Aspergillus Infections Still Present Treatment Challenge

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Aspergillosis Treatment Remains Suboptimal

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NEW YORK (Reuters Health) Dec 26 - Infection with

Aspergillus species remains a significant risk factor

for shortened survival, according to a report in the

December 1st issue of Clinical Infectious Diseases.

Dr. Perfect from Duke University Medical Center

in Durham, North Carolina and colleagues in the

Mycoses Study Group studied the spectrum of

aspergillosis at 24 medical centers by examining the

factors associated with 1477 Aspergillus-positive

cultures in 1209 patients.

Aspergillus fumigatus was the most common cause of

invasive aspergillosis, the authors report, though A.

terreus and A. flavus were also commonly isolated.

Only 245 of the patients had clinical disease, the

report indicates, with 148 cases of invasive

aspergillosis, 43 cases of aspergilloma, 35 cases of

allergic bronchopulmonary aspergillosis (ABPA), and 19

cases of chronic necrotizing aspergillosis.

Invasive aspergillosis was more common among patients

with underlying diseases or conditions (including bone

marrow or solid organ transplants, hematologic cancer,

HIV infection), neutropenia, and malnutrition, the

researchers note.

More than half the patients with invasive

aspergillosis died within 3 months of a positive

culture, despite treatment with amphotericin B, Dr.

Perfect and colleagues found, with 38% of these deaths

directly attributed to aspergillosis.

Survival at 3 months was higher among patients with

chronic necrotizing aspergillosis (63%), aspergilloma

(81%), or ABPA (100%), the investigators say.

" Successful management of invasive aspergillosis

remains a great challenge, " the authors conclude.

" Despite the use of polyenes and azoles, the rate of

failure of invasive aspergillosis treatment remains

unacceptably high. "

Clin Infect Dis 2001;33:1824-1833.

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