title: [Invasive aspergillosis with extrapulmonary involvement: pathogenesis, clinical characteristics and prognosis].
abstract: BACKGROUND
  The incidence of invasive aspergillosis has increased worldwide. Information regarding the clinical characteristics of patients with extrapulmonary involvement is scarce.
  
  
  OBJECTIVE
  We aimed to describe the pathogenesis, characteristics and outcomes of patients with invasive aspergillosis and extrapulmonary disease.
  
  
  METHODS
  A retrospective study conducted in a university hospital in Barcelona, Spain (1995-2011).
  
  
  RESULTS
  A total of 12 cases of invasive aspergillosis and extrapulmonary involvement were found. The most common clinical manifestations were invasive sinusitis, early postoperative prosthetic valve endocarditis, fungaemia, postoperative meningitis, multiple brain abscesses and lumbar spondylitis with epidural abscess. Sinusitis occurred frequently in patients without immunosuppression and had invasive brain involvement in one case. Endocarditis was associated with multiple septic metastases. Concomitant lung involvement was documented in 5 cases. The strains isolated were Aspergillus fumigatus (5), Aspergillus flavus (3), and Aspergillus niger (2). The species of Aspergillus was not established for 3 isolates. All patients were treated with antifungals and surgery was performed in 8 cases. Outcome was related with the source of infection; all patients with invasive sinusitis survived, while the remaining patients had a high mortality rate (88%).
  
  
  CONCLUSIONS
  Invasive aspergillosis with extrapulmonary involvement is rare. The most common presentation is invasive sinusitis, which has a lower mortality. Other clinical forms with extrapulmonary involvement were associated with severe immunosuppression or previous surgery, and had a poor outcome.
authors: Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, España.
authors: Luis Eduardo
authors: LE
authors: López-Cortés
authors: Carolina
authors: C
authors: Garcia-Vidal
authors: Josefina
authors: J
authors: Ayats
authors: Carlota
authors: C
authors: Gudiol
authors: Marta
authors: M
authors: Bodro
authors: Isabel
authors: I
authors: Sánchez-Ortega
authors: Carmen
authors: C
authors: Peña
authors: Jordi
authors: J
authors: Carratalá
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000601:surgery; D001922:Brain Abscess / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D003131:Combined Modality Therapy; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000601:surgery; D004696:Endocarditis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D016867:Immunocompromised Host; D008159:Lumbar Vertebrae / Q000382:microbiology; D008297:Male; D016921:Meningitis, Fungal / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012852:Sinusitis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D013030:Spain / Q000453:epidemiology; D013166:Spondylitis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D055815:Young Adult
chemical_list: D000935:Antifungal Agents