ObjectiveTo analyze risk factors, clinical features and outcome factors of invasive pulmonary aspergillosis (IPA) in severe H1N1 patients so as to achieve early diagnosis and improve prognosis.MethodsFifty severe H1N1 influenza patients with IPA admitted to West China Hospital and 64 severe H1N1 influenza patients in the same period matched by age and gender were collected. Patient characteristics, laboratory examinations, radiological imaging, microbiology data and prognostic indicators were involved into analysis.ResultsThe mortality of severe H1N1 influenza patients with IPA was significantly higher than those without IPA (51.6% vs. 32.0%, P=0.036). However, the incidence of IPA in severe H1N1 influenza patients was not related with the patient's age, gender, underlying disease, glucocorticoid use and CD4+ T cell count. Serum C-reactive protein level [(125.0±88.8) vs. (86.1±80.1) mg/L, P=0.038] and interleukin-6 level [(148.7±154.2) vs. (81.7±110.2) μg/L, P=0.039] of severe H1N1 influenza patients with IPA were significantly higher than those without IPA. Besides, more patients presented with fever (81.3% vs. 64.0%, P=0.038) and dyspnea (51.6% vs. 24.0%, P=0.003) in severe H1N1 patients with IPA. The radiological imaging of severe H1N1 patients with IPA were mostly characterized by combining with nodular changes on the basis of ground-glass opacity.ConclusionThe occurrence of IPA in severe H1N1 influenza patients may be related with pulmonary excessive inflammatory response secondary to viral invasion rather than basic condition of the patient.
Co-infection with severe influenza and bacterial is well known, but in recent years, more and more studies report that aspergillus have been identified as important pathogens, secondary only to bacteria in severe influenza. Influenza-associated aspergillus (IAA) brings a high death rate and heavy burden to our country. Therefore, early diagnosis and effective treatment are needed. In order to better understand IAA, this review summarizes the available literature on the association of IAA, including epidemiology, diagnosis and treatment.
【摘要】 目的 探討并分析導致肺曲霉病患者誤診的原因，為早期診斷并及時正確治療提供科學的依據。 方法 回顧性分析2010年1-4月間確診為肺曲霉病的3例患者在診治過程中被誤診的原因。 結果 3例患者均缺乏明顯的特異性臨床表現和影像學表現，最后確診均依據病理學活檢證實。 結論 肺部的曲霉菌感染缺乏特異性的臨床和影像學表現，及早行纖維支氣管鏡檢查或肺組織活檢可提高早期診斷率。【Abstract】 Objective To analyze the misdiagnostic causes of pulmonary aspergillosis. Methods The clinical data of three patients with pulmonary aspergillosis from January to April 2010 were retrospectively analyzed, and the misdiagnostic causes were analyzed. Result No specific clinical and imaging findings were found in the three patients, and pulmonary aspergillosis was finally diagnosed according to the pathological biopsy. Conclusion Pulmonary aspergillus lacks specific clinical and imaging manifestations; early fiberoptic bronchoscopy or pulmonary biopsy may improve the rate of accurate diagnosis.
Objective Allergic bronchopulmonary aspergillosis (ABPA) is characterized by anexaggerated reaction to airway colonization aspergillus which affects patients with underlying diseases such asbronchial asthma, cystic fibrosis or other respiratory diseases. ABPA exhibit significant heterogeneity due to theunderlying diseases. The clinical features of patients with ABPA were analyzed retrospectively, so as to explore theimpact of underlying diseases on clinical characteristics. Methods The clinical data of hospitalized patients diagnosed with ABPA from January 2010 to September 2019 in Peking University People's Hospital were reviewed for retrospective analysis. Results A total of 40 ABPA patients were enrolled. Of which 8 cases (20.0%) were previously diagnosed as chronic obstructive pulmonary disease and/or bronchiectasis, named non-asthma group; while the other 32 cases met the diagnosis criteria of asthma, named asthma group. The non-asthma ABPA patients had a shorter course [78 (6 - 300) months vs. 192 (39 - 480) months, P=0.02], a higher percentage of peripheral blood neutrophils (79.9%±12.5% vs. 68.1%±18.1%, P=0.01) and higher score of emphysema [2 (0 - 2) vs. 0 (0 - 1), P=0.02] than the asthma group. Conclusions There is no significant difference in clinical and radiological characteristics between ABPA patients without asthma and those with asthma. The diagnosis of ABPA should also be considered when patients with chronic pulmonary diseases such as chronic obstructive pulmonary disease and bronchiectasis have aggravation of dyspnea, increase of eosinophils in peripheral blood and typical imaging features such as mucus attenuation.
