Aspergillosis In Immunocompetent Patient Research Articles

Aspergillus coinfection in critically Ill patients with severe dengue

In 2014–2015, a significant outbreak of dengue fever occurred in southern Taiwan, with a subsequent decline in dengue incidence. Despite this, there is emerging concern about virus-associated aspergillosis, yet limited research has explored coinfections involving dengue and aspergillosis. We conducted a retrospective study at a single center in Southern Taiwan, specifically focusing on dengue patients admitted to the intensive care unit during the period between July and November 2015. Among the 142 dengue patients studied, only 8.06 % (10/142) underwent serum galactomannan testing, with a single patient undergoing bronchoalveolar lavage (BAL) galactomannan assay. Out of those tested, 20 % (2/10) returned positive serum galactomannan results. Herein, we present two consecutive cases of coinfection involving dengue and pulmonary aspergillosis in immunocompetent patients.

COVID-19-associated pulmonary aspergillosis in immunocompetent patients: a virtual patient cohort study.

The opportunistic fungus Aspergillus fumigatus infects the lungs of immunocompromised hosts, including patients undergoing chemotherapy or organ transplantation. More recently however, immunocompetent patients with severe SARS-CoV2 have been reported to be affected by COVID-19 Associated Pulmonary Aspergillosis (CAPA), in the absence of the conventional risk factors for invasive aspergillosis. This paper explores the hypothesis that contributing causes are the destruction of the lung epithelium permitting colonization by opportunistic pathogens. At the same time, the exhaustion of the immune system, characterized by cytokine storms, apoptosis, and depletion of leukocytes may hinder the response to A. fumigatus infection. The combination of these factors may explain the onset of invasive aspergillosis in immunocompetent patients. We used a previously published computational model of the innate immune response to infection with Aspergillus fumigatus. Variation of model parameters was used to create a virtual patient population. A simulation study of this virtual patient population to test potential causes for co-infection in immunocompetent patients. The two most important factors determining the likelihood of CAPA were the inherent virulence of the fungus and the effectiveness of the neutrophil population, as measured by granule half-life and ability to kill fungal cells. Varying these parameters across the virtual patient population generated a realistic distribution of CAPA phenotypes observed in the literature. Computational models are an effective tool for hypothesis generation. Varying model parameters can be used to create a virtual patient population for identifying candidate mechanisms for phenomena observed in actual patient populations.

A rare case of invasive pulmonary aspergillosis in an immunocompetent individual

Invasive aspergillosis is a highly lethal opportunistic infection that poses a significant threat to immunocompromised patients. In these patients, the incidence of the disease is increasing, and the mortality rates remain high, so early diagnosis and treatment are very important to improve patient survivability. However, there are few described cases of invasive aspergillosis in immunocompetent patients without any type of comorbidity. We present the case of a 44-year-old immunocompetent woman who presented with a history of productive cough and fever for 1 week. Initially, the clinical and radiological presentation pointed to an infection. Several courses of antibiotics were administrated, with no improvement. Bronchofibroscopy with bronchial biopsies was performed and the bronchoalveolar lavage was negative for all investigations (including fungi). The patient started presenting massive hemoptysis, unresponsive to non-invasive therapies or bronchial artery embolization, requiring pneumonectomy as a life-saving procedure. Definitive diagnosis was made by histological demonstration of tissue invasion by the fungus and growth of Aspergillus in culture. Despite aggressive treatment, the patient is currently under antifungal therapy and respiratory kinesiotherapy, showing great clinical, analytical and radiological improvement. This case emphasizes the importance of maintaining a high index of suspicion and also to remember that invasive aspergillosis can also affect immunocompetent individuals.

P274 COVID-associated invasive pulmonary aspergillosis (CAPA) — a case report

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMCOVID-associated pulmonary aspergillosis (CAPA) is a severe fungal infection with a high mortality rate. The incidence of CAPA is on the rise possibly due to the prescription of corticosteroids and tocilizumab two repurposed drugs used for treating SARS COV-2. Diagnosis is challenging due to the non-specific nature of symptoms. Voriconazole is the mainstay of therapy. We present a case of a 42-year-old male presenting with left hydro pneumothorax post recovery from COVID infection, and later succumbed to this complication. Patients developing pulmonary aspergillosis after short-term steroid therapy is uncommon. The possibility of aspergillosis in immunocompetent patients should be considered in those on systemic steroids and deteriorating pulmonary functions.

