Methods: We conducted a retrospective chart review of patients who had a fungal isolate in a pleural fluid culture between 1/2005 and 8/2013. Based on EORTC/MSG diagnostic definition, FET was classified as a proven fungal disease (PFD), probable fungal disease or indeterminate, and risks for fungal infection were grouped as high risk (HR) and intermediate-low risk (IR).
Results: A total of 106 fungal isolates were identified in 97 patients. Candida spp. (58%) (mainly C. albicans and C. glabrata) and Aspergillus spp. (10%) were the most frequent pathogens. Compared to Aspergillus, Candida FET was associated with IR (81% vs. 36%, P=0.01), and preceding invasive thorasic or abdominal procedures (44% vs. 0%, P=0.01). In addition, patients with FET due to Candida spp. had frequent surgical drainage for empyema (65% vs. 27%, P=0.04) and better outcome (37% vs. 60%, P=0.32). All 11 pts with Aspergillus FET, and 83% of pts with Candida FET (45/54) were classified as a PFD. Three of Aspergillus group and 29% of Candida group (13/45), however, did not receive systemic antifungals (SA), but only one patient in each group (excluded one and three patients who lost follow up, respectively) had a poor outcome at six week (1/2, 50% and 1/10, 10%, respectively). Interestingly, eight out of the nine Candida untreated patients who had a favorable outcome without SA had IR. In non-Aspergillus molds, Penicillium spp. (N=12) were mainly isolated, however, excluded from this analysis since it is often considered as a laboratory contamination. Despite eleven patients with saprophytic molds were classified as a PFD, only one of them had persistent positive cultures. Most of the rest (8/10) were classified as IR, and did well without SA, except for one whose death was attributed to an underlying cancer.
Conclusion: While Candida FET was more frequent and associated with preceding procedures and IR, Aspergillus FET had a higher mortality. Most saprophytic molds appeared to represent non-pathologic isolates in pleural fluid, especially in IR patients.
M. Vial, None
Y. Jiang, None
J. J. Tarrand, None
C. Jimenez, None
D. P. Kontoyiannis, Merck: Scientific Advisor , Research support
Pfizer: Research support , Research support
Gilead: Speaker's Bureau , Speaker honorarium
Astellas: Consultant and Speaker's Bureau , Speaker honorarium
F2G: Consultant , Consulting fee
T2 Biosystems: Speaker's Bureau , Speaker honorarium
Mylan, Inc: Speaker's Bureau , Speaker honorarium