Table 6 Invasive aspergillosis in hematological patients
Total | Non-neutropenic | Neutropenic (NF < 500) | p-value* (significance value p < 0.001) | |
|---|---|---|---|---|
Number of patients | 22 | 12/22 (54.5%) | 10/22 (45.5%) | |
Demographic data | ||||
Sex: | ||||
Male | 16 (72.7%) | 10/12 (83.3%) | 6/10 (60%) | |
Female | 6 (27.3%) | 2/12 (16.7%) | 4/10 (40%) | |
HSCT | 7 (31.8%) | 5/12 (41.7%) | 2/10 (20%) | 0.381 |
GVHD (only HSCT) | 3/7 (42.9%) | 3/7 (42.9%) | 0 (0%) | 0.429 |
Lung disease | 6 (27.3%) | 4/12 (33.3%) | 2/10 (20%) | 0.646 |
COPD | 2 (9.1%) | 1/12 (8.3%) | 1/10 (10%) | 0.999 |
Kidney disease | 3 (13.6%) | 3/12 (25%) | 0 (0%) | |
Dialysis | 0 (0%) | 0 (0%) | 0 (0%) | |
Liver disease | 0 (0%) | 0 (0%) | 0 (0%) | |
Heart disease | 1 (4.5%) | 1/12 (8.3%) | 0 (0%) | |
COVID (last month) | 3 (13.6%) | 3/12 (25%) | 0 (0%) | 0.221 |
Influenza (last month) | 0 (0%) | 0 (0%) | 0 (0%) | – |
Prior letermovir | 0 (0%) | 0 (0%) | 0 (0%) | – |
CMV reactivation | 4 (18.2%) | 4/12 (33.3%) | 0 (0%) | 0.999 |
Lymphopenia (< 1000) | 11 (50%) | 4/12 (33.3%) | 7/10 (70%) | 0.198 |
Quimiotherapy | 12 (54.5%) | 3/12 (25%) | 9/10 (90%) | 0.004 |
Previous steroids | 10 (45.5%) | 9/12 (75%) | 1/10 (10%) | 0.004 |
Targeted therapy | 8 (36.4%) | 6/12 (50%) | 2/10 (20%) | 0.204 |
Ibrutinib | 1 (4.5%) | 1/12 (8.3%) | 0 (0%) | |
Venetoclax | 2 (9.1%) | 1/12 (8.3%) | 1/10 (10%) | |
Rituximab | 2 (9.1%) | 2/12 (16.7%) | 0 (0%) | |
Other | 4 (18.2%) | 3/12 (25%) | 1/10 (10%) | |
Tocilizumab | 3 (13.6%) | 3/12 (25%) | 0 (0%) | |
IFI data | ||||
IFI category | ||||
Proven | 3 (13.6%) | 2/12 (16.7%) | 1/10 (10%) | 0.560 |
Probable | 18 (81.8%) | 9/12 (75%) | 9/10 (90%) | |
Possible | 1 (4.5%) | 1/12 (8.3%) | 0 (0%) | |
Presentation of the IFI | ||||
Disseminated | 1 (4.5%) | 1/12 (8.3%) | 0 (0%) | 0.999 |
Localized | 21 (95.5%) | 11 (91.7%) | 10/10 (100%) | |
Site of involvement | ||||
Pulmonary | 22 (100%) | 12/12 (100%) | 10/10 (100%) | |
Cerebral | 1 (4.5%) | 1/12 (8.3%) | 0 (0%) | |
Others | 0 (0%) | 0 (0%) | 0 (0%) | |
Microbiology | ||||
Patients with any positive culture | 10 (45.5%) | 5/12 (41.7%) | 5/10 (50%) | |
Aspergillus species isolates (total n = 13, cultures or PCR) | ||||
A. fumigatus sensu stricto | 8/13 (61.5%) | 5/7 (71.4%) | 3/6 (50%) | 0.444 |
A. flavus | 1/13 (7.7%) | 1/7 (14.3%) | 0 (0%) | |
A. niger | 1/13 (7.7%) | 0 (0%) | 1/6 (16.7%) | |
A. terreus | 1/13 (7.7%) | 1/7 (14.3%) | 0 (0%) | |
A. nidulans | 0 (0%) | 0 (0%) | 0 (0%) | |
Aspergillus sp | 1/13 (7.7%) | 0 (0%) | 1/6 (16.7%) | |
Mixed | 0 (0%) | 0 (0%) | 0 (0%) | |
Cryptic species: Neosartorya udagawae | 1/13 (7.7%) | 0 (0%) | 1/6 (17.5%) | |
Beta-D-glucan + serum (total n = 6) | 1/6 (16.7%) | 1/1 (100%) | 0 (0%) | 0.236 |
Galactomannan + serum (total n = 22) | 7 (31.8%) | 2/22 (9.1%) | 5/10 (50%) | 0.172 |
Bronchoscopy performed | 20 (90.9%) | 10/12 (83.3%) | 10/10 (100%) | |
Galactomannan + BAL (total n = 19) | 14/19 (73.7%%) | 8/10 (80%) | 6/9 (66.7%) | 0.476 |
PCR Aspergillus BAL (total n = 15): Positives | 8/15 (53.3%) | 3/6 (50%) | 5/9 (55.6%) | 0.162 |
PCR Mucor BAL (total n = 4): Positives | 0 (0%) | 0 (0%) | 0 (0%) | – |
