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Comparison of Clinical Manifestation, Diagnosis, and Outcomes of Invasive Pulmonary Aspergillosis and Pulmonary Mucormycosis

Objects: Invasive pulmonary mold infection usually has devastating outcomes. Timely differentiation between invasive pulmonary aspergillosis (IPA) from pulmonary mucormycosis (PM) is critical for treatment decision-making. However, information on IPA and PM differentiation is limited. Methods: We co...

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Autores principales: Lin, Chun-Yu, Wang, I-Ting, Chang, Che-Chia, Lee, Wei-Chun, Liu, Wei-Lun, Huang, Yu-Chen, Chang, Ko-Wei, Huang, Hung-Yu, Hsiao, Hsuan-Ling, Kao, Kuo-Chin, Huang, Chung-Chi, Dimopoulos, George
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6920790/
https://www.ncbi.nlm.nih.gov/pubmed/31694308
http://dx.doi.org/10.3390/microorganisms7110531
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author Lin, Chun-Yu
Wang, I-Ting
Chang, Che-Chia
Lee, Wei-Chun
Liu, Wei-Lun
Huang, Yu-Chen
Chang, Ko-Wei
Huang, Hung-Yu
Hsiao, Hsuan-Ling
Kao, Kuo-Chin
Huang, Chung-Chi
Dimopoulos, George
author_facet Lin, Chun-Yu
Wang, I-Ting
Chang, Che-Chia
Lee, Wei-Chun
Liu, Wei-Lun
Huang, Yu-Chen
Chang, Ko-Wei
Huang, Hung-Yu
Hsiao, Hsuan-Ling
Kao, Kuo-Chin
Huang, Chung-Chi
Dimopoulos, George
author_sort Lin, Chun-Yu
collection PubMed
description Objects: Invasive pulmonary mold infection usually has devastating outcomes. Timely differentiation between invasive pulmonary aspergillosis (IPA) from pulmonary mucormycosis (PM) is critical for treatment decision-making. However, information on IPA and PM differentiation is limited. Methods: We conducted a retrospective, multicenter, observational study, with proven and probable IPA and PM patients from January 2004 to December 2017. Demographics, clinical manifestations, image reports, histopathological findings, and outcomes were analyzed. Results: A total of 46 IPA (33 proven and 13 probable) and 19 PM (18 proven and one probable) cases were analyzed. The majority of tissues (81% in IPA and 61% in PM) were obtained using bronchoscopy. Prior influenza infection was a predisposing factor for IPA, and abscess formation in CT scan was associated with PM (p = 0.0491, p = 0.0454, respectively). The positive culture rate for PM was lower than that for IPA (37% vs. 67%, p = 0.0294). The galactomannan (GM) level from serum and bronchoalveolar lavage (BAL) fluid was significantly higher in IPA than in PM (3.3 ± 0.5 vs. 0.8 ± 0.6, p = 0.0361; 4.0 ± 0.6 vs. 0.59 ± 0.1, p = 0.0473, respectively). The overall mortality rate was 65%, which was similar among IPA and PM groups. Systemic steroid exposure and high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores on admission were independently correlated to mortality in IPA (p = 0.027, p = 0.026, respectively). However, there was no predictor for mortality found in PM patients. Conclusions: Influenza infection, abscess formation in CT scan, and GM level may help physicians to differentiate IPA and PM. Bronchoscopy-guided biopsy and lavage specimen provide timely and definite diagnosis. The prognosis of IPA is associated with systemic steroid exposure and higher APACHE II scores on admission.
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spelling pubmed-69207902019-12-24 Comparison of Clinical Manifestation, Diagnosis, and Outcomes of Invasive Pulmonary Aspergillosis and Pulmonary Mucormycosis Lin, Chun-Yu Wang, I-Ting Chang, Che-Chia Lee, Wei-Chun Liu, Wei-Lun Huang, Yu-Chen Chang, Ko-Wei Huang, Hung-Yu Hsiao, Hsuan-Ling Kao, Kuo-Chin Huang, Chung-Chi Dimopoulos, George Microorganisms Article Objects: Invasive pulmonary mold infection usually has devastating outcomes. Timely differentiation between invasive pulmonary aspergillosis (IPA) from pulmonary mucormycosis (PM) is critical for treatment decision-making. However, information on IPA and PM differentiation is limited. Methods: We conducted a retrospective, multicenter, observational study, with proven and probable IPA and PM patients from January 2004 to December 2017. Demographics, clinical manifestations, image reports, histopathological findings, and outcomes were analyzed. Results: A total of 46 IPA (33 proven and 13 probable) and 19 PM (18 proven and one probable) cases were analyzed. The majority of tissues (81% in IPA and 61% in PM) were obtained using bronchoscopy. Prior influenza infection was a predisposing factor for IPA, and abscess formation in CT scan was associated with PM (p = 0.0491, p = 0.0454, respectively). The positive culture rate for PM was lower than that for IPA (37% vs. 67%, p = 0.0294). The galactomannan (GM) level from serum and bronchoalveolar lavage (BAL) fluid was significantly higher in IPA than in PM (3.3 ± 0.5 vs. 0.8 ± 0.6, p = 0.0361; 4.0 ± 0.6 vs. 0.59 ± 0.1, p = 0.0473, respectively). The overall mortality rate was 65%, which was similar among IPA and PM groups. Systemic steroid exposure and high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores on admission were independently correlated to mortality in IPA (p = 0.027, p = 0.026, respectively). However, there was no predictor for mortality found in PM patients. Conclusions: Influenza infection, abscess formation in CT scan, and GM level may help physicians to differentiate IPA and PM. Bronchoscopy-guided biopsy and lavage specimen provide timely and definite diagnosis. The prognosis of IPA is associated with systemic steroid exposure and higher APACHE II scores on admission. MDPI 2019-11-05 /pmc/articles/PMC6920790/ /pubmed/31694308 http://dx.doi.org/10.3390/microorganisms7110531 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lin, Chun-Yu
Wang, I-Ting
Chang, Che-Chia
Lee, Wei-Chun
Liu, Wei-Lun
Huang, Yu-Chen
Chang, Ko-Wei
Huang, Hung-Yu
Hsiao, Hsuan-Ling
Kao, Kuo-Chin
Huang, Chung-Chi
Dimopoulos, George
Comparison of Clinical Manifestation, Diagnosis, and Outcomes of Invasive Pulmonary Aspergillosis and Pulmonary Mucormycosis
title Comparison of Clinical Manifestation, Diagnosis, and Outcomes of Invasive Pulmonary Aspergillosis and Pulmonary Mucormycosis
title_full Comparison of Clinical Manifestation, Diagnosis, and Outcomes of Invasive Pulmonary Aspergillosis and Pulmonary Mucormycosis
title_fullStr Comparison of Clinical Manifestation, Diagnosis, and Outcomes of Invasive Pulmonary Aspergillosis and Pulmonary Mucormycosis
title_full_unstemmed Comparison of Clinical Manifestation, Diagnosis, and Outcomes of Invasive Pulmonary Aspergillosis and Pulmonary Mucormycosis
title_short Comparison of Clinical Manifestation, Diagnosis, and Outcomes of Invasive Pulmonary Aspergillosis and Pulmonary Mucormycosis
title_sort comparison of clinical manifestation, diagnosis, and outcomes of invasive pulmonary aspergillosis and pulmonary mucormycosis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6920790/
https://www.ncbi.nlm.nih.gov/pubmed/31694308
http://dx.doi.org/10.3390/microorganisms7110531
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