Invasive aspergillosis in neutropenic patients: rapid neutrophil recovery is a risk factor for severe pulmonary complications

Background In invasive aspergillosis, the duration of neutropenia is an acc epted risk factor, and recovery from neutropenia is generally associated wi th a favourable outcome. However, the rapidity of granulocyte recovery may rarely be associated with adverse sequelae. The purpose of this study was t o define the relationship between neutrophil (polymorphonuclear, PMN) recov ery after chemotherapy-induced bone marrow aplasia and the occurrence of se vere pulmonary complications (haemoptysis, pneumothorax and death) in patie nts with haematological malignancies who developed invasive fungal pneumoni as. Methods Twenty consecutive patients were retrospectively studied; eight of them had developed pulmonary events between 5 and 11 days after neutrophil recovery that followed deep neutropenia (PMN < 100 mu L-1). Results Five patients had haemoptysis (one of these also had pneumothorax) and three had pneumothorax. According to the multiplicative logistic model, the odds of occurrence of a pulmonary event increased significantly with i ncreasing PMN count on the fifth day (P < 0.001). Five of the eight patient s who had pulmonary complications died. Also, the risk of death was larger in the presence of rapid neutrophil recovery, although the difference was n ot statistically significant (P = 0.111). Analysis of clinical and laborato ry data showed that the risk of pulmonary complications significantly incre ased when the neutrophil concentration was >4500 mu L-1 on day 5 after deep granulocyte neutropenia (PMN < 100 mu L-1). There was no correlation betwe en pulmonary complications, dosage of amphotericin B and deaths. Conclusion The occurrence of life-threatening complications in patients wit h invasive fungal pneumonia is closely related to rapid PMN recovery.