Epidemiology and clinical characteristics of invasive mould infections: A multicenter, retrospective analysis in five Asian countries
Journal
Medical mycology
Journal Volume
56
Journal Issue
2
Pages
186
Date Issued
2018-02-01
Author(s)
Rotjanapan, P
Chakrabarti A.
Rudramurthy, S M
Watcharananan, S
Watcharananan S.
Saffari, S E
Saffari S.E.
YEE-CHUN CHEN
Abstract
Formal, large-scale, multicenter studies of invasive mould infection (IMI) in Asia are rare. This 1-year, retrospective study was designed to assess the incidence and clinical determinants of IMI in centers in five countries (Thailand, Taiwan, Singapore, China, India). Patients treated in a single year (2012) were identified through discharge diagnoses, microbiology, and histopathology logs, and entered based on published definitions of IMI. A total of 155 cases were included (median age 54 years; 47.7% male). Of these, 47.7% had proven disease; the remainder had probable IMI. The most frequent host factors were prolonged steroid use (39.4%) and recent neutropenia (38.7%). Common underlying conditions included diabetes mellitus (DM; 30.9%), acute myeloid leukemia (19.4%), and rheumatologic conditions (11.6%). DM was more common in patients with no recent history of neutropenia or prolonged steroid use (P = .006). The lung was the most frequently involved site (78.7%), demonstrating a range of features on computed tomography (CT). Aspergillus was the most common mould cultured (71.6%), primarily A. fumigatus and A. flavus, although proportions varied in different centers. The most often used antifungal for empiric therapy was conventional amphotericin. Ninety-day mortality was 32.9%. This is the first multicenter Asian study of IMI not limited to specific patient groups or diagnostic methods. It suggests that DM and rheumatologic conditions be considered as risk factors for IMI and demonstrates that IMI should not be ruled out in patients whose chest features on CT do not fit the conventional criteria.
Subjects
diabetes mellitus; invasive aspergillosis; invasive mould disease
SDGs
Other Subjects
amphotericin; amphotericin B deoxycholate; corticosteroid; echinocandin; fluconazole; immunomodulating agent; iron chelating agent; itraconazole; posaconazole; voriconazole; amphotericin B; antifungal agent; acute myeloid leukemia; adolescent; adult; aged; antifungal therapy; Article; Aspergillus; Aspergillus flavus; Aspergillus fumigatus; child; China; clinical feature; diabetes mellitus; female; fungus culture; human; incidence; India; infection risk; invasive aspergillosis; lung; lung biopsy; major clinical study; male; medical history; mortality; neutropenia; nonhuman; retrospective study; rheumatic disease; Singapore; Taiwan; Thailand; treatment duration; treatment outcome; very elderly; x-ray computed tomography; Asia; clinical trial; diagnostic imaging; fungus; incidence; microbiology; middle aged; multicenter study; physiology; preschool child; risk factor; systemic mycosis; young adult; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Asia; Aspergillus; Child; Child, Preschool; Female; Fungi; Humans; Incidence; Invasive Fungal Infections; Lung; Male; Middle Aged; Retrospective Studies; Risk Factors; Treatment Outcome; Young Adult
Publisher
OXFORD UNIV PRESS
Type
journal article