Invasive pulmonary aspergillosis: high incidence of disseminated intravascular coagulation in fatal cases
Chih-Cheng Lai, Shwu-Jen Liaw, Li-Na Lee, Cheng-Hsiang Hsiao, Chong-Jen Yu, Po-Ren Hsueh
Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Lotung Poh-Ai Hospital, Yi-Lan; School of Medical Technology, National Taiwan University College of Medicine, Taipei; and Departments of Internal Medicine, Laboratory Medicine, and Pathology, National Taiwan University Hospital, Taipei, Taiwan
Received: January 17, 2007 Revised: February 1, 2007 Accepted: February 15, 2007
Background and purpose:
Disseminated intravascular coagulation (DIC) is a rarely described finding in invasive pulmonary aspergillosis (IPA) with unclear impact on mortality.
This study included patients with positive cultures of Aspergillus spp. from respiratory specimens, serological evidence of aspergillosis, or lung biopsy findings supporting aspergillosis treated at National Taiwan University Hospital from January 1999 to June 2005. IPA was defined based on the consensus of the European Organization for Research and Treatment of Cancer, and the Mycosis Study Group of the National Institute of Allergy and Infectious Diseases. Univariate logistic regression analysis was used to evaluate the factors associated with mortality.
Proven or probable IPA was diagnosed in 26 patients. Hematological malignancy was found in 11 patients (42%) and immunosuppressive agents had been administered to 17 patients (65%). Among 20 culture-proven infections (77%), the most frequently encountered fungi were Aspergillus fumigatus (46%) and Aspergillus flavus (23%). The overall mortality rate was 62%. Univariate and multivariate analyses revealed that DIC was the only factor that was significantly associated with death attributable to IPA (p<0.01).
IPA is associated with a high mortality rate, particularly for patients with DIC.
Aspergillosis; Aspergillus fumigatus; Blood coagulation; Mortality
J Microbiol Immunol Infect. 2007;40:141-147.