Invasive pulmonary aspergillosis in interstitial lung disease

A recent study published in BMC Pulmonary Medicine has shed light on the clinical features and risk factors associated with invasive pulmonary aspergillosis (IPA) in patients suffering from interstitial lung disease (ILD). Most ILD patients are not immunocompromised and yet affected by IPA, as in other conditions compromising lung function.

The main finding was a relatively high frequency of IPA in ILD – 16.4% of those ILD patients admitted to hospital. There are estimated to be 4.71 million people worldwide with ILD according to the Global Burden of Disease consortium.

Key findings of the study indicated that common symptoms of IPA in patients with ILD included persistent cough, fever (55%), and worsening respiratory distress. Radiological examinations often revealed new or expanding pulmonary infiltrates, nodules, or cavitations, which are often indicative of fungal infection, but notably halo and air crescent signs were rare (2%). Additionally, laboratory tests frequently showed elevated levels of inflammatory markers, such as C-reactive protein and erythrocyte sedimentation rate, alongside positive galactomannan assays.

Clinical associations with IPA were lymphopenia (OR = 2.745) and honeycombing on CT scan (OR = 2.915). Univariate risk factor analysis found prolonged corticosteroid therapy, especially with higher cumulative doses, nintedanib (but not pirfenidone) and autoimmune disease linked, which were not confirmed on multivariate analysis. The study also highlighted that patients with a rapidly progressing form of ILD were at greater risk for IPA, emphasizing the need for vigilant monitoring in this subgroup.

The findings underscore the importance of early recognition and prompt treatment of IPA in ILD patients to improve clinical outcomes. Healthcare providers are advised to maintain a high index of suspicion for IPA in ILD patients presenting with new or worsening respiratory symptoms, especially those undergoing long-term corticosteroid therapy. Early diagnostic interventions, including appropriate imaging studies and laboratory tests, are crucial for timely initiation of antifungal therapy, which can significantly enhance patient prognosis.

The overall 90-days survival of IPA patients

Invasive pulmonary aspergillosis in interstitial lung disease

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