scholarly journals 1147. Short Course of Voriconazole Therapy as a Risk Factor for Relapse of Invasive Pulmonary Aspergillosis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S600-S601
Author(s):  
Dong Hoon Shin ◽  
Seung-Jin Yoo ◽  
Jongtak Jung ◽  
Kang Il Jun ◽  
Hyungjin Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Tertiary Care ◽  
Invasive Pulmonary Aspergillosis ◽  
Care Hospital ◽  
Pulmonary Aspergillosis ◽  
Treatment Termination ◽  
Duration Of Therapy ◽  
Short Course ◽  
Life Threatening

Abstract Background Invasive pulmonary aspergillosis (IPA) is a life-threatening opportunistic infection which usually occurs in immunocompromised patients. Recommended duration of voriconazole therapy is a minimum of 6-12 weeks for IPA, despite the lack of any firm evidence. In addition, risk factors for relapse of IPA are still unclear. Here, we explored risk factors for IPA relapse after initial treatment. Methods All patients with proven or probable IPA who had finished voriconazole treatment between 2005 and 2019 in a tertiary-care hospital were reviewed. IPA relapse was defined as re-diagnosis of proven or probable IPA at the same site within 1 year after treatment termination. Short course of voriconazole treatment was defined as a treatment less than 9 weeks, which is a median of the recommended minimum duration of therapy from the Infectious Disease Society of America. The radiological response was defined as a reduction in IPA burden by more than 50% on chest computed tomography (CT). Results Of 87 patients who had completed voriconazole treatment, 14 (16.1%) experienced IPA relapse. Multivariable Cox regression identified that short voriconazole treatment duration (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.1–12.3; P=0.033) and radiological non-response (aHR, 4.6; 95% CI, 1.2–17.5; P=0.026) were independently associated with relapse of IPA after adjusting for several clinical risk factors. Conclusion Less improvement in CT, and short duration of voriconazole therapy were the independent risk factors for relapse after treatment of IPA. Longer duration of therapy should be considered for those at higher risk of relapse. Disclosures All Authors: No reported disclosures

scholarly journals Short course of voriconazole therapy as a risk factor for relapse of invasive pulmonary aspergillosis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Dong Hoon Shin ◽  
Seung-Jin Yoo ◽  
Kang Il Jun ◽  
Hyungjin Kim ◽  
Chang Kyung Kang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Tertiary Care ◽  
Invasive Pulmonary Aspergillosis ◽  
Care Hospital ◽  
Pulmonary Aspergillosis ◽  
Treatment Termination ◽  
Duration Of Therapy ◽  
Short Course ◽  
Radiological Response

Abstract To investigate associations of the duration of voriconazole treatment and radiological response with relapse of invasive pulmonary aspergillosis (IPA) in immunocompromised patients, we explored the risk factors for IPA relapse after successful initial treatment. All patients with proven or probable IPA who had finished voriconazole treatment between 2005 and 2019 in a tertiary-care hospital were reviewed. IPA relapse was defined as re-diagnosis of proven or probable IPA at the same site within 1 year after treatment termination. Short course of voriconazole treatment was defined as a treatment less than 9 weeks, which is a median of the recommended minimum duration of therapy from the Infectious Disease Society of America. The radiological response was defined as a reduction in IPA burden by more than 50% on chest computed tomography. Of 87 patients who had completed voriconazole treatment, 14 (16.1%) experienced IPA relapse. Multivariable Cox regression identified that short voriconazole treatment duration (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.1–12.3; P = 0.033) and radiological non-response (aHR, 4.6; 95% CI, 1.2–17.5; P = 0.026) were independently associated with relapse of IPA after adjusting for several clinical risk factors. Longer duration of therapy should be considered for those at higher risk of relapse.

scholarly journals 1707. Invasive Pulmonary Aspergillosis in Patients with Severe Fever with Thrombocytopenia Syndrome

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S625-S626
Author(s):  
Seongman Bae ◽  
Jiwon Jung ◽  
Min Jae Kim ◽  
Eunbeen Cho ◽  
Mi Young Kim ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Fatal Outcome ◽  
Invasive Pulmonary Aspergillosis ◽  
Rank Test ◽  
Care Hospital ◽  
Pulmonary Aspergillosis ◽  
Corticosteroid Administration ◽  
Log Rank Test ◽  
Tick Borne Disease ◽  
Severe Fever

