title: Development of Aspergillosis in a cohort of non-neutropenic, non-transplant patients colonised by Aspergillus spp.
abstract: A previous study explored factors discriminating colonization and true infection among non-transplant, non-neutropenic patients with repeated Aspergillus spp. isolation from lower respiratory samples. The present study explored the evolution of patients with Aspergillus colonization in that study to determine the percentage of cases progressing to aspergillosis and time to development.
  
  
  
  Clinical records were retrospectively reviewed (for each patient from his end date in the past study) and data from all respiratory processes suffered by patients up to April 2015 were recorded. Comparisons of variables were performed between colonized patients that developed aspergillosis and those that did not. A Kaplan-Meier curve was used to describe time to development of aspergillosis in chronic obstructive pulmonary disease (COPD) patients for II-IV stages of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification.
  
  
  
  Sixty seven colonized patients were followed, 12 of them (17.9%) developed aspergillosis. Diagnoses included six tracheobronchitis (4 invasive, 2 simple tracheobronchitis), four pulmonary disease (2 invasive pulmonary aspergillosis, 2 chronic pulmonary aspergillosis), one allergic bronchopulmonary aspergillosis and one pulmonary aspergilloma. Up to 47 (70.4%) of the study patients presented COPD. Among patients developing aspergillosis COPD was more frequent (100%) than among those that did not develop aspergillosis (35 out of 55; 63.6%) (p = 0.012), as well as GOLD IV patients were more frequent among COPD patients developing aspergillosis than among COPD patients that did not (50.0 vs. 26.1%, p = 0.046). Mean time to development of aspergillosis was 18.4 months (median: 8.5) with a wide range (1-58). Overtime, the percentage of patients developing aspergillosis was significantly higher among GOLD IV patients than among GOLD II-III patients (p = 0.032).
  
  
  
  The high percentage of cases progressing to aspergillosis among colonized patients, especially among those with COPD (25.5%), stresses the importance of colonization as risk factor, and creates awareness of the possible change from colonization to invasive disease in GOLD IV patients.
authors.affiliation: Internal Medicine Dpt., Hospital Universitario Monteprincipe, Universidad San Pablo-CEU, Boadilla del Monte, Avda. Monteprincipe 25, 28660, Boadilla del Monte, Madrid, Spain. josebarberan@telefonica.net.
authors.forename: José
authors.initials: J
authors.lastname: Barberán
authors.affiliation: Pneumology Dpt., Hospital Universitario de la Princesa, calle Diego de León 62, 28006, Madrid, Spain.
authors.forename: Francisco-Javier
authors.initials: FJ
authors.lastname: García-Pérez
authors.affiliation: Pneumology Dpt., Hospital Universitario 12 de Octubre, Avda. de Córdoba s/n, 28041, Madrid, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Villena
authors.affiliation: Pneumology Dpt., Complexo Hospitalario Universitario de Vigo, Clara Campoamor 341, 36204, Vigo, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Fernández-Villar
authors.affiliation: Internal Medicine Dpt., Hospital Universitario Infanta Sofia, Paseo de Europa 34, 28703, San Sebastián de los Reyes, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Malmierca
authors.affiliation: Internal Medicine Dpt., Hospital Universitario Marqués de Valdecilla, Avda. Valdecilla s/n, 39008, Santander, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Salas
authors.affiliation: PRISM-AG, calle Don Ramon de la Cruz 72, 28006, Madrid, Spain.
authors.forename: María-José
authors.initials: MJ
authors.lastname: Giménez
authors.affiliation: Preventive Medicine, Hospital Universitario Infanta Cristina, Avda. 9 de Junio 2, 28981, Parla, Madrid, Spain.
authors.forename: Juan-José
authors.initials: JJ
authors.lastname: Granizo
authors.affiliation: PRISM-AG, calle Don Ramon de la Cruz 72, 28006, Madrid, Spain.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Aguilar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001230:Aspergillus / Q000472:pathogenicity*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D016377:Organ Transplantation; D055732:Pulmonary Aspergillosis / Q000175:diagnosis / Q000209:etiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Aspergillosis; Aspergillus; COPD; Colonization; Incubation period