Intracranial aspergillosis in immunocompetent adult patients without risk factors: a systematic review.

The clinical features and prognostic factors of intracranial aspergillosis in immunocompetent patients without risk factors are not well known. PubMed, Scopus, Google Scholar, and Web of Science were searched for all relevant case reports/series on adult patient (≥ 18years) with aspergillosis published from 1976 to 2018. One hundred eighty-two patients (median age, 40years; range, 18-83years; male:female, 115:67) were identified. Types of intracranial aspergillosis included intracranial mass from the skull base (54.9%), pure intraparenchymal disease (23.6%), meningoencephalitis (13.2%), and dural-based mass (8.2%). Vascular complications occurred in 44 patients (26.3%). Eighty-one patients (44.5%) had favourable final clinical outcomes without any deficits, whereas 58 (31.9%) died. Disease-related mortality improved significantly over time (43.1% [28/65] before 2000, 25.9% [30/116] after 2001; p = 0.021). Patients with meningoencephalitis demonstrated the highest mortality rate (79.2%, 19/24). Medical non-responders (patients whose disease course worsened after receiving the initial medication regimen) and vascular complications (the presentation of subarachnoid haemorrhage, intracerebral haemorrhage, or infarction related to the rupture or occlusion of intracranial vessels) were significantly associated with mortality (p < 0.001). Findings from the current review may help predict patient prognosis at the initial assessment and determine potential prognostic factors.

Pulmonary Aspergillosis in immunocompetent patients

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.&#x0D; 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.&#x0D; 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. &#x0D; 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.

Recurrent Invasive Aspergillosis in Immunocompetent Patient

Invasive cardiac aspergillosis is a rare form of disseminated Aspergillus infection which carries a very high mortality rate even with aggressive treatment. Importantly, patients with pre-existing cardiac lesions, prosthetic valves, stents, coronary bypass grafts, and implanted devices are at greater risk. A case of fatal, recurrent, disseminated Aspergillus infection in an immunocompetent patient with invasion of a structurally normal heart in the context of multiorgan involvement is presented. Supplemental material is available for this article. Keywords: CT, Echocardiography, Infection © RSNA, 2021.

Central nervous system aspergillosis in immunocompetent patients: Case series and literature review.

The aim of this study was to investigate the clinical characteristics of central nervous system (CNS) aspergillosis in immunocompetent patients.This study enrolled six immunocompetent patients diagnosed with CNS aspergillosis. Additionally, we reviewed the clinical profiles for 28 cases reported in the literature. The age, gender, etiology of Aspergillus infection, clinical manifestations, location of the lesion, treatment, and prognosis were analyzed.There were 19 men (average age, 54.6 ± 14.3 years) and 15 women (average age, 47.0 ± 19.4 years). The clinical manifestations included headache (55.9%; n = 19), visual impairment (32.4%; n = 11), diplopia (32.4%; n = 11), hemiplegia (20.6%; n = 7), fever (17.6%; n = 6), and epilepsy (8.8%; n = 3). According to the radiological features, CNS aspergillosis lesions were divided into two subtypes: parenchymal lesions in the cerebral lobes (n = 11), and meningeal lesions in the meninges (n = 23). The patients with meningeal lesions are easy to be complicated with more serious cerebrovascular diseases, such as subarachnoid hemorrhage and massive infarction. Most of the lesions in brain parenchyma were abscess formation, and magnetic resonance imaging showed ring enhancement. The clinical diagnosis of Aspergillus infection was mainly based on brain biopsy (n = 14), autopsy (n = 8), pathological examination of adjacent brain tissues (n = 7), cerebrospinal fluid (CSF) or tissue culture (n = 3), and second-generation sequencing analysis of the CSF (n = 3). Clinical improvement was achieved in 23 cases, and 11 patients succumbed to the disease. Voriconazole treatment was effective in 24 (70.6%) cases.Immunocompetent subjects are also at risk for Aspergillus infections. Concomitant cerebrovascular diseases are common in patients with CNS aspergillosis, especially in patients with meningeal aspergillosis. Parenchymal aspergillosis lesions are usually localized and manifest as brain abscesses with annular enhancement on magnetic resonance imaging. Biopsy, CSF culture, and next-generation sequencing are mainstream diagnostic modalities. Voriconazole is an effective treatment for Aspergillus infection, and early diagnosis and treatment should be highlighted.