ObjectiveTo investigate the clinical features of patients who went through Nocardia co-infection with Aspergillus in lung.MethodsClinical data of 3 pulmonary nocardiosis patients complicated with aspergillosis from China-Japan Hospital during June 2015 and May 2016 were retrospectively analyzed. Nine related literatures found at PubMed were reviewed and they all were case report. No Chinese literature was found at Wanfang data and Chinese Journal Fulltext Database.ResultsAll of the 3 patients were diagnosed as pulmonary nocardiosis by etiological detection, at the same time meeting the diagnostic criteria of invasive pulmonary aspergillosis. Two cases were infected with Aspergillus fumigatus. Aspergillus was not detected in the third case, but the galactomannan of serum and bronchoalveolar lavage fluid significantly increased.ConclusionPulmonary nocardiosis complicated with aspergillosis trends to occur in immunocompromised patients, and pathogen detection is important for diagnosis.
Objective To retrospectively analyze the clinical features of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU), so as to improve the level of clinical diagnosis and treatment. Methods A total of 81 patients diagnosed as IPA from March, 2017 to March, 2022 in the ICU of The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China were selected as infection group. A total of 81 non-IPA patients with pulmonary infection and Aspergillus negative sputum culture were selected as the control group. The host factors, Acute Physiology and Chronic Health Assessment Ⅱ score at admission, underlying diseases, clinical symptoms and signs, relevant laboratory test results, and lung CT findings were compared between the two groups. Univariate analysis and multivariate conditional logistic regression analysis were used to identify the risk factors for the occurrence of pulmonary aspergillosis in IPA patients in ICU. At the same time, the types of aspergillus in the IPA group and the outcomes of the two groups at 28 days after ICU admission were analyzed. Results Of the 81 IPA patients, 4 were proven diagnosed and 77 were putative diagnosed. IPA patients were mainly infected with Aspergillus fumigatus and Aspergillus flavus. Symptoms and signs such as fever, cough and expectoration, dyspnea and pulmonary rales occurred in both groups. The level of procalcitonin in IPA group was higher than that in non-IPA group, and the difference was statistically significant (P=0.016). The positive rate of serum galactomannan antigen test (GM test) in the IPA group was higher than that in the non-IPA group, and the differences was statistically significant (P=0.000). The incidence of pulmonary imaging cavities in IPA group was higher than that in non-IPA group, and the difference was statistically significant (P=0.022). Univariate analysis showed that central venous catheterization, septic shock, complete parenteral nutrition, chronic obstructive pulmonary disease, and immunosuppression were risk factors for IPA (P<0.05); Multivariate conditional logistic regression analysis showed that complete parenteral nutrition, chronic obstructive pulmonary disease, and immunosuppression were independent risk factors for IPA (P<0.05). The 28-day fatality rate in IPA group was higher than that in non-IPA group (55.6% vs. 34.6%, P=0.007). Conclusions IPA patients have no specific clinical symptoms and signs, and are mainly infected with Aspergillus fumigatus and Aspergillus flavus; GM test has guiding significance for the diagnosis of IPA. Serum GM test and pulmonary imaging have cavity findings that are helpful for the diagnosis of IPA. Patients with a history of chronic obstructive pulmonary disease, immunosuppression, or complete parenteral nutrition need to be on high alert for the possibility of IPA during ICU stay.
