PULMONARY FUNGAL-INFECTIONS IN IMMUNOCOMPROMISED PATIENTS - INCIDENCEAND RISK-FACTORS

In a prospective study, 178 patients with fever > 38.4 degrees C and n ewly diagnosed pulmonary infiltrates underwent bronchoscopy with bronc hoalveolar lavage (BAL), aspiration of bronchial secretions (BS) and, in 71 cases, protected specimen brushing (PSB). In 42/143 immunocompro mised patients (haematological malignancies, n = 92; AIDS, n = 22; imm unosuppressant therapy, n = 29) and in 4/35 patients with no defined u nderlying disease fungal pneumonia was present (candidosis, n = 35; as pergillosis, n = 8 mixed fungal infection, n = 3). Candidosis was comb ined, in 17 cases, with Aspergillus (n = 3), bacterial (n = 15) or cyt omegalovirus (n = 2) infection. Aspergillosis was combined in eight ca ses with infection with Candida (n = 3), Pneumocystis carinii (n = 1) or bacteria (n = 5). The sensitivity of BAL and PSB in Candida pneumon ia was 48% and 50%, respectively; specificity was 75% and 74% respecti vely. Bronchial secretions were more sensitive in detecting Candida pn eumonia, but specificity was only 55%. In aspergillosis, the specifici ty of BAL, BS and PSB in each case was 100%; the sensitivity of BAL, B S and PSB was 38%, 64% and 100%. Twenty-four fungal infections were fa tal. Unfavourable prognostic factors were respiratory failure needing mechanical ventilation, diffuse bilateral pulmonary infiltrates, mixed fungal infections and start of i.v. antifungal treatment > 14 days af ter fever onset, which were associated with a mortality rate of 74%, 6 7%, 67% and 63% respectively.