Invasive aspergillosis in a tertiary-care hospital in Thailand.
BACKGROUND
Invasive aspergillosis (1A) is one of the most common and serious fungal infections in immuno-compromised host. Available data regarding IA among Asian patients are limited.


OBJECTIVE
To determine patients' characteristics, clinical presentation, treatment, and outcomes of patients with IA in a Tertiary-care Hospital in Thailand.


METHODS
The authors retrospectively reviewed medical and laboratory records of adult patients with IA from January 2000 to December 2005.


RESULTS
Ninety-four patients were identified and classified as proven (n = 35), probable (n = 10), and possible IA (n = 49) according to the criteria designed for cancer patients (EORTC/MSG). Mean +/- SD age was 48 +/- 19 (range, 17-89) years old and 54 patients (57%) were male. Acute leukemia was the most common underlying condition (30%). Major predisposing factors were neutropenia (39%), chemotherapy (34%), and receiving corticosteroid therapy (25%). Common sites of infection were lungs (68%), sinus (17%), and eyes (8%). Aspergillus fumigatus (67%) was the most frequently isolated species. Amphotericin B followed by itraconazole was the mainstay of treatment. Thirty-six patients (38%) had complete or partial response to therapy whereas 44 patients (47%) died due to aspergillosis. Multivariate analysis showed that corticosteroid therapy [hazard ratio (HR) 10.65; 95% confidence interval (CI) 1.03-110.15, p = 0.047] and pulmonary infection [HR 18.06; 95% CI 4.28-76.17, p < 0.001] were significant predictive factors of death.


CONCLUSIONS
Epidemiology and outcomes of IA among Thai patients were comparable to those in Western countries. Early diagnosis of lA in patients at risk is still essentially required in order to offer appropriate therapy, decrease morbidity, and mortality rate.
Kiertiburanakul
Sasisopin
S
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama 6 Rd, Bangkok 10400, Thailand. rasal@mahidol.ac.th
Thibbadee
Chittima
C
Santanirand
Pitak
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B