Cargando…
P141 Study of prevalence, antifungal profile and predictors of mortality in chronic pulmonary Aspergillosis in a cohort of liver disease patient
POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: OBJECTIVES: Chronic pulmonary aspergillosis (CPA) is a neglected cause of respiratory disease even in high-TB burden countries like India. It is a term that includes simple aspergilloma, chronic cavitary pulmonary aspergillosis which is the...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9509990/ http://dx.doi.org/10.1093/mmy/myac072.P141 |
_version_ | 1784797352014381056 |
---|---|
author | Kale, Pratibha Bhattacharyya, Debajyoti Khillan, Vikas Sarin, Shiv Kumar |
author_facet | Kale, Pratibha Bhattacharyya, Debajyoti Khillan, Vikas Sarin, Shiv Kumar |
author_sort | Kale, Pratibha |
collection | PubMed |
description | POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: OBJECTIVES: Chronic pulmonary aspergillosis (CPA) is a neglected cause of respiratory disease even in high-TB burden countries like India. It is a term that includes simple aspergilloma, chronic cavitary pulmonary aspergillosis which is the most common variant that presents with formation of lung cavities with or without an aspergilloma or nodules, and chronic fibrosing pulmonary aspergillosis. CPA is a chronic progressive infection that destroys lung tissue in non-immunocompromised patients. So, we studied the prevalence of CPA in liver disease patients with respect to spectrum of infections, fungus isolated, and outcome. METHODS: A cohort of 2250 liver disease patients with isolation of Aspergillus in respiratory samples, was analyzed retrospectively for the diagnosis of CPA, from June 2018 to June 2020. The demographic characteristics, clinical, radiological, and laboratory objective and subjective variables including age, sex, previous pulmonary conditions, dyspnea score, quality of life, serum albumin, ESR, etc were assessed using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards modeling. In samples of patients, retrospective review of time from likely onset of CPA to referral and cause of death were also investigated. RESULTS: CPA was diagnosed in 16% of the patients. Survival was 72%, at 1 year. Increased mortality was associated with chronic obstructive pulmonary disease (hazard ratio 2.57; P = .029), nontuberculous mycobacterial infection (2.04; P <.001), increasing age (1.03, P <.001), lower albumin (0.92, per g/L), underlying chronic liver disease (2.07; P <.001) were significantly associated with CPA. The Aspergillus species isolated were A. flavus (66%), A. fumigatus (31%), Aspergillus nidulans (1%), A. terreus (1%), and other Aspergillus species (1%). All the isolates were sensitive to echinocandins and amphotericin B. Azole-resistance was detected in 3% isolates. Multiple pulmonary lesions were more common (73%) than single cavitary lesion. Mortality was seen in 64% of cases. CONCLUSION: CPA pulmonary aspergillosis is a common complication and cause of mortality in post-cavitary pulmonary disease. Several factors impact on mortality of CPA, and can be evaluated as tools to assess CPA prognosis. Underlying liver disease is an important predictor of mortality. As there is a rise in azole-resistance, appropriate diagnosis, and antifungal sensitivity testing should be done in all suspected cases. Early diagnosis and treatment can prevent mortality in CPA patients. |
format | Online Article Text |
id | pubmed-9509990 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-95099902022-09-26 P141 Study of prevalence, antifungal profile and predictors of mortality in chronic pulmonary Aspergillosis in a cohort of liver disease patient Kale, Pratibha Bhattacharyya, Debajyoti Khillan, Vikas Sarin, Shiv Kumar Med Mycol Oral Presentations POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: OBJECTIVES: Chronic pulmonary aspergillosis (CPA) is a neglected cause of respiratory disease even in high-TB burden countries like India. It is a term that includes simple aspergilloma, chronic cavitary pulmonary aspergillosis which is the most common variant that presents with formation of lung cavities with or without an aspergilloma or nodules, and chronic fibrosing pulmonary