Role of increased environmental Aspergillus exposure for patients with chronic obstructive pulmonary disease (COPD) treated with corticosteroids in an intensive care unit.
We report about a 75-year-old woman and a 62-year-old man hospitalised for infection-related exacerbation of chronic obstructive pulmonary disease (COPD). In both patients, respiratory function worsened after initial stabilisation and the disease took a fatal course. A careful inspection of the intensive care unit (ICU) revealed several circumstances known to be risk factors for invasive aspergillosis (reconstruction activities near to the ICU, contamination of the window sills with pigeon droppings, moist building materials due to water leakage). The case reports suggest that both critically ill patients receiving high dose corticosteroid medication possibly have acquired aspergillosis on account of increased environmental exposure to Aspergillus conidia (> 10(2) CFU/m3 air). However, due to the severity of the disease confirmation by invasive diagnostic procedures was not possible. The role of high dose corticosteroid treatment as a risk factor for invasive aspergillosis should be taken into consideration, and increased exposure to fungi consequently be reduced in health care environments, especially for patients at risk.
Kistemann
Thomas
T
Institute of Hygiene and Public Health, University of Bonn, Sigmund-Freud-Str. 25, D-53105 Bonn, Germany.
Hüneburg
Hilmar
H
Exner
Martin
M
Vacata
Vladimir
V
Engelhart
Steffen
S
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D000818:Animals; D001228:Aspergillosis / Q000150:complications*; D001230:Aspergillus / Q000302:isolation & purification / Q000472:pathogenicity*; D001717:Birds; D003252:Construction Materials; D003428:Cross Infection; D018450:Disease Progression; D017809:Fatal Outcome; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology* / Q000473:pathology; D012307:Risk Factors
D000305:Adrenal Cortex Hormones