Abstract Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease often accompanied by immune catastrophic course and subsequent fatal outcome. More than 90% of patients with SFTS had leukopenia and about one-third of those need the admission of intensive care unit (ICU) during the hospital course. So, there has been growing concern about the complications such as invasive pulmonary aspergillosis (IPA) in critical SFTS patients. We thus investigate the incidence and clinical characteristics of IPA in patients with SFTS. Methods All patients who were confirmed as SFTS in a tertiary care hospital, Seoul, South Korea, between January 2013 and October 2018 were enrolled. The modified AspICU algorithm was used to identify cases of putative invasive pulmonary aspergillosis (PIPA) and discriminate these invasive diseases from colonization. Results Of the 45 PCR-confirmed SFTS patients, 16 (36%) received ICU care. Of these 16 patients, 9 (56%) developed PIPA during hospitalization. The median duration from admission to the first evidence of PIPA was 8 days (range, 2–11 days). None of the PIPA cases met the revised EORTC/MSG criterion. Septic shock and corticosteroid administration preceded more frequently in PIPA group than non-PIPA group (100% vs. 19%, P < 0.0001 and 67% vs. 14%, P = 0.003, respectively). Patients complicated by PIPA showed significantly higher mortality than non-PIPA patients (44% vs. 8%, P = 0.048 by log-rank test). Mortality was lower in patients with PIPA who received antifungal treatment (17% [1/6]) than in those with PIPA who did not (100% [3/3]) (log-rank test, P = 0.002). Conclusion More than half of patients with SFTS in ICU were complicated by IPA during early hospital course. Cautious scrutiny for IPA in patients with SFTS followed by early appropriate antifungal therapy for IPA is needed. Disclosures All authors: No reported disclosures.

scholarly journals Risk Factors For Drug Induced Hepatitis Under Dots Programme In General Population

2013 ◽  
Vol 10 (1) ◽  
pp. 19-26
Author(s):  
Gajanan S Gaude ◽  
J Hattiholi ◽  
AK Reyas
Keyword(s):  
Risk Factors ◽  
Alcohol Intake ◽  
Tertiary Care ◽  
Female Gender ◽  
Care Hospital ◽  
Drug Induced ◽  
Short Course ◽  
Short Course Chemotherapy ◽  
Independent Risk Factors ◽  
A Prospective Study

Background: Short course chemotherapy containing rifampicin and isoniazid in combination has proved to be highly effective under DOTS regimens in the treatment of tuberculosis, but one of its adverse effects is hepatotoxicity. Little however has been published regarding drug induced hepatitis (DH) under general programme conditions. In this study, we aimed to determine the prevalence of drug induced hepatitis and the risk factors associated with the development of hepatitis over a period of 5 years. Methodology: This was a prospective study done from 2007 to 2011 in a tertiary care hospital. A total of 116 patients were included in the study that presented with hepatitis due to short course chemotherapy and were being treated under various categories of drug regimens. Fourty cases were being followed up and other 76 were seen at the hospital for the first time after the development of hepatitis. The diagnostic criteria’s for drug-induced hepatitis were made according to the ATS criteria’s. Various risk factors were analyzed for the development of DH. Results: The prevalence of DH in the present study was 3.6%. It was observed that DH patients were older and their serum albumin levels were lower. Regular alcohol intake, more extensive disease radiologically and female gender were observed to be independent risk factors for the development of DH. No other risk factors analyzed had any signifi cant association with DH. Conclusion: Of the various risk factors analyzed, advanced age, hypoalbuminaemia, regular alcohol intake and advanced nature of the disease were independent risk factors for the development of DH. The risk of hepatitis in the presence of one or more of these risk factors may be increased. SAARC Journal of Tuberculosis, Lung Diseases & HIV/AIDS; 2013; X(1); 19-26 DOI: http://dx.doi.org/10.3126/saarctb.v10i1.8673

scholarly journals 747. Diagnostic Performance of Bronchoalveolar Lavage Fluid Galactomannan Assay in Patients with Negative Serum Galactomannan Assay Suspected with Invasive Pulmonary Aspergillosis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S421-S421
Author(s):  
So Yun Lim ◽  
Jinyeong Kim ◽  
Sunghee Park ◽  
Jiwon Jung ◽  
Min Jae Kim ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Diagnostic Performance ◽  
Bronchoalveolar Lavage Fluid ◽  
Diagnostic Yield ◽  
Tertiary Care ◽  
Invasive Pulmonary Aspergillosis ◽  
Lavage Fluid ◽  
Fungal Culture ◽  
Care Hospital ◽  
Pulmonary Aspergillosis

Abstract Background There are limited data in real clinical practice on the diagnostic value of BAL (bronchoalveolar lavage) fluid galactomannan (GM) assay in patients with suspected invasive pulmonary aspergillosis (IPA) who had negative serum GM results. Methods This study was performed at Asan Medical Center, a 2700 bed tertiary-care hospital in Seoul, South Korea between May 2008 and April 2019. All patients with suspected IPA whose serum GM assays revealed negative results and sequentially underwent BAL were enrolled in this study. Patients were classified as proven, probable, possible or not IPA by the revised 2019 EORTC/MSG definition. Results A total of 341 patients with suspected IPA including 4 proven IPA, 38 probable IPA, 107 possible IPA, and 192 not IPA were enrolled. Of these 341 patients, 107 (31%) with possible IPA were excluded from the final analysis. Of 42 patients with proven or probable IPA who had initial negative serum GM results, 24 (57%) revealed positive BAL GM results (n=24) or BAL fungal culture (n=8). Among the remaining 18 (43%), 2 (5%) were diagnosed as proven IPA by the histopathologic exam from transbronchial lung biopsy, 6 (14%) as probable IPA by subsequent sputum fungal culture, and 10 (24%) as probable IPA by repeated serum GM assay after BAL. Of 192 patients with not IPA, 14 (7%) revealed positive BAL GM results (n=14) or BAL fungal culture (n=8). The diagnostic performance of various tests is shown in Table 1. Table 1. Diagnostic performance of various diagnostic tests in patients with suspected IPA who had negative serum GM results Conclusion Sequential BAL in patients with suspected IPA who had initial negative serum GM results provided additional diagnostic yield in about half of patients. Disclosures All Authors: No reported disclosures

