Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Differences in Clinical Characteristics of Invasive Tracheobronchial Aspergillosis according to the Presence of Invasive Pulmonary Aspergillosis

  • Pak, Chuiyong (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Jo, Woori (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Kim, Jin Hyoung (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Im, Jae Uk (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Jeong, Joseph (Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Cha, Hee Jeong (Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Choi, Eun-Young (Department of Internal Medicine, Yeungnam University Medical Center, University of Yeungnam College of Medicine) ;
  • Ra, Seung Won (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
  • Received : 2021.02.15
  • Accepted : 2021.06.23
  • Published : 2021.10.31
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Abstract

Background: The association of invasive tracheobronchial aspergillosis (ITBA) with invasive pulmonary aspergillosis (IPA) is not well established. We aimed to compare clinical characteristics between patients who exhibited ITBA with IPA and those who exhibited isolated ITBA (iITBA). Additionally, the usefulness of serum or bronchial galactomannan (GM) tests in diagnosing ITBA was evaluated. Methods: This retrospective single-center case-control study was conducted over a period of 4 years. Fifteen patients were enrolled after confirming the presence of ITBA using bronchoscopy-guided biopsy (iITBA, 7 vs. ITBA+IPA, 8). Clinical characteristics of patients and results obtained from serum or bronchial GM tests were compared between the two groups. Mortality was assessed using data collected from a 6-month follow-up period. Results: The ITBA+IPA group showed a higher prevalence of hematologic malignancy (75% vs. 14%, p=0.029), a greater number of patients with multiple bronchial ulcers (75% vs. 14%, p=0.029), lower platelet counts (63,000/μL vs. 229,000/μL, p<0.001), and a mortality rate which was significantly higher (63% vs. 0%, p=0.026) than the iITBA group. In the ITBA+IPA group, 57% of patients tested positive according to the serum GM assay, whereas in the iITBA group, all patients tested negative (p=0.070). The bronchial GM level was high in both groups, but there was no significant difference between them. Conclusion: Patients with ITBA+IPA had a greater number of hematologic malignancies with lower platelet counts and a poorer prognosis than patients diagnosed with iITBA. Findings obtained from bronchoscopy and bronchial GM tests were more useful in diagnosing ITBA than the serum GM test results.

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References

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