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Updated: Nov 11, 2025
Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis
Published on: March 9, 2018
Putative invasive pulmonary aspergillosis within medical wards and intensive care units: a 4-year retrospective,
Silvia Corcione1,2, Tommaso Lupia3, Stefania Raviolo1
1Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy.
Abstract:
Blot and colleagues have proposed putative invasive pulmonary aspergillosis (PIPA) definitions for troublesome diagnosis in suspected patients outside the classical criteria of immunosuppression. We retrospectively included in the study all admitted patients with an Aspergillus spp. positive culture within lower airway samples. Overall, Aspergillus spp. positivity in respiratory samples was 0.97 every 1000 hospital admissions (HA): 4.94 and 0.28/1000/HA, respectively, in intensive care units (ICUs) and medical wards (MW). 66.6% fulfilled PIPA criteria, and 33.4% were defined as colonized. 69.2% of PIPA diagnosis occurred in the ICU. Antifungal therapy was appropriate in 88.5% of subjects with PIPA and 37.5% of colonized, confirming the comparison between deads and lives. Patients with PIPA in the ICUs had more frequent COPD, sepsis or septic shock, acute kidney injury (AKI), needed more surgery, mechanical ventilation (MV), vasopressors, hemodialysis, blood or platelets transfusions. PIPA in MW had associated with a history of smoking, interstitial lung disease and inhaled steroid therapy. Overall mortality within 21 days was 50%: 54.2% in ICU, 36,8% in MW. Factors associated with death were length of hospitalization, influenza, pneumonia, liver transplant, AKI, ARDS, sepsis and septic shock. PIPA in the ICU had higher disease severity and needed more organ support than MW cases, despite that cases of PIPA in MW are emerging with trends difficult to demonstrate given the problematic diagnosis.
Insights
Putative invasive pulmonary aspergillosis (PIPA) is challenging to diagnose. This study found PIPA occurred more in ICUs, requiring significant organ support, while medical ward cases are emerging.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pulmonology
Background:
- Classical diagnostic criteria for invasive pulmonary aspergillosis (IPA) are often insufficient for non-immunosuppressed patients.
- Putative invasive pulmonary aspergillosis (PIPA) definitions have been proposed to aid diagnosis in challenging cases.
- Aspergillus spp. infections pose a significant threat in hospital settings, particularly in intensive care units (ICUs).
Purpose of the Study:
- To evaluate the incidence and characteristics of PIPA in hospitalized patients.
- To compare PIPA cases in intensive care units (ICUs) versus medical wards (MW).
- To identify factors associated with PIPA diagnosis, treatment, and mortality.
Main Methods:
- Retrospective study including all admitted patients with Aspergillus spp. positive lower airway cultures.
- Patients were categorized as fulfilling PIPA criteria or being colonized.
- Data on clinical characteristics, treatment, organ support, and outcomes were collected and analyzed.
Main Results:
- Aspergillus spp. positivity was 0.97 per 1000 hospital admissions, higher in ICUs (4.94/1000 HA) than MW (0.28/1000 HA).
- 66.6% of patients fulfilled PIPA criteria, with 69.2% diagnosed in the ICU. Appropriate antifungal therapy was given to 88.5% of PIPA patients.
- PIPA patients in ICUs experienced higher disease severity, requiring more organ support (e.g., mechanical ventilation, hemodialysis). Overall 21-day mortality was 50%, with factors like sepsis, AKI, and ARDS associated with death.
Conclusions:
- PIPA is more prevalent and severe in ICUs, necessitating aggressive management and organ support.
- Emerging cases of PIPA in medical wards present diagnostic challenges and require further investigation.
- Accurate diagnosis and timely antifungal treatment are crucial for improving outcomes in patients with PIPA.
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