Epidemiology of invasive aspergillosis and risk factors in non neutropaenic patients - 19/10/10

Doi : 10.1016/j.rmr.2010.01.004

J.-P. Gangneux ^a,^⁎ , C. Camus ^b, B. Philippe ^c
^a EA SeRAIC 4427, IRSET, parasitology-mycology laboratory, centre hospitalier universitaire de Rennes, université Rennes-1, 1, rue Henri-le-Guilloux, 35000 Rennes, France
^b Infectious Diseases and medical Intensive Care department, university hospital, Rennes, France
^c Chest Clinic, hôpital Foch, Suresnes, France

Corresponding author.

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Summary

Introduction

Invasive aspergillosis is a major cause of mortality in allogeneic bone marrow transplant recipients and patients treated for blood malignancies. The diagnostic tools, treatments and preventive strategies, essentially developed for neutropaenic patients, have not been assessed in populations whose immune systems are considered to be competent.

State of the art

Beside the standard picture of chronic Aspergillus infection, the incidence of invasive aspergillosis is increasing in non neutropaenic patients, such as those with chronic lung diseases or systemic disease treated with long-term immunosuppressive drugs and solid organ transplant recipients. This study reviews the specific features of invasive aspergillosis in non neutropaenic subjects (NNS) and discusses the value of the diagnostic tools and treatment in this population.

Prospects

A better understanding of the pathophysiology and the epidemiological characteristics of invasive aspergillosis would provide a means of adapting the staging and classification of the disease for NNS.

Conclusions

Invasive aspergillosis is under diagnosed in NNS who may already be colonised when they receive immunosuppressive treatment; this can lead to an adverse outcome in patients who are considered to be a moderate risk population.

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Keywords : Invasive aspergillosis, Aspergillus fumigatus, Non neutropaenic, Solid organ transplantation, Immunosuppressive treatment

Esquema

Introduction

Epidemiology and pathophysiology

Invasive aspergillosis in patients with chronic respiratory disorders

Invasive aspergillosis in solid organ transplant recipients

Invasive aspergillosis in non-transplanted non neutropaenic patients

Principles of diagnosis

Laboratory findings

Principles of treatment

Conclusion

To cite the present paper, use exclusively the following reference: Gangneux JP, Camus C, Philippe B. Épidémiologie et facteurs de risque de l’aspergillose invasive du sujet non neutropénique (full text in english on www.em-consulte.com/revue/rmr). Rev Mal Respir 2008;25:139–53: doi: RMR-02-2008-25-2-01761-8425-101019-200802945.