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Smoking appears to increase the risk of IFI, particularly from dimorphic fungi

August 27 2020

Smoking is known to increase the risk of oral candidiasis as well as bacterial pneumonia and meningitis, but large studies looking at the risk of invasive fungal infections (IFIs) across different patient groups have been lacking.

Dr Annabelle Pourbaix and colleagues in Paris have published a systematic review of smoking as a risk factor for IFI, based on 25 cohort and case-control studies.

In the meta-analysis, they found a pooled risk ratio (RR) of 1.41 (CI 1.09-1.81; p=0.008) for IFIs overall. The risk was higher for dimorphic fungi, which tend to cause disease following inhalation. However, no increased risk was seen for aspergillosis, Pneumocystis pneumonia or invasive candidiasis. They identified some evidence that IFIs were more severe in smokers, and one older study found that Pneumocystis pneumonia occurred earlier in smokers living with HIV.

The authors noted that the studies included were heterogeneous and many were affected by methodological weaknesses and confounding, and call for larger high-quality studies to be carried out.

Relative risk of invasive fungal disease for smokers compared with nonsmokers.