Pulmonary fungal infections in immunocompromised patients: incidence and risk factors.
In a prospective study, 178 patients with fever > 38.4 degrees C and newly diagnosed pulmonary infiltrates underwent bronchoscopy with bronchoalveolar lavage (BAL), aspiration of bronchial secretions (BS) and, in 71 cases, protected specimen brushing (PSB). In 42/143 immunocompromised patients (haematological malignancies, n = 92; AIDS, n = 22; immunosuppressant therapy, n = 29) and in 4/35 patients with no defined underlying disease fungal pneumonia was present (candidosis, n = 35; aspergillosis, n = 8 mixed fungal infection, n = 3). Candidosis was combined, in 17 cases, with Aspergillus (n = 3), bacterial (n = 15) or cytomegalovirus (n = 2) infection. Aspergillosis was combined in eight cases with infection with Candida (n = 3), Pneumocystis carinii (n = 1) or bacteria (n = 5). The sensitivity of BAL and PSB in Candida pneumonia was 48% and 50%, respectively; specificity was 75% and 74% respectively. Bronchial secretions were more sensitive in detecting Candida pneumonia, but specificity was only 55%. In aspergillosis, the specificity of BAL, BS and PSB in each case was 100%; the sensitivity of BAL, BS and PSB was 38%, 64% and 100%. Twenty-four fungal infections were fatal. Unfavourable prognostic factors were respiratory failure needing mechanical ventilation, diffuse bilateral pulmonary infiltrates, mixed fungal infections and start of i.v. antifungal treatment > 14 days after fever onset, which were associated with a mortality rate of 74%, 67%, 67% and 63% respectively.
von Eiff
M
M
Department of Internal Medicine A, University of Münster, Germany.
Roos
N
N
Fegeler
W
W
von Eiff
C
C
Zühlsdorf
M
M
Glaser
J
J
van de Loo
J
J
D001228:Aspergillosis / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D002177:Candidiasis / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008172:Lung Diseases, Fungal / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors