Invasive pulmonary aspergillosis: high incidence of disseminated intravascular coagulation in fatal cases.
OBJECTIVE
Disseminated intravascular coagulation (DIC) is a rarely described finding in invasive pulmonary aspergillosis (IPA) with unclear impact on mortality.


METHODS
This study included patients with positive cultures of Aspergillus spp. from respiratory specimens, serological evidence of aspergillosis, or lung biopsy findings supporting aspergillosis treated at National Taiwan University Hospital from January 1999 to June 2005. IPA was defined based on the consensus of the European Organization for Research and Treatment of Cancer, and the Mycosis Study Group of the National Institute of Allergy and Infectious Diseases. Univariate logistic regression analysis was used to evaluate the factors associated with mortality.


RESULTS
Proven or probable IPA was diagnosed in 26 patients. Hematological malignancy was found in 11 patients (42%) and immunosuppressive agents had been administered to 17 patients (65%). Among 20 culture-proven infections (77%), the most frequently encountered fungi were Aspergillus fumigatus (46%) and Aspergillus flavus (23%). The overall mortality rate was 62%. Univariate and multivariate analyses revealed that DIC was the only factor that was significantly associated with death attributable to IPA (p<0.01).


CONCLUSIONS
IPA is associated with a high mortality rate, particularly for patients with DIC.
Lai
Chih Cheng
CC
Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Lotung Poh-Ai Hospital, Yi-Lan, Taiwan.
Liaw
Shwu Jen
SJ
Lee
Li Na
LN
Hsiao
Cheng Hsiang
CH
Yu
Chong Jen
CJ
Hsueh
Po Ren
PR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000908:Antibodies, Fungal / Q000097:blood; D001228:Aspergillosis / Q000150:complications / Q000382:microbiology / Q000401:mortality* / Q000473:pathology*; D001231:Aspergillus flavus / Q000302:isolation & purification; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D001706:Biopsy; D004211:Disseminated Intravascular Coagulation / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality* / Q000473:pathology; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D007165:Immunosuppression Therapy; D015994:Incidence; D016015:Logistic Models; D008168:Lung / Q000382:microbiology / Q000473:pathology; D008172:Lung Diseases, Fungal / Q000150:complications / Q000382:microbiology* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis
D000908:Antibodies, Fungal