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Invasive aspergillosis in Bahrain

May 16 2016

The true epidemiology of invasive aspergillosis (IA) remains uncertain in many areas. In a retrospective study, Alsalman et al. (2016) studied the epidemiology of IA in 60 patients with Aspergillus-positive cultures over 5 years in a major hospital in Bahrain.  Patients were classified according to two different systems 1. The European Organization for the Research and Treatment of Cancer/Mycoses Study Group (MSG) criteria and 2. validated criteria to distinguish Aspergillus colonization from IA (putative or proven IA). They also investigated the risk factors, clinical presentation, underlying conditions and outcomes.

Using the EORTC/ MSG criteria, 26.7% of the 60 patients were diagnosed with probable  IA, compared to the alternative criteria, where 46% were diagnosed with putative IA. Patients with IA were more likely to have chronic obstructive pulmonary disease (COPD), hematologic malignancies and/or receiving radiotherapy/chemotherapy. Most patients were also on immunosuppressive drugs or corticosteroid therapy.  Mortality was 25% among colonised patients, 44% in probably cases and 32% in those with putative IA. Voriconazole was the treatment of choice for those who received antifungal therapy, and mortality rate was found to be lower for voriconazole compared to the alternatives.

Several other independent risk factors for mortality were found, including older age, history of mechanical ventilation, renal replacement therapy and higher sequential organ failure assessment scores at diagnosis. Significantly, there were considerable delays in the diagnosis and treatment of these patients. Immediate testing is recommended, including sampling of respiratory fluids, and biopsy specimens. An aggressive approach is required, aiming to recognise patients as soon as possible and initiate antifungal therapy promptly. Greater effort is required to achieve this aim;  when diagnosis is confirmed, it is often already too late.

 
Chest radiograph with ‘classical’ appearance of a pulmonary infaction – a wedge-shaped lesion peripherally set against the pleura.

Source: Alsalman et al. (2016)