Abstract
Objective: The goal of this study was to reveal the clinical manifestations of nonneutropenic invasive pulmonary aspergillosis (IPA), which are different from those of neutropenic patients.Methods: The clinical data of patients with nonneutropenic IPA were collected at the Department of Respiratory and Critical Care Medicine, Jinling Hospital, from February 2009 to November 2019. We analyzed the general conditions, clinical manifestations, imaging findings, and laboratory tests of these IPA patients.Results: A total of 116 patients with nonneutropenic IPA (31 proven and 85 probable) were included. They had an average age of 59.8 years. The most common underlying disease was chronic obstructive pulmonary disease (COPD, n = 33). The common clinical symptoms included cough (93.1%, n = 108), expectoration (59.5%, n = 69), fever (57.8%, n = 67), hemoptysis (30.2%, n = 35), and dyspnea (40.5%, n = 47). The common CT imaging manifestations included consolidation (47.4%, n = 55), cavities (47.4%, n = 55), air crescent sign (14.7%, n = 17), and nodules (8.6%, n = 10). Multiple lesions (74.1%, n = 86) were more common than single lesions (17.2%, n = 20) and diffuse lesions (8.6%, n = 10). The positive rate of laboratory tests was 88.2% (30/34) for BALF galactomannan (GM), 55.4% (56/101) for serum GM, 45.3% (48/106) for 1,3-β-D-glucan (BDG), 43.3% (46/106) for sputum culture, and 36.4% (20/55) for BALF culture. Patients who had high serum GM level [GM optical density index (ODI) >1] were more likely to have severe respiratory symptoms and higher serum ferritin. Further investigation showed that there was a positive correlation between serum GM level and serum ferritin level.Conclusion: The clinical symptoms and radiological manifestations of nonneutropenic IPA are diverse and often lead to delayed diagnosis. It is important to become more vigilant of aspergillosis in nonneutropenic patients in order to achieve early diagnosis and treatment and to reduce mortality.
Highlights
Aspergillus is a ubiquitous fungus that is abundant in nature air and is tiny enough (2–3 μm) to be inhaled into the small airway
A total of 116 patients with nonneutropenic invasive pulmonary aspergillosis (IPA) were included in this study
Further analysis revealed (Figure 1) that there was a positive correlation between serum GM level and serum ferritin level (r = 0.588, P = 0.0003), but serum GM had no significant correlation with IL-6 (r = 0.14, P = 0.358)
Summary
Aspergillus is a ubiquitous fungus that is abundant in nature air and is tiny enough (2–3 μm) to be inhaled into the small airway. Aspergillus fumigatus is the most common species of this genus, and it may cause invasive infection. The patients most at risk for invasive pulmonary aspergillosis (IPA) are neutropenic patients [1, 2]. According to statistics from the American Healthcare Cost and Utilization Project—Nationwide Inpatient Sample database in 2004, the top three groups of patients most prone to invasive fungal infection (IFI) are those with chronic obstructive pulmonary disease (COPD), diabetes, and hematological malignancies [3]. In contrast to patients with neutropenia, nonneutropenic patients have diverse clinical manifestations and often are ignored by clinicians for the consideration of IPA. They are misdiagnosed with other infectious diseases. This article aims to explore the clinical features of IPA in nonneutropenic patients and provide valuable information for clinical diagnosis and treatment
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