Chest
Volume 120, Issue 1, July 2001, Pages 177-184
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Clinical Investigations
Infection
Pulmonary Fungal Infection: Emphasis on Microbiological Spectra, Patient Outcome, and Prognostic Factors

https://doi.org/10.1378/chest.120.1.177Get rights and content

Study objectives

To investigate the microbiologicalspectra, patient outcome, and prognostic factors of pulmonary fungalinfection.

Design

The medical and microbiologicalrecords of patients with pulmonary fungal infection wereretrospectively analyzed.

Setting

Auniversity-affiliated tertiary medical center.

Patients andmethods

From January 1988 to December 1997, all cases ofpulmonary fungal infection were reviewed. The criteria for inclusionwere obvious lung lesion shown on chest radiographs and one of thefollowing: (1) the presence of fungi in or isolation of fungi from thebiopsy specimen of open thoracotomy, thoracoscopy, transbronchial lungbiopsy, or ultrasound-guided percutaneous needle aspiration/biopsy; or(2) isolation of fungi from pleural effusion or blood, with no evidenceof extrapulmonary infection.

Results

A total of 140patients were included. Ninety-four cases of pulmonary fungal infection(67%) were community acquired. The most frequently encountered fungiwere Aspergillus species (57%), followed by Cryptococcus species(21%) and Candida species (14%). There were 72 patients with acuteinvasive fungal infection, with a mortality rate of 67%. Multivariatelogistic regression analysis showed that nosocomial infection(p = 0.014) and respiratory failure (p = 0.001) were significantlyand independently associated with death of acute invasive fungalinfection.

Conclusions

Pulmonary fungal infection ofcommunity-acquired origins is becoming a serious problem. It should betaken into consideration for differential diagnosis ofcommunity-acquired pneumonia. Furthermore, acute invasive fungalinfection is associated with a much higher mortality rate for patientswith nosocomial infection or complicating respiratory failure. Earlydiagnosis with prompt antifungal therapy, or even with surgicalintervention, might be warranted to save patients’lives.

Section snippets

Materials and Methods

The medical records of consecutive patients with diagnoses of pulmonary fungal infection treated at National Taiwan University Hospital during the period of January 1988 through December 1997 were reviewed. The inclusion of a patient required that the following criteria were met: obvious lung lesion shown on chest radiography and at least one of the following: (1) identification of fungi in biopsy specimens obtained from open thoracotomy, thoracoscopy, transbronchial lung biopsy, or

Clinical Characteristics

From January 1988 to December 1997, medical and microbiological records of 187 patients with pulmonary fungal infection were reviewed. Of these, 140 patients fulfilled the inclusion criteria by various diagnostic methods (Table 1). There were 74 patients included by pathologic examinations of biopsy specimens. Fifty-eight patients had fungi isolated from biopsy specimens, aspirated fluids, pleural effusions, or blood. Three patients had cryptococci confirmed by microscopic examinations of

Discussion

There has been an increasing incidence of pulmonary fungal infection at our hospital in the past decade. A large portion was acquired from sources other than the hospital. The most frequently encountered pathogens were Aspergillus species, followed by Cryptococcus species and Candida species. The major prognostic factors of acute invasive fungal infection were the source of fungal infection and the occurrence of respiratory failure.

Previous literature was concerned mostly with invasive and

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    Manusript received August 1, 2000; revision accepted February 14, 2001.

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