The Clinical Features And Risk Factors Of Invasive Pulmonary Aspergillosis

Objective In this paper,the types of bacteria,clinical symptoms and signs,imaging findings,laboratory results and risk factors in patients with invasive pulmonary aspergillosis(IPA)were analyzed.The clinical characteristics and risk factors of IPA were summarized on the basis of comparing with non-IPA patients one by one,in order to provide reference for early diagnosis and intervention of IPA.Methods A total of 80 patients diagnosed with IPA discharged from the First Affiliated Hospital of Anhui Medical University from August 2014 to August 2017 were collected as the Infection group.According to the 1:1 pairing principle,80non-IPA patients with fever and/or respiratory symptoms admitted to the same ward on the same day were selected as control group.The distribution of bacterial flora,composition of basic diseases,clinical manifestation,chest CT findings and laboratory examinations were collected and comparative analysis.Then logistic regression model analysis of risk factors of IPA group susceptibility.Results From the 80 IPA patients,who consisted of 52 males and 28 females with an average age of 60.15±15.91 years.The non-IPA group also included 52 males and 28 females with an average age of 62.13±14.34 years.The fumagillin infection in the IPA group was significantly more than that of aflatoxin(69.4% vs 30.6% P<0.05).There were 24 cases of COPD and 16 cases of diabetes mellitus in IPA group,2 cases of COPD and 2 cases of diabetes mellitus in non-IPA group.There were significantly more patients with COPD and Diabetes in the IPA group than the non-IPA group(P<0.05).,and there was no significant difference among of the other underlying diseases(P>0.05).The clinical symptoms and signs of fever,cough,chest tightness,asthma,hemoptysis,chest pain,pulmonarydry and moist rales were found in both IPA and non-IPA group,which was no significant difference between the two groups(P>0.05).The CT findings in the IPA group included 8 cases of aspergillus,24 cases of cavities,6 cases of new lunar sign,8 cases of halo sign,37 cases of pleural effusion,24 cases of lymphadenopathy,and 22 cases of bronchial thickening,whose difference was statistically significant compared with non-IPA group(P<0.05).Other CT findings including nodules,masses,consolidation,and patch infiltration were not significantly different from non-IPA group(P>0.05).The number of patients with positive G test,GM test,and sputum culture in the IPA group was significantly higher than that in the non-IPA group(P<0.05).The CRP and erythrocyte sedimentation in IPA group were significantly higher than those in non-IPA group too.While leukocyte,neutrophil and lymphocyte counts in IPA group were not different from those in non-IPA group(P>0.05).The uni-variate analysis showed that nine risk factors were probably related to the IPA.Multi-variate conditional logistic regression analysis showed that the independent risk factors of IPA were long-term glucocorticoid application(OR=3.129,95%CI 1.349-10.244,P=0.021),multiple hospitalizations(OR=5.164,95%CI2.072-15.386,P=0.002),the patients combined with COPD(OR=3.972,95%CI1.863-11.354,P=0.010),Agranulocytosis(OR=6.255,95%CI 2.683-19.931,P=0.001).Conclusion Multiple hospitalizations,complicating COPD,agranulocytosisand receiving long-term glucocorticoid therapy are the independent risk factors of IPA infection.For patients with IPA risk factors,if clinic symptoms and signs of pulmonary infection exist with chest CT revealing Aspergillus ball,cavity,crescent sign,or halo sign and G test,GM test and sputum culture of Aspergillus positive,we should highly pay attention to the occurrence of IPA infection.