Poster Presentation: e-POSTER VIEWING: Mycology: paper no. EV0981postprin

Chan, JFW

Cheng, VCC

Hung, IFN

Lau, SKP

To, KKW

Wong, SCY

Woo, PCY

Yuen, KY

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TitleComparative analysis of patients with chronic pulmonaryaspergillosis and invasive pulmonary aspergillosis: a ten-yearretrospective studyAuthor(s) Chan, JFW; Lau, SKP; Wong, SCY; To, KKW; Hung, IFN; Cheng,VCC; Yuen, KY; Woo, PCYCitationThe 25th European Congress of Clinical Microbiology andInfectious Diseases (ECCMID 2015), Copenhagen, Denmark, 25-28 April 2015Issued Date 2015URL http://hdl.handle.net/10722/217561Rights Creative Commons: Attribution 3.0 Hong Kong LicenseTable 1. Significant differences between patients with CPA & IPA Comparative analysis of patients with chronic pulmonary aspergillosis and invasive pulmonary aspergillosis: a ten-year retrospective study Jasper Fuk-Woo Chan1,2,3,4,*, Susanna Kar-Pui Lau1,2,3,4, Sally Cheuk-Ying Wong2, Kelvin Kai-Wang To1,2,3,4, Ivan Fan-Ngai Hung3,5, Vincent Chi-Chung Cheng2, Kwok-Yung Yuen1,2,3,4, and Patrick Chiu-Yat Woo1,2,,3,4 1State Key Laboratory of Emerging Infectious Diseases, 2Department of Microbiology, 3Research Centre of Infection and Immunology, 4Carol Yu Centre for Infection, 5Department of Medicine, The University of Hong Kong, Queen Mary Hospital, HKSAR, China. (*Correspondence: Jasper F. W. Chan. Email: jfwchan@hku.hk. Tel: (852) 22554892. Fax: (852) 28551241.) Objectives: Chronic pulmonary aspergillosis (CPA) is considered as a “semi-invasive” form of pulmonary aspergillosis that occurs in patients with chronic lung disease or mild immunosuppression. A major limitation of published studies on CPA is the lack of direct and systematic comparison of the characteristics of CPA with those of invasive pulmonary aspergillosis (IPA) in patients from the same population over a unified study period. Thus, their comparative epidemiological, clinical, radiological, mycological, and prognostic characteristics remain incompletely understood. Misdiagnosis of IPA as CPA may occur in patients without classical risk factors, especially critically ill patients in the intensive care unit and patients with chronic obstructive pulmonary disease. We therefore conducted this 10-year retrospective cohort study to compare the characteristics of CPA with those of IPA in hospitalised patients at a tertiary referral center in Hong Kong.  Methods: The case records of hospitalised patients diagnosed with CPA and IPA (using previously described diagnostic criteria) at Queen Mary Hospital, Hong Kong, between 1 July 2003 and 30 June 2013 were reviewed. For IPA, only patients with proven, probable, or probable IPA without prespecified radiologic findings were included. Their characteristics and outcome were recorded into a predefined database and compared.   Results: A total of 29 and 51 patients with CPA and IPA respectively were included. The CPA group was significantly older than the IPA group (p<0.001). Significantly more patients in the CPA group had past pulmonary tuberculosis, chronic lung diseases, silicosis, and/or bronchiectasis (p<0.001-0.008). The presenting symptoms differed significantly, with the CPA group having weight loss and predominantly respiratory symptoms including cough, sputum, and haemoptysis, while the IPA group often had fever with minimal respiratory symptoms and weight loss (p<0.001-0.004). The CPA group had higher lymphocyte count, haemoglobin level, platelet count, and globulin level, and lower total bilirubin, sodium, and urea levels (p<0.001-0.034).  Fig 1. Kaplan-Meier survival curves for CPA and IPA through one year after admission Results: Cavitary lesion and consolidation/collapse were the most common findings in both CXR and thoracic CT scan in the CPA and IPA groups respectively. Only around one-third of the IPA group had the classical findings of cavitary lesion, halo and/or air-crescent signs. Fibrosis was more commonly found in the CPA group in both CXR and thoracic CT scan (p<0.001). The seropositive rate of anti-Aspergillus antibody was significantly higher in the CPA group (p<0.001). Nearly one-tenth of the culture-positive CPA patients had >1 species isolated from respiratory tract specimens. More patients in the CPA group received antifungal treatment (p=0.011). The duration of hospitalisation was significantly shorter in the CPA group (p=0.031). Significantly more patients in the IPA group died at one year after admission (p=0.019).  Conclusion: The comparative characteristics of patients with CPA and IPA were identified. The outcome of patients with CPA supported the notion that it was a “semi-invasive” form of pulmonary aspergillosis. 

Comparative analysis of patients with chronic pulmonary aspergillosis and invasive pulmonary aspergillosis: a ten-year retrospective study

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Comparative analysis of patients with chronic pulmonary aspergillosis and invasive pulmonary aspergillosis: a ten-year retrospective study

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