Invasive respiratory Aspergillosis is a treatable disease with early diagnosis and aggressive therapy

Abstract

19632 Background: Invasive respiratory aspergillosis (IRA) is a fulminant infection in immunocompromised hosts. This study aims to evaluate the effectiveness of early screening of patients and the outcome of them during febrile neutropenia (FNP) episodes. Methods: Between 2003 and 2006, 212 FNP episodes were evaluated and the cases who are still febrile at their fifth FNP treatment were screened with computerized tomography (CT) of sinus, thorax and and other relevant sites. Results: Fungal infection rate was 15%, while IRA was detected in 22 patients. Thirteen of these patients were male. Fifteen patients had hematological malignancies, 6 had solid tumors and one patient had combined immunodeficiency and hemophagocytic lymphohistiocytosis. All patients had absolute neutrophil count of zero for 5 to 30 days (median 11.5 days). IRA cases were classified as definite (n:3), probable (n:7) and possible (n:12) according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group. Amphotericin B was administered emprically to all cases and continued as a single agent in 7 patients. Variable modifications with caspofungin, voriconazole or itraconazole were done in 11, 9 and 2 patients, respectively. At present, 7 patients are disease-free after completion of treatment, 6 patients are still on antifungal therapy, 4 patients were lost despite antifungal therapy and 5 patients died of underlying disease while in remission or with stabile disease for a median of 339 days (range: 13–1027 days). Therefore, our remission rate and overall survival rates are 83% and 60% respectively. Conclusions: Contrary to the previous reports, we suggest that IRA is a treatable disease with early diagnosis and aggressive antifungal therapy and it is worthwhile to screen FNP patients who are resistant to wide-spectrum antibiotics with CT for early intervention. No significant financial relationships to disclose.