Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease
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  • 作者:Nuri Tutar (4)
    Gokhan Metan (4)
    Ay?e Nedret Ko? (4)
    Insu Yilmaz (4)
    Ilkay Bozkurt (4)
    Zuhal Ozer Simsek (4)
    Hakan Buyukoglan (4)
    Asiye Kanbay (4)
    Fatma Sema Oymak (4)
    Inci Gulmez (4)
    Ramazan Demir (4)
  • 关键词:Aspergillosis ; Chronic obstructive pulmonary disease ; COPD ; Invasive pulmonary aspergillosis
  • 刊名:Multidisciplinary Respiratory Medicine
  • 出版年:2013
  • 出版时间:December 2013
  • 年:2013
  • 卷:8
  • 期:1
  • 全文大小:173KB
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  • 作者单位:Nuri Tutar (4)
    Gokhan Metan (4)
    Ay?e Nedret Ko? (4)
    Insu Yilmaz (4)
    Ilkay Bozkurt (4)
    Zuhal Ozer Simsek (4)
    Hakan Buyukoglan (4)
    Asiye Kanbay (4)
    Fatma Sema Oymak (4)
    Inci Gulmez (4)
    Ramazan Demir (4)

    4. Department of Microbiology, Kayseri, Turkey
  • ISSN:2049-6958
文摘
Background Invasive pulmonary aspergillosis (IPA) is an infection often occurring in neutropenic patients and has high mortality rates. In recent years, it has been reported that the incidence of IPA has also increased in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study is to investigate the clinical and demographic characteristics and treatment responses of IPA in patients with COPD. Methods Seventy-one patients with a positive culture of Aspergillus from lower respiratory tract samples were examined retrospectively. Eleven (15.4%) of these patients, affected with grade 3 or 4 COPD, had IPA. Results Aspergillus hyphae were detected in lung biopsy in three (27.3%) out of 11 patients and defined as proven IPA; a pathological sample was not taken in the other eight (72.7%) patients, and these were defined as probable IPA. Aspergillus isolates were identified as six cases of Aspergillusfumigatus and three of Aspergillusniger in nine patients, while two isolates were not identified at species level. While five patients required intensive care unit admission, four of them received mechanical ventilation. The most common finding on chest X-ray and computed tomography (CT) (respectively 63.6%, 72.7%) was infiltration. Amphotericin B was the initial drug of choice in all patients and five patients were discharged with oral voriconazole after amphotericin B therapy. Six patients (54.5%) died before treatment was completed. Conclusions IPA should be taken into account in the differential diagnosis particularly in patients with severe and very severe COPD presenting with dyspnea exacerbation, poor clinical status, and a new pulmonary infiltrate under treatment with broad-spectrum antibiotics and steroids.

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