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Published on: March 9, 2018
Prevalence, Risk Factors, and Mortality of Invasive Pulmonary Aspergillosis in Patients with Anti-MDA5+
Xixia Chen1, Sang Lin2, Qiwen Jin1
1Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People's Republic of China.
Objective:
To investigate the prevalence, risk factors and prognosis of invasive pulmonary aspergillosis (IPA) in patients with anti-melanoma differentiation-associated gene 5 positive dermatomyositis (anti-MDA5+ DM).
Methods:
A retrospective analysis was conducted in anti-MDA5+ DM patients diagnosed between January 2016 and March 2023. Patients with lower respiratory tract specimens were categorized into IPA+ and IPA- groups based on the presence of IPA and their clinical characteristics and prognoses then compared.
Results:
Of the 415 patients diagnosed with anti-MDA5+ DM, 28 cases had IPA (prevalence rate of 6.7%) with Aspergillus fumigatus being the most common species. The patients were categorized into IPA+ (n=28) and IPA- (n=98) groups, with no significant age or gender-related differences (P>0.05). The IPA+ group had a lower lymphocyte count, particularly the CD4+ T-cell count, and reduced serum albumin and higher serum ferritin levels (P all<0.05). An elevated bronchoalveolar lavage fluid (BALF) galactomannan level was found to be the sole independent risk factor for the occurrence of IPA (adjusted OR=2.191, P=0.029) with a cut-off value of 0.585 and area under the curve of 0.779. The mortality rate in the IPA+ group was 25%. Compared to survivors, non-survivors in this group exhibited a higher incidence of rapidly progressive interstitial lung disease, lower lymphocyte counts, and increased co-infection with Pneumocystis jirovecii (P all<0.05).
Conclusion:
IPA was not rare in patients with anti-MDA5+ DM, with elevated BALF galactomannan levels being an independent risk factor for IPA occurrence. Clinicians must exercise vigilance to identify patients exhibiting the aforementioned risk factors.
Insights
Invasive pulmonary aspergillosis (IPA) affects 6.7% of anti-melanoma differentiation-associated gene 5 positive dermatomyositis (anti-MDA5+ DM) patients. Elevated bronchoalveolar lavage fluid galactomannan is a key risk factor for IPA in this population.
Area of Science:
- Mycology
- Rheumatology
- Pulmonology
Background:
- Anti-melanoma differentiation-associated gene 5 positive dermatomyositis (anti-MDA5+ DM) is an autoimmune condition associated with significant morbidity.
- Invasive pulmonary aspergillosis (IPA) is a serious fungal infection that can complicate immunosuppressive conditions.
Purpose of the Study:
- To determine the prevalence, risk factors, and prognosis of IPA in patients diagnosed with anti-MDA5+ DM.
- To identify clinical predictors for IPA development in this specific patient cohort.
Main Methods:
- Retrospective analysis of anti-MDA5+ DM patients diagnosed between January 2016 and March 2023.
- Categorization into IPA-positive (IPA+) and IPA-negative (IPA-) groups based on lower respiratory tract specimens.
- Comparison of clinical characteristics, laboratory findings, and prognoses between the two groups.
Main Results:
- A prevalence of 6.7% for IPA was observed among 415 anti-MDA5+ DM patients, with Aspergillus fumigatus being the most common pathogen.
- IPA+ patients showed lower lymphocyte counts (including CD4+ T-cells), reduced serum albumin, and higher serum ferritin compared to IPA- patients.
- Elevated bronchoalveolar lavage fluid (BALF) galactomannan (cut-off 0.585) was the sole independent risk factor for IPA (adjusted OR=2.191, P=0.029).
- The mortality rate in the IPA+ group was 25%, with non-survivors having higher rates of rapidly progressive interstitial lung disease, lower lymphocyte counts, and Pneumocystis jirovecii co-infection.
Conclusions:
- IPA is a significant concern in patients with anti-MDA5+ DM, occurring in 6.7% of cases.
- Elevated BALF galactomannan levels serve as an independent risk factor for IPA development.
- Clinicians should maintain high vigilance for IPA in anti-MDA5+ DM patients presenting with identified risk factors.
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