Not Blood Tumor And Transplantation Of Invasive Pulmonary Fungal Infection In Patients With Clinical Characteristics

Objective: To investigate the predictive value of clinical and radiographic features for fungal pathogen identification in pulmonary invasive fungal infection(IFI) in non-hematologic and non-hematological malignancy patients. Methods: All consecutive immunocompromised adult patients with pulmonary IFI in a 25-bed respiratory intensive care unit(ICU) in the First Affiliated Hospital of Xinjiang Medical University were recruited during a 2-year period. All patients met the 2008 European Organization for Research and Treatment of Cancer and Mycoses Study Group(EORTC/MSG) criteria for proven or probable IFI and responded to antifungal agents. The demographic, clinical and radiographic features, plus serological test results, of the patients were collected. Differences in the clinical and radiographic features of pulmonary IFIs caused by yeasts and molds were compared by ?2 test. A logistic regression model was used to perform discriminant analysis, and the effect of discrimination was assessed for accuracy. Results: The study included 143 patients with a probable diagnosis of IFI who ha d the following risk factors: diabetes mellitus(43.4%), chronic lung disease(32.2%), broad-spectrum antibiotic use(≥14 days; 35.7%), malignancy(23.1%), corticosteroid use(≥14 days; 23.1%), chronic renal failure and renal replacement therapy(16.1%), and immunological disease(10.5%). Frequent broad-spectrum antibiotic useas associated with yeast infection( P < 0.05), while mold infection was associated with chronic lung disease(P < 0.05). Yeast was more often isolated in patients with concurrent bacterial infection and on mechanical ventilation( P < 0.05). Thoracic high-resolution computed tomography(HRCT) showed the following: bronchial pneumonia/pulmonary consolidation(53.1%), massive shadowing(29.4%), small nodules(24.5%), large nodules(18.9%), pleural effusion(18.9%), halo sign(14%), and cavitatio n(9.8%). Imaging showed that mold was more common than yeast in patients with pleural and pericardial effusions( P < 0.05). Logistic regression modeling showed that broad-spectrum antibiotic use, prolonged mechanical ventilation, and pleural and pericardi al effusions were statistically significant in fungal identification( P < 0.05), with a predictive accuracy of 77.6%. Conclusions: For non-hematologic and non-hematological malignancy patients with pulmonary IFI, most of the risk factors, the main Clinical and chest HRCT features did not help to predict the type of fungal pathogen, and yeast but not cryptococcus may be accompanied or colonized.