Invasive Aspergillus infections in hospitalized patients with chronic lung disease

Figures & data

Figure 1 Patient selection.

Table 1 Mean baseline characteristics of patients with chronic lung disease and immunocompromised patients

	Chronic lung disease n = 57	Immunocompromised patients n = 56	P value
Age, years	63.1 (15.9)	52.9 (13.6)	0.26
Male, n (%)	25 (43.9)	35 (62.5)	0.06
Race, white, n (%)	38 (66.7)	27 (48.2)	0.28
Charlson comorbidity index
• Low/medium points, n (%)	31 (54.4)	36 (64.2)	0.32
• High/very high points, n (%)	26 (45.6)	20 (35.7)	0.34
Comorbidities, n (%)
• Solid tumor	0	11 (19.6%)	<0.0001
• Liquid tumor	7 (12.3%)	16 (28.6%)	0.04
• Diabetes	10 (17.5%)	8 (14.3%)	0.79
• BMT	1 (1.7%)a	8 (14.3%)	0.02
• HIV/AIDS	0	5 (8.9%)	0.03
Positive BAL, n (%)	21 (70%)	9 (37.5%)	0.03
Risk factors,b n (%)
• Prior surgical procedure	5 (8.8%)	25 (44.6%)	<0.0001
• Steroids	31 (54.4%)	8 (14.3%)	<0.0001
• Neutropeniac	5 (8.8%)	11 (19.6%)	0.11

Notes:

a One patient had a liquid tumor treated with BMT;

b for invasive pulmonary aspergillosis;

c absolute neutrophil count < 1000 cells/μL.

Abbreviations: BAL, bronchoalveolar lavage fluid; BMT, bone marrow transplantation; HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome.

Table 2 Presenting symptoms of patients with chronic lung disease by primary diagnosis

Primary diagnosis	n (%)	Presence of symptom, n (%)
		Cough	Fever	Hemoptysis	Weight loss	Shortness of breath	Chest pain
Emphysema	35 (61%)	27 (77%)	11 (31%)	2 (6%)	6 (17%)	28 (83%)	7 (20%)
Asthma	10 (18%)	8 (80%)	0	0	0	8 (80%)	3 (30%)
Bronchiectasis	5 (9%)	5 (100%)	0	1 (20%)	0	4 (80%)	1 (20%)
Othera	7 (12%)	4 (57%)	3 (43%)	2 (29%)	2 (29%)	6 (86%)	1 (14%)

Notes:

a Idiopathic lung disease (n = 2), sarcoid (n = 2), bronchitis (n = 1), bronchiolitis obliterans with organizing pneumonia (n = 1), and pulmonary leukostasis (n = 1).

Table 3 All-cause mortality by Aspergillus species identified at baseline between treatment groups

Species	Chronic lung disease	Mortality	Immunocompromised	Mortality
Aspergillus fumigatus	33 (71.7%)	15 (53.6%)	19 (55.9%)	13 (81.3%)
Aspergillus flavus	4 (8.9%)	1 (33.3%)	2 (5.9%)	0 (0.0%)
Aspergillus niger	2 (4.4%)	0	7 (20.6%)	0
Aspergillus terreus	1 (2.2%)	0	2 (5.9%)	0
Other	2 (4.4%)	0	2 (5.9%)	0
Mixed	4 (8.7%)	2 (50.0%)	2 (5.9%)	1 (50.0%)

Table 4 Outcome by treatment according to group

Treatment	Chronic lung disease			Immunocompromised
	n	Curea	Mortalityb	n	Curea	Mortalityb
Voriconazole	29	15 (51.7)	12 (41.4)	12	6 (50.0)	6 (50.0)
Itraconazole	7	4 (57.1)	1 (14.3)	1	1 (100.0)	1 (100.0)
Amphotericin B	1	0 (0.0)	1 (100.0)	2	1 (50.0)	1 (50.0)
Otherc	4	3 (75.0)	1 (25.0)	20	13 (65.0)	8 (40.0)
No treatment	6	3 (50.0)	2 (33.3)	4	4 (100.0)	1 (25.0)

Notes:

a Cure was determined by an independent review panel;

b all-cause mortality;

c other includes caspofungin, micafungin, posaconazole, combination therapy, and not otherwise specified therapy.

Figure 2 Kaplan–Meier plot of all-cause mortality by time of those patients with chronic lung disease (–) and immunocompromised patients (---).