title: Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Invasive pulmonary aspergillosis (IPA) is an infection often occurring in neutropenic patients and has high mortality rates. In recent years, it has been reported that the incidence of IPA has also increased in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study is to investigate the clinical and demographic characteristics and treatment responses of IPA in patients with COPD.
  
  
  METHODS
  Seventy-one patients with a positive culture of Aspergillus from lower respiratory tract samples were examined retrospectively. Eleven (15.4%) of these patients, affected with grade 3 or 4 COPD, had IPA.
  
  
  RESULTS
  Aspergillus hyphae were detected in lung biopsy in three (27.3%) out of 11 patients and defined as proven IPA; a pathological sample was not taken in the other eight (72.7%) patients, and these were defined as probable IPA. Aspergillus isolates were identified as six cases of Aspergillusfumigatus and three of Aspergillusniger in nine patients, while two isolates were not identified at species level. While five patients required intensive care unit admission, four of them received mechanical ventilation. The most common finding on chest X-ray and computed tomography (CT) (respectively 63.6%, 72.7%) was infiltration. Amphotericin B was the initial drug of choice in all patients and five patients were discharged with oral voriconazole after amphotericin B therapy. Six patients (54.5%) died before treatment was completed.
  
  
  CONCLUSIONS
  IPA should be taken into account in the differential diagnosis particularly in patients with severe and very severe COPD presenting with dyspnea exacerbation, poor clinical status, and a new pulmonary infiltrate under treatment with broad-spectrum antibiotics and steroids.
authors.affiliation: Department of Pulmonary Medicine, Erciyes University Faculty of Medicine, Kayseri 38039, Turkey.
authors.forename: Nuri
authors.initials: N
authors.lastname: Tutar
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Erciyes University Faculty of Medicine, Kayseri, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Metan
authors.affiliation: Department of Microbiology, Kayseri, Turkey.
authors.forename: Ayşe Nedret
authors.initials: AN
authors.lastname: Koç
authors.affiliation: Department of Pulmonary Medicine, Erciyes University Faculty of Medicine, Kayseri 38039, Turkey.
authors.forename: Insu
authors.initials: I
authors.lastname: Yilmaz
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Erciyes University Faculty of Medicine, Kayseri, Turkey.
authors.forename: Ilkay
authors.initials: I
authors.lastname: Bozkurt
authors.affiliation: Department of Pulmonary Medicine, Erciyes University Faculty of Medicine, Kayseri 38039, Turkey.
authors.forename: Zuhal Ozer
authors.initials: ZO
authors.lastname: Simsek
authors.affiliation: Department of Pulmonary Medicine, Erciyes University Faculty of Medicine, Kayseri 38039, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Buyukoglan
authors.affiliation: Department of Pulmonary Medicine, Erciyes University Faculty of Medicine, Kayseri 38039, Turkey.
authors.forename: Asiye
authors.initials: A
authors.lastname: Kanbay
authors.affiliation: Department of Pulmonary Medicine, Erciyes University Faculty of Medicine, Kayseri 38039, Turkey.
authors.forename: Fatma Sema
authors.initials: FS
authors.lastname: Oymak
authors.affiliation: Department of Pulmonary Medicine, Erciyes University Faculty of Medicine, Kayseri 38039, Turkey.
authors.forename: Inci
authors.initials: I
authors.lastname: Gulmez
authors.affiliation: Department of Pulmonary Medicine, Erciyes University Faculty of Medicine, Kayseri 38039, Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Demir
keywords: Aspergillosis; COPD; Chronic obstructive pulmonary disease; Invasive pulmonary aspergillosis