Department of Medical Intensive Care.
MP3CV-EA 7517.
Am J Respir Crit Care Med. 2020 Sep 1;202(5):708-716. doi: 10.1164/rccm.201910-1931OC.
Invasive tracheobronchial aspergillosis (ITBA) is an uncommon but severe clinical form of invasive pulmonary aspergillosis in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. To analyze the diagnostic and prognostic differences between tracheobronchial aspergillosis and pulmonary aspergillosis without tracheobronchial lesions among patients admitted to the ICU with severe influenza. This retrospective, observational study included critically ill patients with influenza associated with pulmonary aspergillosis from three hospital ICUs between 2010 and 2019. Patient characteristics and clinical and mycologic data at admission and during ICU stay were collected in a database to evaluate variables in the two groups. Thirty-five patients admitted to the ICU with severe influenza and pulmonary aspergillosis were included. Ten patients were included in the group with ITBA ( = 10 of 35; 28.6%), and 25 patients were included in the group without ITBA. The group with ITBA comprised more patients with active smoking, diabetes mellitus, and higher severity scores (Simplified Acute Physiology Score II). Ninety-day mortality rates in the groups with and without ITBA were 90% and 44%, respectively ( = 0.02). Moreover, significantly higher serum 1,3-β-d-glucan and galactomannan and BAL fluid galactomannan concentrations were observed in the group with ITBA compared with the group without ITBA ( < 0.0001, = 0.003, and = 0.008, respectively). ITBA was associated with higher severity scores, mortality, and serum and BAL fluid galactomannan and 1,3-β-d-glucan concentrations than invasive pulmonary aspergillosis without tracheobronchial lesions. ITBA should be systematically researched by bronchoscopic examination in ICU patients with concomitant pulmonary aspergillosis and influenza.Clinical trial registered with www.clinicaltrials.gov (NCT04077697).
气管支气管曲霉病（ITBA）是一种罕见但严重的侵袭性肺曲霉病临床形式，其中真菌感染完全或主要局限于气管支气管树。分析 ICU 收治的严重流感患者中气管支气管曲霉病与无气管支气管病变的肺曲霉病之间的诊断和预后差异。本回顾性观察性研究纳入了 2010 年至 2019 年期间来自三个医院 ICU 的与流感相关的伴有肺曲霉病的重症患者。在数据库中收集入院时和 ICU 住院期间的患者特征和临床及真菌学数据，以评估两组中的变量。共纳入 35 例 ICU 收治的严重流感和肺曲霉病患者。10 例患者纳入 ITBA 组（ = 10/35；28.6%），25 例患者纳入无 ITBA 组。ITBA 组更多患者有吸烟、糖尿病和更高的严重程度评分（简化急性生理学评分 II）。两组 90 天死亡率分别为 90%和 44%（ = 0.02）。此外，与无 ITBA 组相比，ITBA 组的血清 1,3-β-d-葡聚糖和半乳甘露聚糖以及 BAL 液半乳甘露聚糖浓度显著更高（ < 0.0001， = 0.003 和 = 0.008，分别）。与无气管支气管病变的侵袭性肺曲霉病相比，ITBA 与更高的严重程度评分、死亡率以及血清和 BAL 液半乳甘露聚糖和 1,3-β-d-葡聚糖浓度相关。在合并肺曲霉病和流感的 ICU 患者中，应通过支气管镜检查系统地研究 ITBA。临床试验在 www.clinicaltrials.gov 注册（NCT04077697）。
