621. Invasive Aspergillosis (IA) in the “Low-Risk” Host: Epidemiology & Risk Factors
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Invasive Aspergillosis is increasingly seen in patients who traditionally were not considered to be at risk for IA. The objective of this study was to describe the epidemiology & risk factors associated with IA in the “low-risk host”.

Methods: A retrospective cohort of pts with proven or probable IA using EORTC/MSG criteria was created. Pts with a history of neutropenia or hematologic malignancy were excluded.

Results: 36 pts with either proven or probable IA were identified over a 5-yr period; 23 pts were proven & 13 probable. Compared to pts with probable IA, pts with proven IA had lower APACHE II scores and were less likely to have had a transplant. The mean age of pts was 55 yrs old (range 21-84 yrs), 58% were male and 58% were white. The most common risk factors included ICU stay 53%, concomitant bacterial pneumonia 47% (P. aeruginosa, Haemophilus spp.), solid organ transplant 33%, renal failure 31%, diabetes & mechanical ventilation 28%, COPD 22%, sarcoidosis 19%, underlying liver disease & viral infections 14%, collagen vascular disease and alcohol abuse 8%. The most common medications associated with these pts included antimicrobials 89%, steroids, 69%, only 39% of pts were on any immunosuppresive regimen (tacrolimus 31%, mycophenolate 20%, sirolimus 11%). The most frequent sites of infection included the lungs 67%, sinuses 19%, and CNS 8%. A. fumigatus was the most commonly recovered species 63%, followed by A. niger 16%. The overall survival at 3 months was 81%.

Conclusion: This study describes the unique and different epidemiology & risk factors of IA in a population previously considered to be “low risk”. Awareness of these risk factors in the non-traditional hosts, an increased index of suspicion and earlier initiation of appropriate antifungal therapy could have an impact on the overall survival and response to therapy. Broader epidemiologic studies in similar populations are warranted to improve the understanding of this underestimated and under diagnosed infection.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Jose A. Vazquez Jr., MD , Henry Ford Hospital/Wayne State University School of Medicine, Detroit, MI
Maria Tovar-Torres, MD , Infectious Disease, Henry Ford Hospital/Wayne State University School of Medicine, Detroit, MI
Ameet Hingwe, MD , Infectious Diseases, Henry Ford Hospital, Detroit, MI
Faiqa Cheema, MD , Infectious Disease, Henry Ford Hospital/Wayne State University School of Medicine, Detroit, MI
Ahmad Zawawi, MD , Infectious Diseases, Henry Ford Hospital/Wayne State University School of Medicine, Detroit, MI
Verna L. Welch, Ph.D., MPH , US Medical Affairs, Pfizer, Inc, New York, NY
Kimbal Ford, Pharm.D. , US Medical Affairs, Pfizer, Inc, New York, NY

Disclosures:

J. A. Vazquez Jr., Yes
Pfizer: Collaborator, Grant Investigator, Investigator and Speaker's Bureau, Grant recipient, Research grant and Speaker honorarium

M. Tovar-Torres, None

A. Hingwe, None

F. Cheema, None

A. Zawawi, None

V. L. Welch, Yes
Pfizer, Inc.: Employee and Shareholder, Salary

K. Ford, Yes
Pfizer, Inc.: Employee,

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