scholarly journals Clinical Characteristics and Prognostic Risk Factors of Patients With Proven Invasive Pulmonary Aspergillosis: A Single-Institution Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiang Tong ◽  
Tao Liu ◽  
Kexin Jiang ◽  
Dongguang Wang ◽  
Sitong Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Prognostic Factors ◽  
Pleural Effusion ◽  
Cox Regression ◽  
Invasive Pulmonary Aspergillosis ◽  
Imaging Features ◽  
Pulmonary Aspergillosis ◽  
Cox Regression Analysis ◽  
Survivor Group

Background: The mortality and burden of medical costs associated with invasive pulmonary aspergillosis (IPA) is very high. Currently, the clinical features and prognostic factors of patients with proven IPA are not very clear, especially in the Chinese population. In this retrospective analysis, we aimed to identify the clinical features and prognostic factors of patients with proven IPA.Methods: The diagnostic criteria for proven IPA were based on the international consensus of the EORTC/MSG. Data of patients with proven IPA at the West China Hospital of Sichuan University between January 2012 and December 2018 were collected. The optimal cut-off value of continuous variables was determined by Receiver Operating Characteristic curve and maximum Youden's index. Finally, using the Cox regression analysis to identify correlations between the clinical parameters associated with morbidity.Results: A total of 117 patients with proven IPA were included in the study, and 32 (27.4%) patients died during the follow-up period. Compared with the survivor group, elderly, patients with comorbidities, and patients undergoing chemotherapy and the level of inflammatory biomarkers [erythrocyte sedimentation rate, platelet count, interleukin-6, C-reactive protein (CRP)] in the non-survivor group were higher, while the albumin level was lower (P = 0.018). The imaging features were consolidation, nodules, cavities, pleural effusion, ground-glass shadows, and halo signs in order. Overall, 41.0% patients had mixed imaging features. The results suggested the most appropriate cut-off value of age and CRP were 60 years and 14.1 mg/L, respectively. The multivariate Cox regression analysis suggested that advanced age (&gt;60 years) [hazard ratio (HR): 10.7, confidence interval (CI): 2.5–44.9, P &lt; 0.001), undergoing chemotherapy (HR: 9.5, CI: 2.7–32.9, P &lt; 0.001), presence of pleural effusion (HR: 5.74, CI: 1.6–20.8, P = 0.008), and increased CRP levels (&gt;14.1 mg/L) (HR: 6.3, CI: 1.2–34.3, P = 0.033) were risk factors for all-cause mortality in patients with proven aspergillosis.Conclusions: This study showed that the prognosis of proven IPA is poor, and the age &gt;60 years, undergoing chemotherapy, pleural effusion on CT image, and CRP levels &gt;14.1 mg/L may be as risk factors for mortality in patients with proven IPA. large samples and real-world studies are needed to confirm these results in the future.

scholarly journals Frequency, risk factors and materno-foetal outcomes among cases of Placenta previa at a tertiary care hospital: a two year study

2019 ◽  
Vol 8 (6) ◽  
pp. 2240
Author(s):  
Pamulaparthi Bindu Reddy ◽  
Gurram Swetha Reddy
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Tertiary Care Hospital ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Previous History ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Early Date

Background: Placenta previa refers to the presence of placental tissue that extends over the internal cervical os.  Placenta previa is linked to maternal hypovolemia, anaemia, and long hospital stay and with prematurity, low birth weight, low APGAR score in newborn. So it is very important to identify the condition at an early date to warn the condition thereby reducing the maternal and foetal morbidity and mortality. The present study was aimed to estimate the prevalence of PP, its associated predisposing risk factors and maternal morbidity, mortality and the perinatal outcome.Methods: A prospective observational study for two years was conducted at a tertiary care hospital. Pregnant mothers with >28 weeks of age with H/o ante partum haemorrhage were screened for placenta previa, confirmed by ultra sonography and included in the study. Clinical history, obstetric examination was done and followed up till the delivery. Maternal and foetal outcomes were recorded. Data analyzed by using SPSS version 20.Results: 1.4% incidence of PP was noted, mean age of group was 29.17±1.6 years. Age group of 21-30 years, multiparity Gravida 2-4, previous history of caesarean section and less number of ante natal checkups were significant risk factors and LSCS was most common outcome. Prematurity, low birth weight and APGAR <7 score for 1 minute was common foetal outcomes.Conclusions: Our study strongly suggests foetal surveillance programmes in cases of placenta previa. Measures should be made to bring awareness about PP, in urban slums and to increase medical checkups regularly. Making USG mandatory during every ANC and referral of cases of PP to tertiary care centres would definitely reduce the chances of morbidity and mortality.

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