Pulmonary fungal infection - Emphasis on microbiological spectra, patient outcome, and prognostic factors

Study objectives: To investigate the microbiological spectra, patient outco me, and prognostic factors of pulmonary fungal infection. Design: The medical and microbiological records of patients with pulmonary fungal infection were retrospectively analyzed. Setting: A university-affiliated tertiary medical center. Patients and methods: From January 1988 to December 1997, all cases of pulm onary fungal infection were reviewed. The criteria for inclusion were obvio us lung lesion shown on chest radiographs and one of the following: (1) the presence of fungi in or isolation of fungi from the biopsy specimen of ope n thoracotomy, thoracoscopy, transbronchial lung biopsy, or ultrasound-guid ed percutaneous needle aspiration/biopsy; or (2) isolation of fungi from pl eural effusion or blood, with no evidence of extrapulmonary infection. Results: A total of 140 patients were included. Ninety-four cases of pulmon ary fungal infection (67%) were community acquired. The most frequently enc ountered fungi were Aspergillus species (57%), followed by Cryptococcus spe cies (21%) and Candida species (14%), There were 72 patients with acute inv asive fungal infection, with a mortality rate of 67%. Multivariate logistic regression analysis showed that nosocomial infection (p = 0.014) and respi ratory failure (p = 0.001) were significantly and independently associated with death of acute invasive fungal infection. Conclusions: Pulmonary fungal infection of community-acquired origins is be coming a serious problem. It should be taken into consideration for differe ntial diagnosis of community-acquired pneumonia, Furthermore, acute invasiv e fungal infection is associated with a much higher mortality rate for pati ents with nosocomial infection or complicating respiratory failure. Early d iagnosis with prompt antifungal therapy, or el en with surgical interventio n, might be warranted to save patients' lives.