Report of 38 cases of tracheobronchitis in non-immunocompromised patients with dual isolation of Aspergillus in lower respiratory tract samples.

INTRODUCTION: Aspergillus tracheobronchitis is an uncommon manifestation of Aspergillus infection. This study retrospectively analysed patients presenting tracheobronchitis among non-neutropenic/non-transplant adult patients with at least two valuable cultures of respiratory samples yielding Aspergillus spp. in Spanish hospitals. METHODS: Clinical records were retrospectively reviewed. Simple tracheobronchitis was considered when the bronchoscopy report described mucosal inflammation and mucus secretions and invasive tracheobronchitis when ulceration and pseudomembrane formation was reported. Cases were considered "proven" (histopathological confirmation) or "probable" aspergillar tracheobronchitis. RESULTS: A total of 38 cases of tracheobronchitis (26 simple, 12 invasive) were identified, all considered probable aspergillar tracheobronchitis. Patients were elderly (89.5% patients were ≥ 65 years), males (76.3%), presented advanced COPD (GOLD III+IV in 81.3%) and heart insufficiency (55.3%), with higher APACHE II score in those with invasive tracheobronchitis (10.17 ± 7.38 vs. 4.32 ± 4.39, p=0.019). Up to 50% patients were taking steroids (accumulated doses >100 mg in 89.5% of them) and 34.2% antibiotics pre-admission. Antifungals were administered to 60.5% patients (57.7% with simple and 66.6% with invasive tracheobronchitis). Voriconazole was the most frequent antifungal (alone or in combination): 69.6% in the 23 treated patients (60.0% simple and 87.5% invasive tracheobronchitis). Mortality was 23.7% (15.4% in simple and 41.7% in invasive tracheobronchitis). CONCLUSIONS: The results of the present study suggest that aspergillar tacheobronchitis should be considered in the differential diagnosis of non-immunocompromised patients with deteriorating chronic airway limitation.

Report of 38 cases of tracheobronchitis in non-immunocompromised patients with dual isolation of Aspergillus in lower respiratory tract samples / Análisis de 38 casos de traqueobronquitis en pacientes inmunocompetentes con doble aislamiento de Aspergillus en muestras de tracto respiratorio inferior

Introduction. Aspergillus tracheobronchitis is an uncommon manifestation of Aspergillus infection. This study retrospectively analysed patients presenting tracheobronchitis among non-neutropenic/non-transplant adult patients with at least two valuable cultures of respiratory samples yielding Aspergillus spp. in Spanish hospitals. Methods. Clinical records were retrospectively reviewed. Simple tracheobronchitis was considered when the bronchoscopy report described mucosal inflammation and mucus secretions and invasive tracheobronchitis when ulceration and pseudomembrane formation was reported. Cases were considered "proven" (histopathological confirmation) or “probable” aspergillar tracheobronchitis. Results. A total of 38 cases of tracheobronchitis (26 simple, 12 invasive) were identified, all considered probable aspergillar tracheobronchitis. Patients were elderly (89.5% patients were ≥65 years), males (76.3%), presented advanced COPD (GOLD III+IV in 81.3%) and heart insufficiency (55.3%), with higher APACHE II score in those with invasive tracheobronchitis (10.17±7.38 vs. 4.32±4.39, p=0.019). Up to 50% patients were taking steroids (accumulated doses >100 mg in 89.5% of them) and 34.2% antibiotics pre-admission. Antifungals were administered to 60.5% patients (57.7% with simple and 66.6% with invasive tracheobronchitis). Voriconazole was the most frequent antifungal (alone or in combination): 69.6% in the 23 treated patients (60.0% simple and 87.5% invasive tracheobronchitis). Mortality was 23.7% (15.4% in simple and 41.7% in invasive tracheobronchitis). Conclusions. The results of the present studty suggest that aspergillar tacheobronchitis should be considered in the differential diagnosis of non-immunocompromised patients with deteriorating chronic airway limitation (AU)