aspergillosis. CPA is a chronic progressive infection that destroys lung tissue in non-immunocompromised patients. So, we studied the prevalence of CPA in liver disease patients with respect to spectrum of infections, fungus isolated, and outcome. METHODS: A cohort of 2250 liver disease patients with isolation of Aspergillus in respiratory samples, was analyzed retrospectively for the diagnosis of CPA, from June 2018 to June 2020. The demographic characteristics, clinical, radiological, and laboratory objective and subjective variables including age, sex, previous pulmonary conditions, dyspnea score, quality of life, serum albumin, ESR, etc were assessed using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards modeling. In samples of patients, retrospective review of time from likely onset of CPA to referral and cause of death were also investigated. RESULTS: CPA was diagnosed in 16% of the patients. Survival was 72%, at 1 year. Increased mortality was associated with chronic obstructive pulmonary disease (hazard ratio 2.57; P = .029), nontuberculous mycobacterial infection (2.04; P <.001), increasing age (1.03, P <.001), lower albumin (0.92, per g/L), underlying chronic liver disease (2.07; P <.001) were significantly associated with CPA. The Aspergillus species isolated were A. flavus (66%), A. fumigatus (31%), Aspergillus nidulans (1%), A. terreus (1%), and other Aspergillus species (1%). All the isolates were sensitive to echinocandins and amphotericin B. Azole-resistance was detected in 3% isolates. Multiple pulmonary lesions were more common (73%) than single cavitary lesion. Mortality was seen in 64% of cases. CONCLUSION: CPA pulmonary aspergillosis is a common complication and cause of mortality in post-cavitary pulmonary disease. Several factors impact on mortality of CPA, and can be evaluated as tools to assess CPA prognosis. Underlying liver disease is an important predictor of mortality. As there is a rise in azole-resistance, appropriate diagnosis, and antifungal sensitivity testing should be done in all suspected cases. Early diagnosis and treatment can prevent mortality in CPA patients. Oxford University Press 2022-09-20 /pmc/articles/PMC9509990/ http://dx.doi.org/10.1093/mmy/myac072.P141 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Oral Presentations Kale, Pratibha Bhattacharyya, Debajyoti Khillan, Vikas Sarin, Shiv Kumar P141 Study of prevalence, antifungal profile and predictors of mortality in chronic pulmonary Aspergillosis in a cohort of liver disease patient |
title | P141 Study of prevalence, antifungal profile and predictors of mortality in chronic pulmonary Aspergillosis in a cohort of liver disease patient |
title_full | P141 Study of prevalence, antifungal profile and predictors of mortality in chronic pulmonary Aspergillosis in a cohort of liver disease patient |
title_fullStr | P141 Study of prevalence, antifungal profile and predictors of mortality in chronic pulmonary Aspergillosis in a cohort of liver disease patient |
title_full_unstemmed | P141 Study of prevalence, antifungal profile and predictors of mortality in chronic pulmonary Aspergillosis in a cohort of liver disease patient |
title_short | P141 Study of prevalence, antifungal profile and predictors of mortality in chronic pulmonary Aspergillosis in a cohort of liver disease patient |
title_sort | p141 study of prevalence, antifungal profile and predictors of mortality in chronic pulmonary aspergillosis in a cohort of liver disease patient |
topic | Oral Presentations |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9509990/ http://dx.doi.org/10.1093/mmy/myac072.P141 |
work_keys_str_mv | AT kalepratibha p141studyofprevalenceantifungalprofileandpredictorsofmortalityinchronicpulmonaryaspergillosisinacohortofliverdiseasepatient AT bhattacharyyadebajyoti p141studyofprevalenceantifungalprofileandpredictorsofmortalityinchronicpulmonaryaspergillosisinacohortofliverdiseasepatient AT khillanvikas p141studyofprevalenceantifungalprofileandpredictorsofmortalityinchronicpulmonaryaspergillosisinacohortofliverdiseasepatient AT sarinshivkumar p141studyofprevalenceantifungalprofileandpredictorsofmortalityinchronicpulmonaryaspergillosisinacohortofliverdiseasepatient |