TITLE:
Invasive Aspergillus Infections in a Thai Tertiary-Care Hospital during 2006-2011
AUTHORS:
Arsa Thammahong, Poomjit Thayidathara, Kanyarat Suksawat, Ariya Chindamporn
KEYWORDS:
Invasive Aspergillosis, Thailand, Epidemiology, Aspergillus, Tertiary Hospital
JOURNAL NAME:
Advances in Microbiology,
Vol.5 No.5,
May
12,
2015
ABSTRACT: From an
increase in the number of immunocompromised hosts including AIDS patients,
organ transplantation, solid-organ tumor, hematological malignancy,
corticosteroid use, and others underlying diseases, it leads to increasing the
incidence of invasive aspergillosis (IA) as one of the most prevalent
opportunistic mould infections. However, the epidemiological data are still
limited. Our objective is to study the epidemiology of IA, patients’
characteristics in a tertiary-care hospital, King Chulalongkorn Memorial
Hospital, Bangkok, Thailand. The retrospective study of IA as principal
diagnosis in both medical and laboratory records in a tertiary-care hospital,
King Chulalongkorn Memorial Hospital, from January 1, 2006 to December 31,
2011, was performed. There were 69 patients who were diagnosed as IA during
2006 till 2011. They were classified as proven (45 patients), probable (3
patients), and possible (21 patients) invasive aspergillosis following the
criteria of European Organization for Research and Treatment of Cancer/Mycoses
Study Group (EORTC/MSG), 2008. The numbers of patients in 2006 to 2011 were 3,
11, 12, 10, 10, and 23 respectively. Male patients were 58 percent. The age
range was from 8 months to 87 years old. Most of patients were from Medicine
ward. Others were derived from Pediatrics, Surgery, and Ear Nose Throat wards.
The most common underlying disease was diabetes mellitus type 2 in the proven
group. The main predisposing factors of patients were the history of pulmonary
tuberculosis and using of immunosuppressive drugs. The sites of infection were
lung (62%), sinus (28%), and brain (8%). Aspergillus fumigatus (69%) and Aspergillus flavus (15%) were common species from the isolated culture.
The treatment used mostly was surgery and followed by amphotericin B or
voriconazole. The case fatality rate of IA was 20 percent. From the
epidemiological data, we can conclude that in this past ten years there is an
incessant increase in the number of IA in the immunocompromised hosts
especially from Aspergillus fumigatus, which is the most prevalent
species found in IA. Diabetes mellitus and history of pulmonary tuberculosis
will play the important role for IA in the future. The plan for prevention and
treatment should be concerned about those underlying diseases and predisposing
factors.