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Disseminated aspergillosis in intensive care unit patients: an autopsy study
G Dimopoulos1, M Piagnerelli, J Berré
1Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium.
Abstract:
Disseminated aspergillosis is an uncommon but frequently fatal disease in critically ill populations. With studies suggesting that the incidence of this disease is increasing, and with relatively few epidemiological data available in this population, we evaluated cases of disseminated aspergillosis identified at autopsy over a one-year period on a 31-bed mixed medico-surgical intensive care unit (ICU) of an academic university hospital. In 1999, there were 489 deaths out of 2984 ICU admissions, and 222 autopsies were performed. Post-mortem examination demonstrated disseminated aspergillosis involving non-contiguous organs in 6 (2.7%) autopsies and, of these, five patients (2.3% of total) had had chronic obstructive pulmonary disease (COPD) and had been treated with corticosteroids and mechanical ventilation for pulmonary infection. One patient also had granulocytopenia. In each patient, sputum and bronchoalveolar lavage (BAL) cultures had been positive for Aspergillus fumigatus after ICU admission but this was considered as colonization and the patients were given fluconazole for suspected candidal infection. In conclusion, COPD patients treated with corticosteroids and presenting with pulmonary infection should be considered at risk for disseminated aspergillosis. The rapidly fatal outcome after ICU admission suggests that colonization with Aspergillus can occur before ICU admission.
Insights
Disseminated aspergillosis is a rare but deadly fungal infection in intensive care units (ICUs). Critically ill patients with chronic obstructive pulmonary disease (COPD) on corticosteroids are at high risk.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Critical Care Medicine
Background:
- Disseminated aspergillosis is an uncommon, often fatal, fungal infection.
- Increasing incidence suggests a need for better epidemiological data in critically ill populations.
- Previous studies lack comprehensive data on this specific patient group.
Purpose of the Study:
- To evaluate the incidence and characteristics of disseminated aspergillosis in an intensive care unit (ICU) setting.
- To identify risk factors and patient populations susceptible to this severe infection.
- To analyze autopsy findings for accurate diagnosis of disseminated aspergillosis.
Main Methods:
- Retrospective autopsy review over a one-year period in a mixed medico-surgical ICU.
- Analysis of 222 autopsies from 2984 ICU admissions.
- Correlation of autopsy findings with clinical data, including patient history and laboratory results.
Main Results:
- Disseminated aspergillosis was found in 2.7% of autopsies (6 cases).
- Five of these patients (2.3% of total deaths) had chronic obstructive pulmonary disease (COPD), received corticosteroids, and mechanical ventilation.
- Aspergillus fumigatus was identified in cultures, but often misdiagnosed as colonization, with fluconazole treatment administered.
Conclusions:
- Chronic obstructive pulmonary disease (COPD) patients on corticosteroids and with pulmonary infections are at significant risk.
- The rapid fatality suggests Aspergillus colonization may precede ICU admission.
- Autopsy confirmation highlights diagnostic challenges and potential for underdiagnosis in ICU settings.