Invasive aspergillesis in immunocompromised patients

Aim. To analyse results of treatment of invasive aspergillesis in immunocompromised patients for 2000-2002. Material and methods. The study was made of patients who, when treated with antibiotics, exhibited foci in the lungs typical for invasive aspergillesis. Aspergillus were detected in the sputum, bronchoalveolar lavage, bronchial wash-ups, aspergilla antigen (galactomannan) was detected in the blood. Results. Invasive aspergillesis was diagnosed in 25 patients. 13 (52%) patients were treated with adjuvant glucocorticoids. 19 (76%) patients had neutropenia. All the patients had fever. Foci in the lungs were in 24 patients. Aspergillus were detected in 15 patients, a positive antigen galactomannan in 7 patients. A. Fumigatus, A flavus, A. Niger occurred in 67, 26.5 and 6.5% patients, respectively. All the patients received amphotericin В (median of the treatment reached 38 days, total dose 880-3500 mg). In 5 patients amphotericin В was replaced for liposomal amphotericin В because of high creatinine. 7 patients continued with itraconasol in a dose 400-600mg/day. The foci were removed in 3 patients. The cure was achieved in 12 patients, 13 patients died (cause of death - respiratory insufficiency). Conclusion. Lethality in invasive aspergillesis in immunocompromised patients remains high - 52%. Cultural detection of mycelial fungi was, as a rule, delayed. Early diagnosis of the disease requires monitoring of the aspergilla antigen in the blood and computer tomography of the chest especially in fever persisting in the treatment of wide-spectrum antibiotics.