title: A retrospective study of the epidemiology and clinical manifestation of invasive aspergillosis in a major tertiary care hospital in Bahrain.
abstract: Limited data are available on the epidemiology, clinical manifestations and outcomes of patients with invasive aspergillosis in Bahrain. This study was conducted retrospectively to determine the epidemiology of invasive aspergillosis and its risk factors, clinical presentation, underlying conditions, and outcomes over the past five years in a major hospital. The medical records of patients with positive Aspergillus cultures admitted to a major tertiary care hospital in Bahrain during 2009-2013 were reviewed. Cases were classified according to (1) the European Organization for the Research and Treatment of Cancer/Mycoses Study Group (MSG) criteria (proven, probable, possible IA or not classifiable) and (2) "validated" criteria to distinguish Aspergillus colonization from IA (putative or proven IA). Demographic, microbiologic and diagnostic data were collected, and outcomes were recorded. A total of 60 patients were included, of whom 44 were colonized (73.3%), and 16 had probable IA (26.7%); no proven or possible IA cases were identified according to the EORTC/Mycoses Study Group (MSG) criteria. In comparison, with the alternative "validated" criteria, 32 were colonized (53.3%), 28 had putative IA (46.7%), and none had proven IA (0%). The lung was the most common site of infection, and Aspergillus fumigatus was the most commonly isolated species (53%). Mortality was 25% among colonized patients, 44% in probable cases and 32% in those with putative IA. All patients were immunocompromised or had one or more predisposing factors. Independent risk factors for death among patients with IA included older age, history of mechanical ventilation, renal replacement therapy and higher sequential organ failure assessment scores at diagnosis.
authors.affiliation: Department of Internal Medicine, Department of Pathology and Microbiology, Salmaniya Medical Complex, Manama, Bahrain. Electronic address: jalsalman@hotmail.com.
authors.forename: Jameela
authors.initials: J
authors.lastname: Alsalman
authors.affiliation: Department of Internal Medicine, Department of Pathology and Microbiology, Salmaniya Medical Complex, Manama, Bahrain.
authors.forename: Thuraya
authors.initials: T
authors.lastname: Zaid
authors.affiliation: Department of Internal Medicine, Department of Pathology and Microbiology, Salmaniya Medical Complex, Manama, Bahrain.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Makhlooq
authors.affiliation: Department of Internal Medicine, Department of Pathology and Microbiology, Salmaniya Medical Complex, Manama, Bahrain.
authors.forename: Maysa
authors.initials: M
authors.lastname: Madan
authors.affiliation: Department of Internal Medicine, Department of Pathology and Microbiology, Salmaniya Medical Complex, Manama, Bahrain.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Mohamed
authors.affiliation: Department of Internal Medicine, Department of Pathology and Microbiology, Salmaniya Medical Complex, Manama, Bahrain.
authors.forename: Amani
authors.initials: A
authors.lastname: Alarayedh
authors.affiliation: Department of Internal Medicine, Department of Pathology and Microbiology, Salmaniya Medical Complex, Manama, Bahrain.
authors.forename: Aysha
authors.initials: A
authors.lastname: Ghareeb
authors.affiliation: Department of Internal Medicine, Department of Pathology and Microbiology, Salmaniya Medical Complex, Manama, Bahrain.
authors.forename: Nermin
authors.initials: N
authors.lastname: Kamal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001230:Aspergillus / Q000145:classification / Q000302:isolation & purification*; D001445:Bahrain / Q000453:epidemiology; D005260:Female; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aspergillus; Epidemiology; Infection; Mortality; Treatment