Kiertiburanakul Sasisopin, Thibbadee Chittima, Santanirand Pitak
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama 6 Rd, Bangkok 10400, Thailand.
J Med Assoc Thai. 2007 May;90(5):895-902.
Invasive aspergillosis (1A) is one of the most common and serious fungal infections in immuno-compromised host. Available data regarding IA among Asian patients are limited.
To determine patients' characteristics, clinical presentation, treatment, and outcomes of patients with IA in a Tertiary-care Hospital in Thailand.
The authors retrospectively reviewed medical and laboratory records of adult patients with IA from January 2000 to December 2005.
Ninety-four patients were identified and classified as proven (n = 35), probable (n = 10), and possible IA (n = 49) according to the criteria designed for cancer patients (EORTC/MSG). Mean +/- SD age was 48 +/- 19 (range, 17-89) years old and 54 patients (57%) were male. Acute leukemia was the most common underlying condition (30%). Major predisposing factors were neutropenia (39%), chemotherapy (34%), and receiving corticosteroid therapy (25%). Common sites of infection were lungs (68%), sinus (17%), and eyes (8%). Aspergillus fumigatus (67%) was the most frequently isolated species. Amphotericin B followed by itraconazole was the mainstay of treatment. Thirty-six patients (38%) had complete or partial response to therapy whereas 44 patients (47%) died due to aspergillosis. Multivariate analysis showed that corticosteroid therapy [hazard ratio (HR) 10.65; 95% confidence interval (CI) 1.03-110.15, p = 0.047] and pulmonary infection [HR 18.06; 95% CI 4.28-76.17, p < 0.001] were significant predictive factors of death.
Epidemiology and outcomes of IA among Thai patients were comparable to those in Western countries. Early diagnosis of lA in patients at risk is still essentially required in order to offer appropriate therapy, decrease morbidity, and mortality rate.
侵袭性曲霉病（IA）是免疫功能低下宿主中最常见且严重的真菌感染之一。亚洲患者中关于IA的现有数据有限。
确定泰国一家三级医院中IA患者的特征、临床表现、治疗及预后情况。
作者回顾性分析了2000年1月至2005年12月期间成年IA患者的医疗和实验室记录。
根据针对癌症患者设计的标准（欧洲癌症研究与治疗组织/美国国立医学研究院，EORTC/MSG），共识别出94例患者，并分为确诊（n = 35）、拟诊（n = 10）和可能的IA（n = 49）。平均年龄±标准差为48±19（范围17 - 89）岁，54例患者（57%）为男性。急性白血病是最常见的基础疾病（30%）。主要的易感因素为中性粒细胞减少（39%）、化疗（34%）以及接受糖皮质激素治疗（25%）。常见的感染部位为肺部（68%）、鼻窦（17%）和眼部（8%）。烟曲霉（67%）是最常分离出的菌种。两性霉素B随后是伊曲康唑是主要的治疗药物。36例患者（38%）对治疗有完全或部分反应，而44例患者（47%）死于曲霉病。多因素分析显示糖皮质激素治疗[风险比（HR）10.65；95%置信区间（CI）1.03 - 110.15，p = 0.047]和肺部感染[HR 18.06；95% CI 4.28 - 76.17，p < 0.001]是死亡的显著预测因素。
泰国患者中IA的流行病学及预后情况与西方国家相当。对于有风险的患者，IA的早期诊断对于提供适当治疗、降低发病率和死亡率仍然至关重要。
