"生物学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MYCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective: To evaluate the clinical characteristics and treatment outcomes of patients with chronic pulmonary aspergillosis (CPA) and to determine risk factors for disease recurrence.

Methods: A total of 43 patients with CPA (mean ± SD age: 61.4 ± 10.5 years, 83.7% were males) were included in this retrospective study. Data on demographic, clinical and disease-related characteristics, galactomannan (GM) test positivity in bronchoalveolar lavage (BAL) samples, histopathological diagnosis, imaging (CT) findings and CPA forms, antifungal therapy, recurrence rate and time to recurrence were recorded.

Results: Chronic obstructive pulmonary disease (COPD;76.7%) was the leading predisposing factor, and the aspergillus nodule (37.2%) was the most prevalent CPA form.GM test positivity was noted in 89.7% (35/39) of BAL samples. Median duration of voriconazole treatment was 180 days. CPA recurrence was noted in 14.0% of patients, while the comorbid tuberculosis sequela (66.7% vs. 16.2%, p = 0.02) and mild immunosuppressive disorder (100.0% vs. 51.4%, p = 0.032) were significantly more common in patients with recurrence vs. those without recurrence. Recurrence rate was 50.0% (3 of 6 patients) in patients with simple aspergilloma, and ranged from 0.0% to 25.0% in those with other CPA forms. Treatment duration and time to recurrence ranged 70-270 days and 1.1-37 months, respectively in simple aspergilloma, while they were ranged 150-180 days and 30-43.3 months, respectively in other CPA forms.

Conclusions: Our findings indicate the importance of considering CPA in differential diagnosis in patients with predisposing conditions, and emphasize the tuberculosis sequela, immunosuppressive disorder and the certain CPA forms managed with shorter duration of antifungal therapy (i.e., simple aspergilloma) as the potential risk factors of CPA recurrence.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

资源有限环境中慢性肺曲霉菌病患者的临床特征、治疗结果和潜在复发风险因素：一项回顾性观察研究。

目的评估慢性肺曲霉菌病（CPA）患者的临床特征和治疗效果，并确定疾病复发的风险因素：这项回顾性研究共纳入 43 名 CPA 患者（平均 ± SD 年龄：61.4 ± 10.5 岁，83.7% 为男性）。研究记录了人口统计学、临床和疾病相关特征、支气管肺泡灌洗液（BAL）样本中半乳甘露聚糖（GM）检测阳性率、组织病理学诊断、影像学（CT）检查结果和 CPA 形态、抗真菌治疗、复发率和复发时间等数据：结果：慢性阻塞性肺病（COPD；76.7%）是最主要的致病因素，曲霉菌结节（37.2%）是最常见的 CPA 形态。89.7%（35/39）的 BAL 样本显示 GM 试验阳性。伏立康唑治疗的中位持续时间为 180 天。14.0%的患者复发了CPA，而复发患者中合并结核后遗症（66.7% vs. 16.2%，p = 0.02）和轻度免疫抑制紊乱（100.0% vs. 51.4%，p = 0.032）的比例明显高于未复发患者。单纯曲霉瘤患者的复发率为50.0%（6名患者中有3名复发），而其他CPA形式患者的复发率从0.0%到25.0%不等。单纯曲霉瘤患者的治疗时间和复发时间分别为 70-270 天和 1.1-37 个月，而其他形式的 CPA 患者的治疗时间和复发时间分别为 150-180 天和 30-43.3 个月：结论：我们的研究结果表明，在鉴别诊断中考虑有易感症状的患者的CPA非常重要，并强调结核病后遗症、免疫抑制紊乱和抗真菌治疗时间较短的某些CPA形式（即单纯曲霉瘤）是CPA复发的潜在风险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Mycopathologia 生物-真菌学

CiteScore

6.80

自引率

3.60%

发文量

审稿时长

3 months

期刊介绍： Mycopathologia is an official journal of the International Union of Microbiological Societies (IUMS). Mycopathologia was founded in 1938 with the mission to ‘diffuse the understanding of fungal diseases in man and animals among mycologists’. Many of the milestones discoveries in the field of medical mycology have been communicated through the pages of this journal. Mycopathologia covers a diverse, interdisciplinary range of topics that is unique in breadth and depth. The journal publishes peer-reviewed, original articles highlighting important developments concerning medically important fungi and fungal diseases. The journal highlights important developments in fungal systematics and taxonomy, laboratory diagnosis of fungal infections, antifungal drugs, clinical presentation and treatment, and epidemiology of fungal diseases globally. Timely opinion articles, mini-reviews, and other communications are usually invited at the discretion of the editorial board. Unique case reports highlighting unprecedented progress in the diagnosis and treatment of fungal infections, are published in every issue of the journal. MycopathologiaIMAGE is another regular feature for a brief clinical report of potential interest to a mixed audience of physicians and laboratory scientists. MycopathologiaGENOME is designed for the rapid publication of new genomes of human and animal pathogenic fungi using a checklist-based, standardized format.