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A four-year review of fatal Aspergillosis
1Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Aussenstelle Grosshadern, Munich, Germany.
Abstract:
To investigate the incidence, underlying diseases, and macropathological and microbiological features of invasive aspergillosis in a university hospital, the protocols of 1187 autopsies performed during the 4-year period 1993-1996 were reviewed. Invasive aspergillosis was diagnosed as the cause of death in 48 (4%) cases, four (8%) of which did not involve severe primary immunosuppression. In seven (15%) cases no pulmonary involvement was found; in six of these cases the portal of infection could not be established, whereas in one case invasive aspergillosis originated from Aspergillus peritonitis. Aspergillus grew in 42% of the samples obtained from the respiratory tracts of 32 patients with pulmonary aspergillosis and submitted within 10 days antemortem; at least one positive culture was obtained from 20 (63%) of these patients. It is concluded that the diagnosis of aspergillosis by means of culture has an appreciable sensitivity. Fatal invasive aspergillosis was rare among patients without severe immunosuppression, whereas invasive aspergillosis without pulmonary involvement was unexpectedly frequent.
Insights
Fatal invasive aspergillosis occurred in 4% of autopsies, with unexpected cases lacking pulmonary involvement. Diagnosis via culture showed appreciable sensitivity for detecting this fungal infection.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pathology
Background:
- Invasive aspergillosis is a serious fungal infection often associated with severe immunosuppression.
- Understanding its incidence, risk factors, and presentation is crucial for timely diagnosis and treatment.
- Autopsy studies provide valuable insights into the epidemiology and pathology of fatal infections.
Purpose of the Study:
- To determine the incidence and mortality of invasive aspergillosis.
- To identify underlying diseases and patient characteristics.
- To describe the pathological and microbiological features, including non-pulmonary presentations.
Main Methods:
- Retrospective review of 1187 autopsy protocols from 1993-1996 at a university hospital.
- Analysis of cases diagnosed with invasive aspergillosis as a cause of death.
- Examination of macropathological findings and microbiological cultures.
Main Results:
- Invasive aspergillosis was the cause of death in 4% (48/1187) of cases.
- Notably, 8% (4/48) of fatal cases did not involve severe primary immunosuppression.
- Pulmonary involvement was absent in 15% (7/48) of cases, with infection originating from peritonitis in one instance.
- Respiratory tract cultures had appreciable sensitivity (63% positive) for diagnosing pulmonary aspergillosis antemortem.
Conclusions:
- Fatal invasive aspergillosis is relatively rare in non-severely immunocompromised patients.
- Invasive aspergillosis without pulmonary involvement is more frequent than previously recognized.
- Antemortem fungal cultures demonstrate useful sensitivity for diagnosing pulmonary aspergillosis.