TABLE 1.
Characteristics of cases of IPA according to cytology results
| Characteristica | Total | Cytology positive | Cytology negative | P |
|---|---|---|---|---|
| No. (%) of patients | 67 | 28 (41.8) | 39 (58.0) | |
| Male (no. [%]) | 44 (65.7) | 21 (75.0) | 23 (59.0) | 0.201 |
| Age (mean ± SD) (yr) | 55.7 ± 15.4 | 53.7 ± 14.6 | 57.2 ± 15.9 | 0.363 |
| Race (no. [%]) | 0.174 | |||
| White | 51 (76.1) | 21 (75.0) | 30 (76.9) | |
| Nonwhite | 16 (23.9) | 7 (25.0) | 9 (23.1) | |
| Hematological disease (no. [%]) | 0.898 | |||
| Acute myeloblastic leukemia/myelodysplastic syndrome | 28 (39.3) | 13 46.4) | 15 (38.5) | |
| Acute lymphoblastic leukemia | 3 (4.5) | 2 (7.1) | 1 (2.6) | |
| Chronic myeloid leukemia | 5 (7.5) | 2 (7.1) | 3 (7.7) | |
| Chronic lymphoid leukemia | 9 (13.4) | 4 (14.3) | 5 (12.8) | |
| Multiple myeloma | 5 (7.5) | 2 (7.1) | 3 (7.7) | |
| Lymphoma | 17 (25.4) | 5 (17.9) | 12 (30.8) | |
| Status of malignancy (no. [%]) | 0.180 | |||
| Active | 42 (62.7) | 14 (50) | 28 (71.8) | |
| Remission | 19 (28.4) | 11 (39.3) | 8 (20.5) | |
| Unknown | 6 (8.9) | 3 (10.7) | 3 (7.7) | |
| SCT (no. [%]) | 31 (46.3) | 18 (64.3) | 13 (33) | 0.015 |
| SCT type | 0.377 | |||
| Autologous (no./total no. [%]) | 7/31 (22.6) | 3 (16.7) | 4 (30.8) | |
| MUD allogenic (no./total no. [%]) | 14/31 (45.2) | 10 (55.6) | 4 (30.8) | |
| MRD allogenic (no./total no. [%]) | 9/31 (29.0) | 5 (27.8) | 4 (30.8) | |
| Cord blood (no. [%]) | 1 (3.2) | 0 (3.2) | 1 (7.7) | |
| Comorbidity (no. [%]) | ||||
| Diabetes mellitus | 7 (10.4) | 2 (7.1) | 5 (12.8) | 0.690 |
| COPD or other lung disease | 6 (8.9) | 2 (7.1) | 4 (10.3) | 1 (NS) |
| ICU admission (no. [%]) | 8 (11.9) | 2 (7.1) | 6 (15.4) | 0.419 |
| Leukocyte count (mean ± SD) (leukocytes/ml) | 210.7 ± 1,548.2 | 446.1 ± 2,303.7 | 16.9 ± 52.7 | 0.333 |
| Neutrophil proportion (mean ± SD) (%) | 69.6 ± 111.7 | 92.4 ± 158.6 | 49.9 ± 34.5 | 0.157 |
| Lymphocyte proportion (mean ± SD) (%) | 21.5 ± 26.1 | 17.1 ± 22.7 | 25.1 ± 28.5 | 0.255 |
| Recent neutropenia (<500 neutrophils/ml for >10 days) (no. [%]) | 15 (22.4) | 7 (25.0) | 8 (20.5) | 0.769 |
| Serum Aspergillus galactomannan positive (no./total no. tested [%]) | 13/30 (43.3) | 6 (66.7) | 7 (33.3) | 0.123 |
| Prolonged use of corticosteroids (no. [%]) | 22 (32.8) | 11 (39.3) | 11 (28.2) | 0.431 |
| Prior azole exposure (no. [%]) | 30 (44.8) | 21 (75.0) | 16 (41.0) | 0.007 |
| Prior fluconazole treatment | 28 (41.8) | 15 (53.6) | 13 (33.3) | 0.133 |
| Prior Aspergillus-active azole treatment | 17 (25.4) | 9 (32.1) | 8 (20.5) | 0.394 |
| Chest CT imaging or X-ray findings (no. [%]) | ||||
| Bilateral lesions | 50 (74.6) | 22 (78.6) | 28 (71.8) | 0.581 |
| Central lesions | 8 (11.9) | 4 (14.3) | 4 (10.3) | 0.711 |
| Cavitary lesions | 11 (16.4) | 9 (32.1) | 2 (5.1) | 0.006 |
| BAL fluid analysis results | ||||
| Direct smear (calcofluor white staining) positive (no./total no. tested [%]) | 2/67 (2.9) | 1 (3.6) | 1 (2.6) | 0.999 |
| Proportion of macrophages with hemosiderin (mean ± SD [median [IQR]]) (%) | 26.9 ± 33.5 (5 [0–50]) | 19.5 ± 28.4 | 32.1 ± 36.1 | 0.133 |
| Aspergillus sp. (no. [%]) | ||||
| A. fumigatus | 34 (50.7) | 16 (57.1) | 18 (46.2) | 0.460 |
| A. flavus | 6 (8.9) | 3 (10.7) | 3 (7.7) | 0.688 |
| A. terreus | 17 (25.4) | 4 (14.3) | 13 (33.3) | 0.094 |
| A. niger | 4 (6.0) | 0 (0.0) | 4 (10.3) | 0.134 |
| Other | 2 (3.0) | 1 (3.6) | 1 (2.6) | 0.999 |
| Mixed | 4 (6.0) | 4 (14.3) | 0 (0.0) | 0.027 |
| Galactomannan positive (no./total no. tested [%]) | 5/12 (41.7) | 0 (0.0) | 5 (45.5) | 0.999 |
| Culture results (no./total no. tested [%]) | ||||
| BAL (aimed at lesion) fluid sample positive | 53/64 (82.8) | 26 (92.9) | 27 (69.2) | 0.007 |
| Bronchial washing (bilateral) sample positive | 27/39 (69.2) | 9 (32.1) | 18 (46.2) | 0.456 |
| Both BAL fluid and bronchial washing samples positive | 15/36 (41.6) | 9 (32.1) | 6 (15.4) | 0.006 |
| Sampling of >1 lobe (no. [%]) | 12 (17) | 6 (21.4) | 6 (15.4) | 0.374 |
| Diagnosis of IPA (no. [%]) | 0.999 | |||
| Proven | 2 (3.0) | 1 (3.6) | 1 (2.6) | |
| Probable | 65 (97) | 27 (96.4) | 38 (97.4) | |
| 42-day death (no. [%]) | 19 (28.4) | 9 (32.1) | 10 (25.6) | 0.354 |
| Time from infection to death (mean ± SD [median [IQR]]) (days) | 19 ± 12.9 (22 [5–28]) | 17.9 ± 16.4 | 20.2 ± 9.67 | 0.718 |
a
MUD, matched unrelated donor; MRD, matched related donor; COPD, chronic obstructive pulmonary disease; ICU, intensive care unit; NS, not significant.