Analysis of pathogenic spectrum and risk factors in 165 non-transplant patients with invasive fungal disease

Abstract

To describe the clinical characteristics of and risk factors for invasive fungal disease, and therefore to improve the early diagnosis and treatment of fungal infections. The clinical data of invasive fungal disease in 165 patients without transplantation from 2006 to 2012 in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The diagnosis was based on the following guidelines: diagnosis and treatment guidelines of critically ill patients with invasive fungal infection (2007), diagnostic criteria and treatment principle of invasive fungal infection in patients with hematopathy/malignant tumors (fourth edition, 2013), diagnostic criteria and treatment principle of invasive pulmonary fungal infection (draft, 2006). Invasive fungal disease was mostly diagnosed in the respiratory department (31.5%). The major pathogens were cryptococcus (48.3%), aspergillus (31.7%) and followed by mucor (5.9%). The most common symptoms included cough, haemoptysis, and fever. Radiological Findings were non-specific, nodules or opacities being more common as compared to classical aspergilloma, halo sign, and crescent sign. The most common underlying diseases were diabetes (15.8%), chronic obstructive pulmonary disease (13.3%), and malignant hematological disease (10.3%). Moreover, 66.1% cases of invasive fungal disease were accompanied by one or more risk factors (eg. administration of antibiotics more than 7 days, invasive operations, and therapy with long-term glucocorticoids or immunosuppressant drugs). The mortality of invasive fungal disease with more than 2 risk factors was 10.6%. The most common pathogens of invasive fungal disease in non-transplant patients were cryptococcus, aspergillus and mucor. The lung and the brain were the mostly involved organs. Compared to cryptococcus, invasive fungal disease caused by other fungal pathogens mainly occurred in patients with serious underlying diseases and risk factors.