Aspergillosis in Immunocompetent Women: Challenging Diagnosis in The Intensive Care Unit
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 13, Issue 2
Abstract
Aspergillosis is a systemic mycosis caused by Aspergillus spp whose invasive form is manifested particularly in immunocompromised patients. In the last decade, reports have documented the expansion of invasive aspergillosis beyond neutropenic patients including patients admitted to the intensive care unit. In this setting clinical diagnostic is challenging due to the low incidence, lack of suspicion and unvalidated diagnostic definitions. We present a case of an elderly woman with bronchiectasis and respiratory failure whose broad-spectrum antibiotic treatment was not effective and whose diagnostic tests suggested invasive aspergillosis. The purpose of this report is to draw attention to the need for high clinical suspicion of invasive fungal infection within intensive care patients, particularly those with risk factors or not responsive to the initial antimicrobial therapy.Aspergillosis is a systemic mycosis caused by Aspergillus spp. They are ubiquitous filamentous fungi found especially in the soil, with decaying matter [1]. They were first described during prolonged neutropenia and most cases of invasive aspergillosis (IA) are seen in the immunocompromised hosts [2]. They can cause broadly spectrum of disease whose main manifestations are expressed in the respiratory tract [3]. A. fumigatus is the main agent of invasive aspergillosis, and chronic and allergic forms [4]. The fungus can colonize the respiratory mucosa even of immunocompetent people. However, the invasive form is manifested particularly in immunocompromised patients, most notable in chronic neutropenic patients [5]. Besides the immunocompromised setting, IA can be seen in the intensive care unit (ICU) in patients who do not meet the above criteria [6]. Incidence rates ranges from 0,3% to 5,8% with mortality rates over 80% [7]. Delsuc et al. in a cohort study in two university hospital ICUs found that IA was a strong death predictor in critically ill patients with chronic obstructive pulmonary disease (COPD). The use of corticosteroids and antibiotics before ICU admission were also a risk factor for IA [8]. The invasive form can be divided in angioinvasive, bronchopulmonary, or chronic necrotizing manifestations. Nonspecific clinical manifestations and radiological patterns, and the limited value of mycological criteria makes diagnostic of this disease challenging in the ICU setting confirming the high mortality rate of this disease.
Authors and Affiliations
Aragão JO, Pinheiro DOBP, Montenegro FS
Keywords
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- EP ID EP587546
- DOI 10.26717/BJSTR.2019.13.002369
- Views 171
- Downloads 0
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