Therapeutic outcome and prognostic factors of invasive aspergillosis in an infectious disease department: a review of 34 cases.
BACKGROUND
Invasive aspergillosis (IA) is one of the most frequent, feared and life-threatening opportunistic infection in immunocompromised patients. We wished to assess the therapeutic outcome and identify prognostic factors of IA.


METHODS
We reviewed retrospectively all patients managed in our department for a proven or probable IA over the last 10 years.


RESULTS
A total of 34 patients were identified: 20 hematopoietic stem cell recipients, 7 infected with the human immunodeficiency virus, 6 hematological malignancies, and only 1 diabetes mellitus. IA involved the lower respiratory tract in all but one case with sinonasal infection. Among patients with pulmonary IA, sinuses were involved in four cases and the brain in five cases. First line antifungal therapy included amphotericin B deoxycholate (56%) or its lipid formulations (18%), itraconazole (15%) and voriconazole (12%). Eight patients also underwent surgery. Median survival was only 64 days and 73% of patients died during follow-up. A favorable outcome of IA was documented in only 48% of patients. Multivariate analysis identified neutropenia as the only factor associated with unsuccessful outcome (p = 0.003).


CONCLUSIONS
IA remains therefore associated with a highmortality rate, especially in patients with neutropenia.
Gallien
S
S
Infectious Disease Dept., Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, University of Paris 7, 1, Avenue Claude Vellefaux, Paris Cedex 10, 75475, France. sebastien_gallien@yahoo.fr
Fournier
S
S
Porcher
R
R
Bottero
J
J
Ribaud
P
P
Sulahian
A
A
Socié
G
G
Molina
J-M
JM
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D001230:Aspergillus / Q000145:classification / Q000302:isolation & purification*; D001232:Aspergillus fumigatus / Q000145:classification / Q000302:isolation & purification; D003141:Communicable Diseases; D005260:Female; D006757:Hospital Units; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000627:therapeutic use; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D010297:Paris; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
D000935:Antifungal Agents; D017964:Itraconazole