Invasive pulmonary aspergillosis in immunocompetent patients hospitalised with influenza A-related pneumonia: a multicenter retrospective study

BackgroundIncreasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported. Howevere, the risk factors for occurence and death are largely unknown.MethodsData of hospitalised patients with influenza A-related pneumonia (FluA-p) obtained from five teaching hospitals from 2031 to 2018, were reviewed. Univariate and multivariate logistical regression analyses were performed to determine the risk factors involved in the acquisition and 60-day mortality in IPA patients.ResultsOf the 693 FluA-p patients included in the study, 3.0% (21/693) were IPA patients with a 60-day mortality of 42.9% (9/21). Adjusted for confounders, a Cox proportional hazard model showed that IPA was associated with increased risk for 60-day mortality [hazard ratio (HR) 4.336, 95% confidence interval (CI) 1.191–15.784, p = 0.026] in FluA-p patients. A multivariate logistic regression model confirmed that age (odd ratio (OR) 1.147, 95% CI 1.048–1.225, p = 0.003), systemic corticosteroids use before IPA diagnosis (OR 33.773, 95% CI 5.681–76.764, p < 0.001), leukocytes > 10 × 109/L (OR 1.988, 95% CI 1.028–6.454, p = 0.029) and lymphocytes < 0.8 × 109/L on admission (OR 34.813, 95% CI 1.676–73.006, p = 0.022), were related with the acquisition of IPA. Early neuraminidase inhibitor use (OR 0.290, 95% CI 0.002–0.584, p = 0.021) was associated with a decreased risk for a 60-day mortality in IPA patients.ConclusionsOur results showed that IPA worsen the clinical outcomes of FluA-p patients. The risk factors for the acquisition and death were helpful for the clinicians in preventing and treating IPA.

Invasive pseudomembranous upper airway and tracheal Aspergillosis refractory to systemic antifungal therapy and serial surgical debridement in an Immunocompetent patient

BackgroundThe development of respiratory infections secondary to Aspergillus spp. spores found ubiquitously in the ambient environment is uncommon in immunocompetent patients. Previous reports of invasive upper airway aspergillosis in immunocompetent patients have generally demonstrated the efficacy of treatment regimens utilizing antifungal agents in combination with periodic endoscopic debridement, with symptoms typically resolving within months of initiating therapy.Case presentationA 43-year-old previously healthy female presented with worsening respiratory symptoms after failing to respond to long-term antibiotic treatment of bacterial sinusitis. Biopsy of her nasopharynx and trachea revealed extensive fungal infiltration and Aspergillus fumigatus was isolated on tissue culture. Several months of oral voriconazole monotherapy failed to resolve her symptoms and she underwent mechanical debridement for symptom control. Following transient improvement, her symptoms subsequently returned and failed to fully resolve in spite of increased voriconazole dosing and multiple additional tissue debridements over the course of many years.ConclusionsInvasive upper airway aspergillosis is exceedingly uncommon in immunocompetent patients. In the rare instances that such infections do occur, combinatorial voriconazole and endoscopic debridement is typically an efficacious treatment approach. However, some patients may continue to experience refractory symptoms. In such cases, continued aggressive treatment may potentially slow disease progression even if complete disease resolution cannot be achieved.

Cranial aspergillosis in immunocompetent patient: a case report

Aspergillosis of the central nervous system is an uncommon sickness, particularly if the patient is immunocompetent. In the immunocompetent individuals, the regular way for the fungus to access the CNS is diffusion by the blood from extracranial sites, commonly the lungs. In this report, a 44-year-old man with no history of recent surgery or immunodeficiency had an episode of falling. A cranial mass close to the cerebrum revealed to be as aspergillosis abscess throughout the operation. This case is showing the significance of assuming a cranial mass as aspergilloma in the differential diagnosis.