Introducción. La traqueobronquitis aspergilar es una manifestación poco frecuente de la infección por Aspergillus. Este estudio analiza de forma retrospectiva los pacientes que presentaron traqueobronquitis entre pacientes adultos no neutropénicos y sin trasplante con al menos dos cultivos de muestras respiratorias del tracto inferior mostrando crecimiento de Aspergillus spp. en hospitales españoles. Métodos. Se revisó retrospectivamente las historias clínicas y se consideró traqueobronquitis simple cuando el informe de la broncoscopia describía inflamación de la mucosa y secreción mucosa y traqueobronquitis invasiva ante la presencia de ulceraciones y pseudomembranas. Los casos se consideraron "probados" (confirmación histopatológica) o "probable traqueobronquitis aspergilar". Resultados. Se identificó un total de 38 casos de traqueobronquitis (26 simples, 12 invasivas), todos ellos considerados probable traqueobronquitis aspergilar. Los pacientes presentaban edad avanzada (89,5% de los pacientes con ≥65 años), eran varones en la mayoría de casos (76,3%), y presentaban enfermedad pulmonar obstructiva crónica avanzada (GOLD III+IV en el 81,3% de los casos) e insuficiencia cardiaca (55,3%), con una mayor puntuación en el APACHE II en aquellos pacientes con traqueobronquitis invasiva (10,17±7,38 vs. 4,32±4,39, p=0,019). Un 50% de los pacientes recibía esteroides (con dosis acumuladas >100 mg en el 89,5% de ellos) y un 34,2% antibióticos previos al ingreso. Se administró antifúngicos al 60,5% de los pacientes (al 57,7% de aquellos con traqueobronquitis simple y al 66,6% de los pacientes con traqueobronquitis invasiva). Voriconazol fue el antifúngico más utilizado (solo o en combinación): 69,6% de los 23 pacientes tratados (60,0% de los pacientes con traqueobronquitis simple que recibieron tratamiento y 87,5% de aquellos con traqueobronquitis invasiva que fueron tratados con antifúngicos). La mortalidad fue del 23,7% (15,4% en traqueobronquitis simple y 41,7% en traqueobronquitis invasiva). Conclusiones. Los resultados del presente estudio sugieren que la traqueobronquitis aspergilar debe considerarse en el diagnóstico diferencial en pacientes no inmunocomprometidos con deterioro crónico de la función respiratoria (AU)

Clinical features of invasive pulmonary aspergillosis vs. colonization in COPD patients distributed by gold stage.

OBJECTIVE: To explore clinical features of invasive pulmonary aspergillosis (IPA) vs. colonization among hospitalized COPD patients. METHODS: Records of COPD patients with two respiratory cultures yielding Aspergillus were retrospectively reviewed. Cases categorized as proven/probable IPA or colonization was analyzed. RESULTS: 118 patients were identified: 70 (59.3%) colonized, 48 (40.7%) with IPA (42 probable, 6 proven). Higher percentage of IPA patients (vs. colonized) presented GOLD III + IV (77.1% vs. 57.1%, p = 0.025). IPA patients presented higher Charlson index (3.5 ± 2.5 vs. 2.6 ± 2.2, p = 0.027), higher rate of ICU admission (27.1% vs. 4.3%, p = 0.001) and worse prognosis (McCabe rapidly fatal category: 31.3% vs. 7.1%, p = 0.001). GOLD-I IPA patients presented risk factors other than COPD. Before hospitalization, 66.7% IPA and 28.6% colonized patients were taking steroids (p < 0.001). Antifungals were administered to 83.3% IPA and 21.4% colonized patients (p < 0.001). Mortality was higher among IPA vs. colonized patients, both in global (58.3% vs. 10.0%, p < 0.001), GOLD-I (75.0% vs. 10.0%, p = 0.041), GOLD-II (42.9% vs. 5.0%, p = 0.042) and GOLD-III patients (54.2% vs. 0.0%, p < 0.001), but not in GOLD-IV patients (69.2% vs. 31.3%, p = 0.066). CONCLUSIONS: IPA should be suspected not only in GOLD-III and GOLD-IV COPD patients, with higher mortality in IPA vs. colonized patients for GOLD-II and -III COPD patients.