PCR Fusarium BAL (total n = 4): Positives | 0 (0%) | 0 (0%) | 0 (0%) | – |
PCR Scedosporium BAL (total n = 4): Positives | 0 (0%) | 0 (0%) | 0 (0%) | – |
PCR panfungal BAL (performed n = 12): Positives | 4/12 (33.3%) | 3/5 (60%) | 1/7 (14.3%) | 0.120 |
Biopsy performed | 4 (18.2%) | 3/12 (25%) | 1/10 (10%) | |
Biopsy positive | 3/4 (75%) | 2/3 (66.7%) | 1/1 (100%) | |
Clinical presentation | ||||
Persistent fever | 16 (72.7%) | 6/12 (50%) | 10/10 (100%) | 0.009 |
Cough | 9 (40.9%) | 5/12 (41.7%) | 4/10 (40%) | 0.937 |
Thoracic pain | 3 (13.6%) | 1/12 (8.3%) | 2/10 (20%) | 0.571 |
Dyspnea | 4 (18.2%) | 3/12 (25%) | 1/10 (10%) | 0.594 |
Respiratory failure | 15 (68.2%) | 10/12 (83.3%) | 5/10 (50%) | 0.172 |
Imaging tests | ||||
Chest CT scan performed | 22 (100%) | 12/12 (100%) | 10/10 (100%) | 0.999 |
Pulmonary nodules | 17 (77.3%) | 9/12 (75%) | 8/10 (80%) | 0.999 |
Halo sign | 6 (27.3%) | 1/12 (8.3%) | 5/10 (50%) | 0.056 |
Cavitation- crescent sign | 3 (13.6%) | 0 (0%) | 3/10 (30%) | 0.078 |
Tree in bud | 1 (4.5%) | 1/12 (8.3%) | 0 (0%) | |
Ground glass opacities | 18 (81.8%) | 9/12 (75%) | 9/10 (90%) | |
Consolidation | 12 (54.5%) | 6/12 (50%) | 6/10 (60%) | |
Interstitial infiltrates | 8 (36.4%) | 5/12 (41.7%) | 3/10 (30%) | |
Pleural effusion | 11 (50%) | 7/12 (58.3%) | 4/10 (40%) | |
PET-CT performed | 9 (40.9%) | 3/12 (25%) | 6/10 (60%) | |
Indication PET-CT | ||||
Fever | 3/9 (33.3%) | 0 (0%) | 3/6 (50%) | |
Staging | 6/9 (66.7%) | 3/3 (100%) | 3/6 (50%) | |
Antifungal therapy | ||||
Antifungal prophylaxis: breakthrough IFI | 8 (36.4%) | 2/12 (16.7%) | 6/10 (60%) | 0.074 |
Prior AF prophylaxis: | ||||
Fluconazole | 4/8 (50%) | 1/2 (50%) | 3/6 (50%) | |
Posaconazole | 3/8 (37.5%) | 0 (0%) | 3/6 (50%) | |
Amphotericin (nebulized) | 1/8 (12.5%) | 1/2 (50%) | 0 (0%) | |
Resistant to prior AF | 5/8 (62.5%) | 1/2 (50%) | 4/6 (66.7%) | 0.135 |
Empirical AF therapy | ||||
Posaconazole | 1 (4.5%) | 0 (0%) | 1/10 (10%) | |
Voriconazole | 4 (18.2%) | 1/12 (8.3%) | 3/10 (30%) | |
Isavuconazole | 11 (50%) | 10/12 (83.3%) | 1/10 (10%) | |
Caspofungin | 1 (4.5%) | 1/12 (8.3%) | 0 (0%) | |
L-Amphotericin (intravenous) | 6 (27.3%) | 0 (0%) | 6/10 (60%) | |
Resistant to empiric AF | 4 (18.2%) | 1/12 (8.3%) | 3/10 (30%) | 0.285 |
Definitive AF therapy | ||||
Posaconazole | 1 (4.5%) | 0 (0%) | 1/10 (10%) | |
Voriconazole | 4 (18.2%) | 0 (0%) | 4/10 (40%) | |
Isavuconazole | 14 (63.6%) | 11/12 (91.7%) | 3/10 (30%) | |
Caspufungin | 1 (4.5%) | 0 (0%) | 1/10 (10%) | |
Micafungin | 1 (4.5%) | 1/12 (8.3%) | 0 (0%) | |
Anidulafungin | 4 (18.2%) | 2/12 (16.7%) | 2/10 (20%) | |
L-Amphotericin (intravenous) | 6 (27.3%) | 0 (0%) | 6/10 (60%) | |
Duration of therapy: Median (IQR) | 29 (14–67.5) | 40 (15–53) | ||
Evolution | ||||
Coinfection | 15 (68.2%) | 11/12 (91.7%) | 4/10 (40%) | 0.020 |
Virus coinfection | 4/15 (26.7%) | 4/11 (36.4%) | 0 (0%) | 0.096 |
Bacterial coinfection | 12/15 (80%) | 8/11 (72.7%) | 4/4 (100%) | |
Mycobacterial coinfection | 0 (0%) | 0 (0%) | 0 (0%) | |
ICU due to IFI | 1 (4.5%) | 0 (0%) | 1/10 (10%) | |
Outcome | ||||
Delay of chemotherapy or HSCT | 7 (31.8%) | 2/12 (16.7%) | 5/10 (50%) | 0.999 |
In-hospital death | 10 (45.5%) | 6/12 (50%) | 4/10 (40%) | 0.716 |