Aspergillus fumigatus as an agent of cutaneous aspergillosis in immunocompetent patient: A rare case

Cutaneous aspergillosis occurs relatively less frequent and therefore remains poorly characterized. Previous reports have described cutaneous aspergillosis as primary or secondary infection. Primary cutaneous aspergillosis usually involves sites of skin injury, at or near intravenous access catheter sites, at sites of traumatic inoculation, and at sites associated with occlusive dressings, burns, or surgery. Primary cutaneous aspergillosis almost always seen in immunocompromised patients and the skin involvement occurs due to hematogenous dissemination from a primary focus or contiguous spread from underlying infected tissues. This is a rare case of an-56-years-old-immunocompetence man with chief complaint of wound and swelling at left leg since 1 year ago that worsen in last 2 months. He got a history of scalded by hot water at his left leg 1 year ago and became swollen with multiple wound on its surface. Examination on regio pedis sinistra there is tumor with verrucous surface 10 cm in diameter, hard with multiple uneven edge ulcer 5 cm in diameter and hyperpigmentation macule unsharply marginated arround. Potassium hydroxide examination showed conidiophores dichotomously branching and septated hyphae that suitable with Aspergillosis sp. From cultures there is velvety-dark-green growth. The microscope findings from the culture specimen showed conidophore, metula, vesicle, phialde, and chains of pigmented conidia that suitable with Aspergillus fumigatus. Blood culture examination showed no growth of fungi. HIV rapid test negative results obtained. Patients treated with Itraconazole 2 x 200 mg for 12 weeks and obtained satisfactory result.

CNS aspergilloma mimicking tumors: Review of CNS aspergillus infection imaging characteristics in the immunocompetent population

Background and purposeCNS Aspergillosis is very rare and difficult to diagnose clinically and on imaging. Our objective was to elucidate distinct neuroimaging pattern of CNS aspergillosis in the immunocompetent population that helps to differentiate from other differential diagnosis. MethodsRetrospective analysis of brain imaging findings was performed in eight proven cases of central nervous system aspergillosis in immunocompetent patients. Immunocompetent status was screened with clinical and radiological information. Cases were evaluated for anatomical distribution, T1 and T2 signal pattern in MRI and attenuation characteristics in CT scan, post-contrast enhancement pattern, internal inhomogeneity, vascular involvement, calvarial involvement and concomitant paranasal, cavernous sinus or orbital extension. All patients were operated and diagnosis was confirmed on histopathology. ResultsThe age range was 19–50 years with mean age of 33.7 years. Concomitant sinonasal disease was seen in six patients (75%). Three patients had orbital extensions. Most of the lesions (n=7) were profoundly hypointense in T2-weighted imaging. The most common enhancement pattern was bright, solid and homogenous enhancement (n=7). Cavernous extension with ICA encasement was always associated with paranasal sinus disease. Six patients showed demineralization or complete resorption of involved bone. All of the fungal masses appear hyperdense on available CT scan images. ConclusionCNS aspergillus infection in immunocompetent patients has distinct imaging features as compared to CNS aspergillosis in immunocompromised patients. A high index of suspicion in proper clinical settings, even with immunocompetent status and typical imaging features allow us to diagnose CNS aspergillosis in such patients.

Surgical Management Of Intracranial Invasive Aspergillosis In Immunocompetent Patients.

Surgical Management Of Intracranial Invasive Aspergillosis In Immunocompetent Patients.

Aspergillus nodules; another presentation of Chronic Pulmonary Aspergillosis.

