Jiwon Jung1, Hyo-Lim Hong2, Sang-Oh Lee1, Sang-Ho Choi1, Yang Soo Kim1, Jun Hee Woo1, Sung-Han Kim3. 1. Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea. 2. Division of Infectious Diseases, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea. 3. Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, University of Ulsan, Seoul, Republic of Korea. Electronic address: kimsunghanmd@hotmail.com.
Abstract
OBJECTIVES: Clinical and radiologic deterioration is sometimes observed during neutrophil recovery in patients with invasive pulmonary aspergillosis (IPA). This deterioration can be caused by immune reconstitution inflammatory syndrome (IRIS) as well as by progression of the IPA. However, there is limited data on IRIS in neutropenic patients. METHODS: Over a 6-year period, adult patients with neutropenia who met the criteria for probable or proven IPA by the revised EORTC/MSG definition were retrospectively enrolled. IRIS was defined as de novo appearance or worsening of radiologic pulmonary findings temporally related to neutrophil recovery, with evidence of a decrease of 50% in serum galactomannan level. RESULTS: Of 153 patients, 36 (24%, 95% CI 18%-31%) developed IRIS during neutrophil recovery. More of these patients received voriconazole than did those with non-IRIS (42% vs. 25%, P = 0.05). Thirty- and ninety-day mortalities were lower in the patients with IRIS than in those with non-IRIS (11% vs. 33%, P = 0.01, and 33% vs. 58%, P = 0.01, respectively). CONCLUSION: IRIS is relatively common among neutropenic patients with IPA, occurring in about one quarter of such patients. It is associated with voriconazole use and has a good prognosis.
OBJECTIVES: Clinical and radiologic deterioration is sometimes observed during neutrophil recovery in patients with invasive pulmonary aspergillosis (IPA). This deterioration can be caused by immune reconstitution inflammatory syndrome (IRIS) as well as by progression of the IPA. However, there is limited data on IRIS in neutropenicpatients. METHODS: Over a 6-year period, adult patients with neutropenia who met the criteria for probable or proven IPA by the revised EORTC/MSG definition were retrospectively enrolled. IRIS was defined as de novo appearance or worsening of radiologic pulmonary findings temporally related to neutrophil recovery, with evidence of a decrease of 50% in serum galactomannan level. RESULTS: Of 153 patients, 36 (24%, 95% CI 18%-31%) developed IRIS during neutrophil recovery. More of these patients received voriconazole than did those with non-IRIS (42% vs. 25%, P = 0.05). Thirty- and ninety-day mortalities were lower in the patients with IRIS than in those with non-IRIS (11% vs. 33%, P = 0.01, and 33% vs. 58%, P = 0.01, respectively). CONCLUSION: IRIS is relatively common among neutropenicpatients with IPA, occurring in about one quarter of such patients. It is associated with voriconazole use and has a good prognosis.
Authors: Maura Manion; Dimana Dimitrova; Luxin Pei; Juan Gea-Banacloche; Adrian Zelazny; Andrea Lisco; Christa Zerbe; Alexandra F Freeman; Steven M Holland; Christopher G Kanakry; Jennifer A Kanakry; Irini Sereti Journal: Clin Infect Dis Date: 2020-02-03 Impact factor: 9.079
Authors: Kai Rejeski; Wolfgang G Kunz; Martina Rudelius; Veit Bücklein; Viktoria Blumenberg; Christian Schmidt; Philipp Karschnia; Florian Schöberl; Konstantin Dimitriadis; Louisa von Baumgarten; Joachim Stemmler; Oliver Weigert; Martin Dreyling; Michael von Bergwelt-Baildon; Marion Subklewe Journal: BMC Infect Dis Date: 2021-01-28 Impact factor: 3.090