[Invasive aspergillosis in immunocompromised patients]

Ter Arkh. 2003;75(7):63-8.
[Article in Russian]

Abstract

Aim: To analyse results of treatment of invasive aspergillesis in immunocompromised patients for 2000-2002.

Material and methods: The study was made of patients who, when treated with antibiotics, exhibited foci in the lungs typical for invasive aspergillesis. Aspergillas were detected in the sputum, bronchoalveolar lavage, bronchial wash-ups, aspergilla antigen (galactomannan) was detected in the blood.

Results: Invasive aspergillesis was diagnosed in 25 patients. 13 (52%) patients were treated with adjuvant glucocorticoids. 19 (76%) patients had neutropenia. All the patients had fever. Foci in the lungs were in 24 patients. Aspergillas were detected in 15 patients, a positive antigen galactomannan in 7 patients. A. Fumigatus, A flavus, A. Niger occurred in 67, 26.5 and 6.5% patients, respectively. All the patients received amphotericin B (median of the treatment reached 38 days, total dose 880-3500 mg). In 5 patients amphotericin B was replaced for liposomal amphotericin B because of high creatinine. 7 patients continued with itraconasol in a dose 400-600 mg/day. The foci were removed in 3 patients. The cure was achieved in 12 patients, 13 patients, 13 patients died (cause of death--respiratory insufficiency).

Conclusion: Lethality in invasive aspergillesis in immunocompromised patients remains high--52%. Cultural detection of mycelial fungi was, as a rule, delayed. Early diagnosis of the disease requires monitoring of the aspergilla antigen in the blood and computer tomography of the chest especially in fever persisting in the treatment of wide-spectrum antibiotics.

Publication types

  • English Abstract

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Amphotericin B / administration & dosage
  • Amphotericin B / therapeutic use
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / therapeutic use
  • Antigens, Fungal / analysis
  • Aspergillosis* / drug therapy
  • Aspergillosis* / immunology
  • Aspergillosis* / microbiology
  • Aspergillosis* / mortality
  • Aspergillus / classification
  • Aspergillus / isolation & purification*
  • Bronchoalveolar Lavage Fluid / microbiology
  • Female
  • Humans
  • Immunocompromised Host*
  • Itraconazole / administration & dosage
  • Itraconazole / therapeutic use
  • Lung / microbiology
  • Male
  • Middle Aged
  • Mucus / microbiology

Substances

  • Antifungal Agents
  • Antigens, Fungal
  • Itraconazole
  • Amphotericin B