Pulmonary Aspergillosis in immunocompetent patients

Abstract

Objective: Although pulmonary aspergillosis (PA) is often seen in patients with immunodeficiency, it also identifies a number of clinical diseases that cause morbidity and mortality, which can also occur in patients with immunodeficiency. The aim of this study was to investigate the disease patterns, demographic and clinical features, treatment and prognosis of pulmonary aspergillosis in immune competent patients.
 Method: Our study is a descriptive cross-sectional study in which the data of immunocompetent patients diagnosed with PA in our hospital between January 2010 and Decenber 2019 were evaluated retrospectively. Patients over the age of 18 with a diagnosis of PA were included in the study. Demographic and clinical features, radiological findings, diagnosis and treatment methods and prognoses of the patients were recorded.
 Results: 8 of the patients were female, 3 were male and the mean age was 61 (53 ± 69). Nine patients were diagnosed with chronic pulmonary aspergillosis and two patients were diagnosed with IPA. Four of the patient diagnosed with KPA were chronic cavitary pulmonary aspergillosis, one was chronic fibrosing pulmonary aspergillosis, two were aspergilloma and two were aspergillus nodules. The most common comorbidity was diabetes mellitus (45.4%) and in total, 72.7% of patients had chronic lung disease such as COPD-asthma, tuberculosis, bronchiectasis. Cough, sputum and hemoptysis (90%, 72.7%, 45.4%, respectively) were the most common symptoms. The most common radiological finding on thorax tomography was crescent sign-cavity (72.7%). The diagnostic method used was mostly bronchoalveolar lavage and wedge resection/ lobectomy (45.4%, respectively). It was observed that eight (72.7%) patients were given voriconazole and three (27.2%) other patients surgical procedure performed and one patient was lost after surgery. 
 Conclusions: Although pulmonary aspergilosis is more frequently seen in immunocompromised patients with malignancy, solid organ and hematological transplants, it has now begun to be seen in immune competent patients. The majority of our patients were middle-aged, women and smokers, people with comorbidity such as DM and chronic lung disease. Therefore, we would like to point out that pulmonary aspergillosis should be kept in mind among differential diagnoses, especially in patients with immunocompetent with comorbidity such as chronic lung disease and DM.