Comparison of Clinical Manifestation, Diagnosis, and Outcomes of Invasive Pulmonary Aspergillosis and Pulmonary Mucormycosis

Chun-Yu Lin; I-Ting Wang; Che-Chia Chang; Wei-Chun Lee; Wei-Lun Liu; Yu-Chen Huang; Ko-Wei Chang; Hung-Yu Huang; Hsuan-Ling Hsiao; Kuo-Chin Kao; Chung-Chi Huang; George Dimopoulos

doi:10.3390/microorganisms7110531

Comparison of Clinical Manifestation, Diagnosis, and Outcomes of Invasive Pulmonary Aspergillosis and Pulmonary Mucormycosis

Microorganisms. 2019 Nov 5;7(11):531. doi: 10.3390/microorganisms7110531.

Authors

Chun-Yu Lin^{1

2

3}, I-Ting Wang⁴, Che-Chia Chang⁵, Wei-Chun Lee⁵, Wei-Lun Liu^{6

7}, Yu-Chen Huang^{2

3}, Ko-Wei Chang^{2

3}, Hung-Yu Huang^{1

2

3}, Hsuan-Ling Hsiao⁸, Kuo-Chin Kao^{2

3}, Chung-Chi Huang^{2

3}, George Dimopoulos⁹

Affiliations

¹ Department of Pulmonary and Critical Care, Saint Paul's Hospital, 330 Taoyuan, Taiwan.
² Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital at Linkou, 333 Taoyuan, Taiwan.
³ College of Medicine, Chang Gung University, 333 Taoyuan, Taiwan.
⁴ Department of Pulmonary and Critical Care, Mackay Memorial Hospital, 10491 Taipei, Taiwan.
⁵ Department of Pulmonary and Critical Care, Chang Gung Memorial Hospital at Chiayi, 613 Chiayi, Taiwan.
⁶ School of Medicine, College of Medicine, Fu Jen Catholic University, 242 New Taipei City, Taiwan.
⁷ Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, 243 New Taipei City, Taiwan.
⁸ Department of Pharmacy, Chang Gung Memorial Hospital at Linkou, 333 Taoyuan, Taiwan.
⁹ Department of Critical Care, ATTIKON University Hospital, University of Athens, Medical School, 12462 Athens, Greece.

Abstract

Objects: Invasive pulmonary mold infection usually has devastating outcomes. Timely differentiation between invasive pulmonary aspergillosis (IPA) from pulmonary mucormycosis (PM) is critical for treatment decision-making. However, information on IPA and PM differentiation is limited.

Methods: We conducted a retrospective, multicenter, observational study, with proven and probable IPA and PM patients from January 2004 to December 2017. Demographics, clinical manifestations, image reports, histopathological findings, and outcomes were analyzed.

Results: A total of 46 IPA (33 proven and 13 probable) and 19 PM (18 proven and one probable) cases were analyzed. The majority of tissues (81% in IPA and 61% in PM) were obtained using bronchoscopy. Prior influenza infection was a predisposing factor for IPA, and abscess formation in CT scan was associated with PM (p = 0.0491, p = 0.0454, respectively). The positive culture rate for PM was lower than that for IPA (37% vs. 67%, p = 0.0294). The galactomannan (GM) level from serum and bronchoalveolar lavage (BAL) fluid was significantly higher in IPA than in PM (3.3 ± 0.5 vs. 0.8 ± 0.6, p = 0.0361; 4.0 ± 0.6 vs. 0.59 ± 0.1, p = 0.0473, respectively). The overall mortality rate was 65%, which was similar among IPA and PM groups. Systemic steroid exposure and high Acute Physiology and Chronic Health Evaluation II (APACHE II) scores on admission were independently correlated to mortality in IPA (p = 0.027, p = 0.026, respectively). However, there was no predictor for mortality found in PM patients.

Conclusions: Influenza infection, abscess formation in CT scan, and GM level may help physicians to differentiate IPA and PM. Bronchoscopy-guided biopsy and lavage specimen provide timely and definite diagnosis. The prognosis of IPA is associated with systemic steroid exposure and higher APACHE II scores on admission.

Keywords: diagnosis; invasive pulmonary aspergillosis; invasive pulmonary mucormycosis; outcomes.