BackgroundThere are a number of different manifestations of pulmonary aspergillosis. This study aims to review the radiology, presentation, and histological features of lung nodules caused by Aspergillus spp.MethodsPatients were identified from a cohort attending our specialist Chronic Pulmonary Aspergillosis clinic. Patients with cavitating lung lesions, with or without fibrosis and those with aspergillomas or a diagnosis of invasive aspergillosis were excluded. Demographic, laboratory, and clinical data and radiologic findings were recorded.ResultsThirty-three patients with pulmonary nodules and diagnostic features of aspergillosis (histology and/or laboratory findings) were identified. Eighteen (54.5 %) were male, mean age 58 years (range 27–80 years). 19 (57.6 %) were former or current smokers. The median Charleston co-morbidity index was 3 (range 0–7). All complained of a least one of; dyspnoea, cough, haemoptysis, or weight loss. None reported fever. Ten patients (31 %) did not have an elevated Aspergillus IgG, and only 4 patients had elevated Aspergillus precipitins. Twelve patients (36 %) had a single nodule, six patients (18 %) had between 2 and 5 nodules, 2 (6 %) between 6 and 10 nodules and 13 (39 %) had more than 10 nodules. The mean size of the nodules was 21 mm, with a maximum size ranging between 5–50 mm. No nodules had cavitation radiographically. The upper lobes were most commonly involved. Histology was available for 18 patients and showed evidence of granulation tissue, fibrosis, and visualisation of fungal hyphae.ConclusionPulmonary nodules are a less common manifestation of aspergillosis in immunocompetent patients. Distinguishing these nodules from other lung pathology may be difficult on CT findings alone.

Aspergillome endo-bronchique révélant un carcinome bronchique

Endobronchial aspergillosis is a rare presentation of pulmonary aspergillosis in immunocompetent patients; this raises questions about structural changes inducing airflow stasis in order to colonize the bronchial lumen. We present the case of a patient diagnosed with endobronchial aspergilloma covering a bronchial adenocarcinoma.

Isolated Orbital Aspergillosis in Immunocompetent Patients: A Multicenter Study

To report clinicopathologic features, radiologic findings, and treatment outcomes of isolated, orbital aspergillosis. Multicenter, retrospective case series. setting: Multicenter. There were 8 lesions in 8 eyes of 8 patients with isolated, orbital aspergillosis. Review of medical records and histopathology slides. Disease control. Of 34 patients with orbital aspergillosis, 8 (23.5%) had isolated orbital involvement at presentation. The mean age at presentation was 34.5 years (median, 43 years: range, 0.5-72 years). Gradually progressive proptosis and eyelid swelling were the most common presenting features (each 4/8). Proptosis ranged from 4mm to 9mm (median, 5.5mm; mean, 5.75mm). Restriction of ocular motility was seen in all 8 patients. Other examination findings included palpable mass (2/8), conjunctival chemosis (2/8), hyperglobus (1/8), hypoglobus (1/8), and resistance to retropulsion (1/8). Microbial culture results were available in 1 patient and showed Aspergillus fumigatus. Two patients were treated with complete surgical excision alone while 6 were treated with antifungal medications. Complete resolution of proptosis and restoration of ocular motility were seen in all patients following treatment. Visual disturbances present in 1 were corrected following treatment. Recurrence was observed in 1 patient. Isolated orbital aspergillosis, though rare, should be considered in the differential diagnosis of a patient presenting with a gradually progressive orbital mass, especially in Asian individuals. Early recognition will help reduce the morbidity and mortality associated with this disease.

Laryngeal aspergilloma: a complication of inhaled fluticasone therapy for asthma.

Primary laryngeal aspergillosis in immunocompetent patients is rare. We describe a case of a 59-year-old woman with laryngeal aspergillosis thought to be secondary to long-term inhaled fluticasone therapy. Laryngeal aspergillosis may be an underrecognized complication of inhaled corticosteroid therapy.

Orbital aspergillosis in immunocompetent patients

PurposeTo describe clinical, ultrasonographic, radiological and histopathological features of orbital aspergillosis in immunocompetent patients.MethodsMedical records of immunocompetant individuals with orbital aspergillosis between November 1995 and November 2010 were reviewed.ResultsThirty-five cases...

Disseminated Aspergillosis due toAspergillus nigerin Immunocompetent Patient: A Case Report

Invasive aspergillosis is a major cause of morbidity and mortality in immunocompromised patients. Many cases of pulmonary, cutaneous, cerebral, and paranasal sinus aspergillosis in immunocompetent patient were defined in literature but disseminated aspergillosis is very rare. Here we present an immunocompetent case with extrapulmonary disseminated aspergillosis due to Aspergillus niger, totally recovered after effective antifungal treatment with voriconazole.