Comparison of clinical characteristics of invasive tracheobronchial aspergillosis with or without invasive pulmonary aspergillosis

Abstract

Background: The association of Invasive tracheobronchial aspergillosis(ITBA) with invasive pulmonary aspergillosis(IPA) is not well-established. We aimed to compare clinical characteristics between patients who exhibited ITBA with IPA and those who exhibited isolated ITBA(iITBA), as well as to evaluate the usefulness of serum or bronchial galactomannan(GM) tests. Methods: A retrospective case-control study, for four years, was conducted at a single center. Fifteen patients were enrolled after confirmation of the presence of ITBA by bronchoscopy-guided biopsy (iITBA=7 vs ITBA+IPA=8). Clinical characteristics and results of serum or bronchial GM test were compared between the two groups. Mortality was assessed through 6-month follow-up data. Results: The ITBA+IPA group showed a higher prevalence of hematologic malignancy (75% vs 14%; p=0.002), greater number of multiple bronchial ulcers (75% vs. 14%; p=0.041), lower platelet counts (63,000/μL vs. 229,000/μL; p=0.001), and significantly higher mortality (63% vs. 0%; p=0.026), relative to those characteristics in the iITBA group. In the ITBA+IPA group, 57% of patients were positive for serum GM test (mean±SEM, 1.61±0.67), whereas all iITBA patients were negative (0.17±0.04; p=0.004). The bronchial GM level was high in both iITBA and ITBA+IPA groups, and did not show a statistical difference (3.13±0.83 vs. 3.45±0.74; p=0.780). Conclusions: Patients with ITBA+IPA had a greater number of hematologic malignancies with lower platelet counts and worse prognoses, compared to those with iITBA. Bronchoscopic findings and bronchial GM test results were more useful than serum GM test results for diagnosing iITBA.