INVASIVE ASPERGILLOSIS IN INTENSIVE CARE UNIT PATIENTS IN IRAN

Mohammad T Hedayati,Sadegh Khodavaisy,Mohammad R Habibi,Masoud Alialy,Saeed Mahdavi Omran

doi:10.14712/18059694.2014.24

Abstract

We assessed the intensive care unit (ICU) patients for Invasive aspergillosis (IA) with culture and non-culture based diagnostic methods from Iran. Thirty-six ICU patients with underlying predisposing conditions for IA were enrolled in the study. Sixty eight Bronchoalveolar lavage (BAL) samples were collected by bronchoscope twice a weekly. BAL samples were analyzed by microscopic examination, fungal culture and galactomannan (GM) detection. The Platelia Aspergillus GM EIA was used to quantify GM indices. Samples with a BAL GM index > or = 1 were considered as positive for GM. Patients were classified as having probable or possible IA. Out of 36 suspected patients to IA, 36.1% of cases showed IA which were categorized as: 4 cases of possible IA and 9 of probable IA. 76.2% of BAL samples were positive for GM. From 13 patients with IA, 11 (84.6%) had at least one positive BAL GM index. Of these patients, 9 (81.8%) showed probable IA. The main underlying predisposing conditions were neutropenia (53.8%) and COPD (30.8%). Our study has indicated that COPD must be considered as one of the main predisposing condition for occurrence of aspergillosis in ICU patients. Our data have also revealed that GM detection in BAL samples play a significant role to IA diagnosis.

Highlights

Aspergillus is one of the most prevalent airborne fungi both in indoor and outdoor environment
A total of 21 Bronchoalveolar lavage (BAL) samples from patients with Invasive aspergillosis (IA) were analyzed by microscopic and culture methods; 18 (85.7%) and 11 (52.4%) of these samples were positive for septate hyphae and Aspergillus growth, respectively
Of 21 BAL samples, 6 (28.6%) samples that were negative for Aspergillus growth on culture had GM index

Summary

Introduction

Aspergillus is one of the most prevalent airborne fungi both in indoor and outdoor environment. Invasive aspergillosis (IA) is one of the most common life-threatening fungal infections among critically ill patients including intensive care unit (ICU) patients. IA in ICU patients is associated with prolonged hospital stay, and increased cost [30]. The diagnosis of IA is still a great challenge in the ICU, and it is often made late in the course of the infection because of clinical manifestations are usually non-specific, mycological cultures are difficult to interpret or fungal growth is often not present even from patients diagnosed with fungal diseases, and invasive procedures require to obtain histological specimens [8, 27, 35, 38]

Methods

Results

Conclusion