Pulmonary Fungal Diseases in Immunocompetent Hosts: A Single-Center Retrospective Analysis of 35 Subjects

• Published in: Mycopathologia (1975) 2016-08, Vol.181 (7-8), p.513-521
• Main Authors: Yan, XiaoPei, Zong, Feng, Kong, Hui, Wang, YanLi, Zhao, XinYun, Liu, WenRui, Wang, ZaiLiang, Xie, WeiPing
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Aged; AIDS; Antifungal Agents - therapeutic use; Aspergillus; Biomedical and Life Sciences; Cancer therapies; Care and treatment; China - epidemiology; Cryptococcus; Debridement; Disease; Epidemiology; Eukaryotic Microbiology; Female; Fungal infections; Fungi - classification; Fungi - isolation & purification; Health aspects; HIV; Hospitals; Human immunodeficiency virus; Humans; Immunocompetence; Infection; Life Sciences; Lung Diseases, Fungal - epidemiology; Lung Diseases, Fungal - microbiology; Lung Diseases, Fungal - pathology; Lung Diseases, Fungal - therapy; Male; Medical Microbiology; Medical research; Microbial Ecology; Microbiology; Middle Aged; Mortality; Mucor; Mycoses; Plant Sciences; Prevalence; Prognosis; Retrospective Studies; Risk factors; Stem cells; Surgery; Survival Analysis; Treatment Outcome; Young Adult
• ISSN: 0301-486X; 1573-0832
• DOI: 10.1007/s11046-016-9999-1

Background Pulmonary fungal disease is an emerging issue in immunocompetent patients, for whom the characteristics are only partially understood. Methods We conducted a single-center retrospective study of histologically verified pulmonary fungal disease in Eastern China from 2006 to 2014 to understand the demographics, clinical manifestations, therapeutic approaches, and factors associated with prognosis in this population. All cases were diagnosed according to the 2008 European Organization for the Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infection Diseases Mycoses Study Group definition criteria. Results A total of 112 cases of pulmonary fungal diseases were enrolled (35 proven, 16 probable, 61 possible), and we analyzed the 35 patients with histologically proven pulmonary fungal diseases in this study. The main fungal species identified were Aspergillus (51.4 %), Cryptococcus (22.9 %), and Mucor (2.4 %). Treatment consisted of antifungal therapeutic agents (54.3 %), surgery and postsurgical agents (25.7 %), or surgery alone (14.3 %). The overall crude mortality rate was 14.3 %, and the mortality due to pulmonary fungal infections was 2.9 %. Significant predictors of mortality by univariate analysis were hypoalbuminemia ( P  = 0.005), cancer ( P  = 0.008), and positive culture ( P  = 0.044). Additionally, hypoalbuminemia was the only risk factor for mortality by multivariate analysis ( RR  = 7.56, 95 % CI 1.38–41.46). Conclusion Pulmonary fungal disease in immunocompetent patients, with Aspergillus as the most common identified species, had a prognosis that was influenced by the level of serum albumin.