Am. J. Respir. Crit. Care Med., Vol 154, No. 2, Aug 1996, 541-544.
Unusual cause of lethal pulmonary aspergillosis in patients with chronic obstructive pulmonary disease
D Pittet, T Huguenin, S Dharan, J Sztajzel-Boissard, G Ducel, JB Thorens, R Auckenthaler and JC Chevrolet
Infection Control Program, Division of Infectious Diseases, University Hospital of Geneva, Switzerland.
Two patients admitted to two different medical wards of our institution
following respiratory decompensation of chronic obstructive pulmonary
disease (COPD) were subsequently transferred to the same room of the
medical intensive care unit (ICU) and intubated. Both patients developed
invasive pulmonary aspergillosis and died soon after. Because COPD itself
is rarely associated with lethal pulmonary aspergillosis, both cases were
reviewed, and a retrospective investigation was conducted. Both patients
had repeated sputum cultures while on the medical ward before their
admission to the ICU; none of the sample grew Aspergillus spp. A. fumigatus
was found in tracheal aspirates of both patients from the first day of
their intubation while in the ICU. The pulmonary condition of both patients
worsened, and invasive aspergillosis was diagnosed by bronchoalveolar
lavage. Despite therapy with amphotericin B, the patients died 16 and 22 d
after intubation, respectively. Both deaths were attributed to pulmonary
aspergillosis; autopsy confirmed a massive pneumonia of the five lobes due
to A. fumigatus in one patient. Investigation revealed that an air filter
had been replaced 30 h before the first patient was admitted to the room.
Experimental air filter replacement performed 12 d after the second patient
died revealed the presence of A. fumigatus on the surface of the filters as
well as a 10-fold increase in room air fungal counts during the procedure.
This study shows that exposure to high concentrations of airborne
Aspergillus spp. related to air filter change was associated with fatal
invasive aspergillosis in two mechanically ventilated patients. Such
infection can be prevented by the establishment and application of
guidelines for air filter replacement.
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Copyright © 1996 American Thoracic Society
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