Clinical risk factors and bronchoscopic features of invasive aspergillosis in intensive care unit patients

Abstract

Introduction: Invasive aspergillosis (IA) is an important cause of morbidity and mortality in immunocompromised patients. During recent years, a rising incidence of IA in Intensive Care Unit (ICU) patients has been reported. The patterns of IA related infection may differ according to the type of underlying disease. Unfortunately little is known about the characteristics of IA in ICU patients. In the present study we assessed IA related clinical and bronchoscopy findings in ICU patients.

Materials and methods: This study was performed at the ICU units in Sari and Babul, Mazandaran from August 2009 through September 2010. We analysed 43 ICU patients with underlying predisposing conditions for IA. Bronchoalveolar lavage (BAL) samples were collected by bronchoscope twice a weekly. The samples were analyzed by direct microscopic examination, culture and non-culture based diagnostic methods. Patients were assigned a probable or possible diagnosis of IA according to the consensus definition of the EORTC/MSG.

Results: Out of 43 suspected patients to IA, 13 (36.1%) cases showed IA. According to criteria presented by EORTC/MSG, they were categorized as: 4 cases (30.8%) of possible IA and 9 (69.2%) of probable IA. The observed mortality was 69.2%. The main underlying predisposing conditions were neutropenia, hematologic malignancy, and COPD. The macroscopic finding in bronchoscopy included of Prulent secretion (46.6%), Mucosal bleeding (30.7%), Mucosal erythema (23%), Trachobronchomalasia (15.3%).

Conclusion: The diagnosis of IA in patients with critical illness in ICU is even more difficult. The clinical diagnostic process is often dependent on indirect circumstantial data enhancing the probability of IA. Bronchoscopy with inspection of the tracheobronchial tree, sampling of deep airway secretions and BAL can be helpful.