Published ahead of print on June 30, 2004, doi:10.1164/rccm.200401-093OC
Am. J. Respir. Crit. Care Med., Volume 170, Number 6, September 2004, 621-625
A more recent version of this article appeared on September 15, 2004
Submitted on January 23, 2004
Accepted on June 23, 2004
Invasive Aspergillosis in Critically Ill Patients without Malignancy
Wouter Meersseman1*, Stefaan J Vandecasteele2, Alexander Wilmer1, Eric Verbeken3, Willy E Peetermans2, and Eric Van Wijngaerden2
1 Department of General Internal Medicine, Medical Intensive Care Unit, University Hospital, Leuven, Leuven, Belgium,
2 Department of General Internal Medicine, Infectious Diseases Unit, University Hospital, Leuven, Leuven, Belgium,
3 Department of Pathology, University Hospital, Leuven, Leuven, Belgium
* To whom correspondence should be addressed. E-mail: wouter.meersseman{at}uz.kuleuven.ac.be.
Using criteria designed for invasive aspergillosis (IA) in cancer patients, we aimed to determine the impact of IA in patients without malignancy in a medical ICU. In this retrospective study, 127 patients out of 1850 admissions (6.9%) hospitalized between 2000 and 2003 had microbiological or histopathological evidence of Aspergillus during their ICU stay. There were 89 cases (70%) without hematological malignancy. These patients were classified as proven IA (n=30), probable IA (n=37), possible IA (n=2) or colonization (n=20). In these patients mean SAPS II score was 52 with a predicted mortality of 48%. The observed mortality was 80% (n= 71). Mortality of the proven and the probable IA was 97% and 87%, respectively. Postmortem examination was done in 46 out of 71 patients and 27 autopsies (59%) showed hyphael invasion with Aspergillus. Aspergillus infections occurred in 5 critically ill patients with proven IA who did not have any predisposing factors according to the currently available definitions. Three of these patients had Child C liver cirrhosis.
IA is an emerging and devastating infectious disease in ICU patients without malignancy. In those patients, host criteria for probable fungal infections should probably be adapted.
Key words: aspergillosis, critically ill
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