title: Aspergillus tracheobronchitis: report of 8 cases and review of the literature.
abstract: Aspergillus tracheobronchitis (AT) is an infrequent but severe form of invasive pulmonary aspergillosis in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We reviewed 8 cases of AT diagnosed in our tertiary care center during an 18-year period, as well as 148 cases previously reported in the English literature from 1985 to July 2011. The demographic, clinical, imaging, bronchoscopic, and outcome characteristics of every eligible patient were excerpted, and predictors of inhospital mortality were identified by logistic regression. Solid organ transplantation (SOT) (44.2%), hematologic malignancy (21.2%), neutropenia (18.7%), and chronic obstructive pulmonary disease (15.4%) were the most common underlying conditions reported. Most cases occurred in patients receiving long-term corticosteroid treatment (71.8%) or chemotherapy (25.0%). Fever and respiratory complaints (cough, dyspnea, stridor, or wheezing) were the most frequent symptoms; one-third of patients developed acute respiratory distress at presentation, and 15.1% were asymptomatic at the time of diagnosis. Initial imaging studies were not informative in 47.4% of the cases. Aspergillus fumigatus was the predominant species (74.4%). The pseudomembranous form was the most commonly observed (31.9% of cases) and was more frequent in neutropenic patients (p = 0.007), whereas ulcerative AT (31.2%) was associated with SOT (p = 0.001). The most frequent antifungal monotherapy regimens were amphotericin B deoxycholate (23.1%) and itraconazole (18.6%), whereas combined therapy was administered in 35.9% of the cases. Overall inhospital mortality was 39.1%, with neutropenia (odds ratio [OR], 20.47; p < 0.001) and acute respiratory distress at presentation (OR, 9.54; p = 0.002) as independent prognostic factors. Our pooled analysis of the literature shows that AT remains a rare opportunistic infection with a nonspecific presentation and a variable course depending on the nature of the predisposing factor.
authors.affiliation: From the Unit of Infectious Diseases (MFR, RSJ, BdD, FLM, ML, JMA), Instituto de Investigación Hospital "12 de Octubre" (i+12), and Department of Pneumology (RGL), Hospital Universitario "12 de Octubre," Madrid; and Department of Internal Medicine (JTS), Hospital Infanta Cristina, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain.
authors.forename: Mario
authors.initials: M
authors.lastname: Fernández-Ruiz
authors.forename: José Tiago
authors.initials: JT
authors.lastname: Silva
authors.forename: Rafael
authors.initials: R
authors.lastname: San-Juan
authors.forename: Begoña
authors.initials: B
authors.lastname: de Dios
authors.forename: Ricardo
authors.initials: R
authors.lastname: García-Luján
authors.forename: Francisco
authors.initials: F
authors.lastname: López-Medrano
authors.forename: Manuel
authors.initials: M
authors.lastname: Lizasoain
authors.forename: José María
authors.initials: JM
authors.lastname: Aguado
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D001230:Aspergillus; D001232:Aspergillus fumigatus; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016867:Immunocompromised Host; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D055732:Pulmonary Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents