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Respiratory infection
Clinical manifestations and outcomes of pulmonary aspergillosis: experience from Pakistan
  1. Nousheen Iqbal1,
  2. Muhammad Irfan1,
  3. Ali Bin Sarwar Zubairi1,
  4. Kauser Jabeen2,
  5. Safia Awan3 and
  6. Javaid A Khan1
  1. 1Department of Medicine, Section of Pulmonary and Critical Care, Aga Khan University Hospital, Karachi, Pakistan
  2. 2Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
  3. 3Department of Medicine, Aga Khan University, Karachi, Pakistan
  1. Correspondence to Dr Nousheen Iqbal; Nousheen.iqbal{at}aku.edu

Abstract

Introduction Pulmonary aspergillosis has variable course of illness, severity and outcomes depending on underlying conditions. There is limited data available on the clinical manifestations and outcome of pulmonary aspergillosis from Pakistan.

Methods To determine the clinical manifestations and outcome of pulmonary aspergillosis in a tertiary care hospital a retrospective study was conducted from 2004 to 2014 in patients admitted with pulmonary aspergillosis at the Aga Khan University Hospital Karachi, Pakistan.

Results Of the 280 cases with provisional diagnosis of aspergillosis 69 met the inclusion criteria. The mean age was 45±15.7 years, 48 (69.6%) were men and 21 (30.4%) had diabetes mellitus (DM). The average length of hospital stay (LOS) was 10.61±9.08 days. Aspergillus fumigatus was the most common (42.0%), followed by Aspergillus flavus (28.9%). More than one-third of patients previously had tuberculosis (TB) (39.13%). The commonest pulmonary manifestation was chronic pulmonary aspergillosis (CPA) 47 (68.1%) followed by invasive pulmonary aspergillosis (IPA) 12 (17.4%) and subacute invasive aspergillosis (SAIA) 8 (11.6%). Surgical excision was performed in 28 patients (40.57%). Intensive care unit admission was required for 18 patients (26.08%). Case fatality rate was 14/69 (20.3%). DM, mean LOS and hypoxic respiratory failure were identified as independent risk factors of mortality on multivariate analysis.

Conclusion A. fumigatus was the most frequent species found especially in patients with prior TB. CPA was the commonest pulmonary manifestation seen as post TB sequel. Diabetes, hypoxic respiratory failure and increased LOS were independent predictors of poor outcomes. Overall patients had good outcome with CPA compared with SAIA and IPA.

  • Aspergillus Lung Disease
  • Respiratory Infection
  • Tuberculosis

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjresp-2016-000155

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    Footnotes

    • Contributors NI and MI have made contributions to conception and design, interpretation of data, drafting of the manuscript and revising it critically for important intellectual content. ABSZ has made contributions to interpretation of data, and drafting of the manuscript. KJ and JAK have made contributions in drafting of the manuscript and revising it critically for important intellectual content. SA has made contributions to acquisition and interpretation of data; and in drafting of the manuscript. All authors have read and approved the final manuscript.

    • Competing interests None declared.

    • Ethics approval Ethical approval was taken from Ethical Review Committee of Aga Khan University Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data set supporting the conclusions of this article is included within the article.