Emerging Invasive Fungal Infections: Clinical Features and Controversies in Diagnosis and Treatment Processes

Figures & data

Table 1 Demographic and Clinical Characteristics for the Patients with Invasive Fungal Infections(IFI)

Variables		n(%)
Age[years, M (Q25, Q75)]		63.0 (51.0, 71.0)
Female, n (%)		56(38.6)
Diagnostic criteria, n (%)	Proven IFI	80(55.2)
	Probable IFI	59(40.7)
	Possible IFI	6(4.1)
Underlying diseases, n (%)	Cardiovascular diseases	50(34.5)
	Immune diseases	39(26.9)
	Chronic obstructive pulmonary disease	33(22.8)
	Diabetes mellitus	29(20.0)
	Hematological neoplasms	9(6.2)
	Gastrointestinal neoplasms	4(2.8)
	Other tumors	8(5.5)
	Chronic renal disorder	13(9.0)
	Tuberculosis	16(11.0)
	Skin fungi	4(2.8)
	AIDS	5(3.4)
	Liver cirrhosis	4(2.8)
Peripheral vascular access, n (%)	Central venous catheter	3(2.1)
	Hemodialysis tube	6(4.1)
Mechanical ventilation, n (%)		4(2.8)
Catheter/Gastric tube/ Peritoneal dialysis tube, n (%)		7(4.8)
Treatment history (<30 days), n (%)	Prednisones	33(22.8)
	Chemotherapy	12(8.3)
	Prior antibiotic therapy	14(9.7)
	ICU	4(2.8)
Long-term bedridden, n (%)		4(2.8)
Outcome, n (%)	Discharged	130(89.7)
	Death	15(10.3)

Figure 1 Clinical manifestations of patients with invasive fungal infection (n=145).

Table 2 Radiologic Findings of Patients with Invasive Fungal Infections

Radiologic Findings		Number (%)
Lung IFI (n=126)	Not done	2(1.6)
	Negative	1(0.8)
	X-ray inflammation	11(8.7)
	Special description	7(5.6)
	Pulmonary interstitial lesions	15(11.9)
	Inflammatory lesions	90(71.4)
Intestine or urinary tract IFI (n=19)	Not done	4(21.1)
	Negative	3(15.8)
	X-ray inflammation	5(26.3)
	Special description	1(5.3)
	Inflammatory lesions	6(31.6)

Figure 2 Microbiological results of patients with pulmonary invasive fungal infection (n=126).

Table 3 Fungal Strains of 75 Patients with Invasive Fungal Infections

Fungal Strains	Number (%)
Candida albicans	35(46.7)
Fungus	22(29.3)
Aspergillus fumigatus	5(6.7)
Mould	4(5.3)
Aspergillus	3(4.0)
Candida glabrata	3(4.0)
Trichosporon asahii	2(2.7)
Saccharomycetes	1(1.3)

Table 4 Results of Diagnosis and Treatment of Patients with Invasive Fungal Infections

Variables	Proven IFI(n=80)	Probable IFI(n=59)	Possible IFI(n=6)	χ^2	P
Discharge diagnosis, n(%)
Yes	78(97.5)	54(91.5)	6(100.0)	2.96	0.228
No	2(2.5)	5(8.5)	0
Antifungal therapy, n(%)
Yes	77(96.3)	49(83.0)	6(100.0)	7.87	0.020
No	3(3.7)	10(17.0)	0
Length of hospital stay, [days, M (Q25, Q75)]	16.0(10.3, 25.8)	12.0(9.0, 18.0)	13.0(13.0, 17.0)	6.53	0.038
The time from admission to the initiation of antifungal therapy, [days, M (Q25, Q75)]	7.0(3.0, 12.0)	4.0(1.0, 8.0)	4.0(1.0, 7.0))	6.87	0.032
The time from admission to the acquisition of positive etiological or hematological results, [days, M (Q25, Q75)]	3.0(1.0, 6.0)	1.0(1.0, 3.0)	–	9.10	0.003
Outcomes, n(%)
Discharge	70(87.5)	54(91.5)	6(100.0)	1.32	0.518
Death	10 (12.5)	5(8.5)	0

Table 5 Regression Analysis of Hospitalization Time and Related Factors

	B	S.E.	Beta	t	Sig.	95% CI
Constant	7.94	1.26		6.31	<0.001	5.45	10.43
The time from admission to the initiation of antifungal therapy	0.85	0.12	0.46	6.86	<0.001	0.60	1.09
Liver cirrhosis	16.59	4.20	0.27	3.95	<0.001	8.28	24.89
Hematological tumors	10.58	2.83	0.25	3.74	<0.001	4.97	16.18
Co-infection	4.03	1.69	0.16	2.38	0.019	0.68	7.38
Immune diseases	3.51	1.55	0.15	2.26	0.025	0.44	6.58

Notes: In stepwise linear regression analysis, hospitalization time is the dependent variable. B = unstandardized regression coefficient, Beta = standardized coefficient. Independent variables are gender, age, diabetes mellitus, hematological neoplasms, gastrointestinal neoplasms, other tumors, cardiovascular diseases, chronic obstructive pulmonary disease, chronic renal disorder, immune diseases, liver cirrhosis, tuberculosis, acquired immune deficiency syndrome, intensive care unit, mechanical ventilation, prednisones, chemotherapy, peripheral vascular access, catheter/gastric tube/peritoneal dialysis tube, co-infection, delayed antifungal therapy, the time from admission to the acquisition of positive etiological or hematological results, the time from admission to the initiation of antifungal therapy.

Abbreviation: SE, standard error.