Farhad Ghanaat1, John A Tayek1. 1. Department of Internal Medicine, Los Angeles BioMedical Research Institute (LaBioMed), Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, USA.
Abstract
Well-established risk factors for aspergillosis include HIV, cancer, recent corticosteroid (prednisone) therapy, chemotherapy, or thoracic surgery. Non-established risk factors may include weight loss and a history of diabetes. Twenty-three patients without the classical risk factors for IA were identified retrospectively at Harbor UCLA Medical Center by discharge diagnosis over a 20 year period (1992-2012). None of the well-known risk factors are for Invasive Apergillious (IA). A history of weight loss was seen in 66% of the patients with IA (15 of 23). The weight loss ranged from 3.3 lbs to 43 lbs. In patients with weight loss the average loss was 22±3 lbs (mean±SEM). In this small group of patients with IA, diabetes was seen in 8 of the 23 (34%), which is significantly higher than the 19% incidence of diabetes seen in 100 patients with severe sepsis (p<0.05). Likewise, the 34% incidence of diabetes was higher than the 21% incidence reported in immunocompromised patients with invasive aspergillus (IA) infection (p<0.05). A reduced serum albumin concentration was seen in 33% of the study patients, which was less common than the 87% incidence seen in patients with severe sepsis or candidaemia (54%). Seventeen of the 23 patients had pulmonary involvement. While no one had a well-established risk factor for aspergillious, four patients had alcoholism as a potential risk factor. Eleven of the 23 (48%) died during the hospital stay despite antifungal therapy. Immunocompromised patients are known to have a mortality rate of approximately 45% for pulmonary or disseminated disease. CONCLUSION: The incidence of diabetes was greater than seen in immunocompromised patients and may be considered an additional risk factor for the development of aspergillois infection. In addition, a history of weight loss should increase the suspicion for the diagnosis of IA in otherwise a non-immunocompromised patient. Early recognition and treatment of aspergillosis in the non-immunocompromised patient may improve outcome. Weight loss and diabetes should be added to the list of well-known risk factors for invasive aspergillosis and its high mortality rate.
Well-established risk factors for aspergillosis include HIV, cancer, recent corticosteroid (prednisone) therapy, chemotherapy, or thoracic surgery. Non-established risk factors may include weight loss and a history of diabetes. Twenty-three patients without the classical risk factors for IA were identified retrospectively at Harbor UCLA Medical Center by discharge diagnosis over a 20 year period (1992-2012). None of the well-known risk factors are for Invasive Apergillious (IA). A history of weight loss was seen in 66% of the patients with IA (15 of 23). The weight loss ranged from 3.3 lbs to 43 lbs. In patients with weight loss the average loss was 22±3 lbs (mean±SEM). In this small group of patients with IA, diabetes was seen in 8 of the 23 (34%), which is significantly higher than the 19% incidence of diabetes seen in 100 patients with severe sepsis (p<0.05). Likewise, the 34% incidence of diabetes was higher than the 21% incidence reported in immunocompromised patients with invasive aspergillus (IA) infection (p<0.05). A reduced serum albumin concentration was seen in 33% of the study patients, which was less common than the 87% incidence seen in patients with severe sepsis or candidaemia (54%). Seventeen of the 23 patients had pulmonary involvement. While no one had a well-established risk factor for aspergillious, four patients had alcoholism as a potential risk factor. Eleven of the 23 (48%) died during the hospital stay despite antifungal therapy. Immunocompromised patients are known to have a mortality rate of approximately 45% for pulmonary or disseminated disease. CONCLUSION: The incidence of diabetes was greater than seen in immunocompromised patients and may be considered an additional risk factor for the development of aspergillois infection. In addition, a history of weight loss should increase the suspicion for the diagnosis of IA in otherwise a non-immunocompromised patient. Early recognition and treatment of aspergillosis in the non-immunocompromised patient may improve outcome. Weight loss and diabetes should be added to the list of well-known risk factors for invasive aspergillosis and its high mortality rate.
Entities:
Keywords:
albumin; cachexia; diabetes; malnutrition; weight loss
Authors: Mohamed Y Rady; Daniel J Johnson; Bhavesh M Patel; Joel S Larson; Richard A Helmers Journal: Mayo Clin Proc Date: 2005-12 Impact factor: 7.616
Authors: M Weinberger; L Leibovici; S Perez; Z Samra; I Ostfeld; I Levi; E Bash; D Turner; A Goldschmied-Reouven; G Regev-Yochay; S D Pitlik; N Keller Journal: J Hosp Infect Date: 2005-10 Impact factor: 3.926
Authors: Raoul Herbrecht; David W Denning; Thomas F Patterson; John E Bennett; Reginald E Greene; Jörg-W Oestmann; Winfried V Kern; Kieren A Marr; Patricia Ribaud; Olivier Lortholary; Richard Sylvester; Robert H Rubin; John R Wingard; Paul Stark; Christine Durand; Denis Caillot; Eckhard Thiel; Pranatharthi H Chandrasekar; Michael R Hodges; Haran T Schlamm; Peter F Troke; Ben de Pauw Journal: N Engl J Med Date: 2002-08-08 Impact factor: 91.245
Authors: Savita Manglik; Eugene Flores; Laura Lubarsky; Fernando Fernandez; Vijay L Chhibber; John A Tayek Journal: Crit Care Med Date: 2003-06 Impact factor: 7.598
Authors: Marina E Kirkland; McKenzie Stannard; Caitlin H Kowalski; Dallas Mould; Alayna Caffrey-Carr; Rachel M Temple; Brandon S Ross; Lotus A Lofgren; Jason E Stajich; Robert A Cramer; Joshua J Obar Journal: mSphere Date: 2021-12-08 Impact factor: 4.389