1. [Invasive aspergillosis in immunocompromised patients].
- Author
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Kliasova GA, Petrova NA, Galstian GM, Gotman LN, Vishnevskaia ES, Sysoeva EP, Khoroshko ND, Mikhaĭlova EA, Parovichnikova EN, and Isaev VG
- Subjects
- Adolescent, Adult, Aged, Amphotericin B administration & dosage, Amphotericin B therapeutic use, Antifungal Agents administration & dosage, Antifungal Agents therapeutic use, Antigens, Fungal analysis, Aspergillus classification, Bronchoalveolar Lavage Fluid microbiology, Female, Humans, Itraconazole administration & dosage, Itraconazole therapeutic use, Lung microbiology, Male, Middle Aged, Mucus microbiology, Aspergillosis drug therapy, Aspergillosis immunology, Aspergillosis microbiology, Aspergillosis mortality, Aspergillus isolation & purification, Immunocompromised Host
- Abstract
Aim: To analyse results of treatment of invasive aspergillesis in immunocompromised patients for 2000-2002., Material and Methods: The study was made of patients who, when treated with antibiotics, exhibited foci in the lungs typical for invasive aspergillesis. Aspergillas were detected in the sputum, bronchoalveolar lavage, bronchial wash-ups, aspergilla antigen (galactomannan) was detected in the blood., Results: Invasive aspergillesis was diagnosed in 25 patients. 13 (52%) patients were treated with adjuvant glucocorticoids. 19 (76%) patients had neutropenia. All the patients had fever. Foci in the lungs were in 24 patients. Aspergillas were detected in 15 patients, a positive antigen galactomannan in 7 patients. A. Fumigatus, A flavus, A. Niger occurred in 67, 26.5 and 6.5% patients, respectively. All the patients received amphotericin B (median of the treatment reached 38 days, total dose 880-3500 mg). In 5 patients amphotericin B was replaced for liposomal amphotericin B because of high creatinine. 7 patients continued with itraconasol in a dose 400-600 mg/day. The foci were removed in 3 patients. The cure was achieved in 12 patients, 13 patients, 13 patients died (cause of death--respiratory insufficiency)., Conclusion: Lethality in invasive aspergillesis in immunocompromised patients remains high--52%. Cultural detection of mycelial fungi was, as a rule, delayed. Early diagnosis of the disease requires monitoring of the aspergilla antigen in the blood and computer tomography of the chest especially in fever persisting in the treatment of wide-spectrum antibiotics.
- Published
- 2003