title: Clinical manifestations and outcomes of pulmonary aspergillosis: experience from Pakistan.
abstract: BACKGROUND
  Pulmonary aspergillosis has variable course of illness, severity and outcomes depending on underlying conditions. There is limited data available on the clinical manifestations and outcome of pulmonary aspergillosis from Pakistan.
  
  
  METHODS
  To determine the clinical manifestations and outcome of pulmonary aspergillosis in a tertiary care hospital a retrospective study was conducted from 2004 to 2014 in patients admitted with pulmonary aspergillosis at the Aga Khan University Hospital Karachi, Pakistan.
  
  
  RESULTS
  Of the 280 cases with provisional diagnosis of aspergillosis 69 met the inclusion criteria. The mean age was 45±15.7 years, 48 (69.6%) were men and 21 (30.4%) had diabetes mellitus (DM). The average length of hospital stay (LOS) was 10.61±9.08 days.Aspergillus fumigatuswas the most common (42.0%), followed byAspergillus flavus(28.9%). More than one-third of patients previously had tuberculosis (TB) (39.13%). The commonest pulmonary manifestation was chronic pulmonary aspergillosis (CPA) 47 (68.1%) followed by invasive pulmonary aspergillosis (IPA) 12 (17.4%) and subacute invasive aspergillosis (SAIA) 8 (11.6%). Surgical excision was performed in 28 patients (40.57%). Intensive care unit admission was required for 18 patients (26.08%). Case fatality rate was 14/69 (20.3%). DM, mean LOS and hypoxic respiratory failure were identified as independent risk factors of mortality on multivariate analysis.
  
  
  CONCLUSIONS
  A. fumigatuswas the most frequent species found especially in patients with prior TB. CPA was the commonest pulmonary manifestation seen as post TB sequel. Diabetes, hypoxic respiratory failure and increased LOS were independent predictors of poor outcomes. Overall patients had good outcome with CPA compared with SAIA and IPA.
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care , Aga Khan University Hospital , Karachi , Pakistan.
authors.forename: Nousheen
authors.initials: N
authors.lastname: Iqbal
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care , Aga Khan University Hospital , Karachi , Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Irfan
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care , Aga Khan University Hospital , Karachi , Pakistan.
authors.forename: Ali Bin Sarwar
authors.initials: AB
authors.lastname: Zubairi
authors.affiliation: Department of Pathology and Laboratory Medicine , Aga Khan University , Karachi , Pakistan.
authors.forename: Kauser
authors.initials: K
authors.lastname: Jabeen
authors.affiliation: Department of Medicine , Aga Khan University , Karachi , Pakistan.
authors.forename: Safia
authors.initials: S
authors.lastname: Awan
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care , Aga Khan University Hospital , Karachi , Pakistan.
authors.forename: Javaid A
authors.initials: JA
authors.lastname: Khan
keywords: Aspergillus Lung Disease; Respiratory Infection; Tuberculosis