Sibel KARA, Ebru ORUÇ, Zuhal EKİCİ ÜNSAL, Hikmet Eda ALIŞKAN, Şule AKÇAY

Pulmonary Aspergillosis in immunocompetent patients

Objective: Although pulmonary aspergillosis (PA) is often seen in patients with immunodeficiency, it also identifies a number of clinical diseases that cause morbidity and mortality, which can also occur in patients with immunodeficiency. The aim of this study was to investigate the disease patterns, demographic and clinical features, treatment and prognosis of pulmonary aspergillosis in immune competent patients.Method: Our study is a descriptive cross-sectional study in which the data of immunocompetent patients diagnosed with PA in our hospital between January 2010 and Decenber 2019 were evaluated retrospectively. Patients over the age of 18 with a diagnosis of PA were included in the study. Demographic and clinical features, radiological findings, diagnosis and treatment methods and prognoses of the patients were recorded.Results: 8 of the patients were female, 3 were male and the mean age was 61 (53 ± 69). Nine patients were diagnosed with chronic pulmonary aspergillosis and two patients were diagnosed with IPA. Four of the patient diagnosed with KPA were chronic cavitary pulmonary aspergillosis, one was chronic fibrosing pulmonary aspergillosis, two were aspergilloma and two were aspergillus nodules. The most common comorbidity was diabetes mellitus (45.4%) and in total, 72.7% of patients had chronic lung disease such as COPD-asthma, tuberculosis, bronchiectasis. Cough, sputum and hemoptysis (90%, 72.7%, 45.4%, respectively) were the most common symptoms. The most common radiological finding on thorax tomography was crescent sign-cavity (72.7%). The diagnostic method used was mostly bronchoalveolar lavage and wedge resection/ lobectomy (45.4%, respectively). It was observed that eight (72.7%) patients were given voriconazole and three (27.2%) other patients surgical procedure performed and one patient was lost after surgery. Conclusions: Although pulmonary aspergilosis is more frequently seen in immunocompromised patients with malignancy, solid organ and hematological transplants, it has now begun to be seen in immune competent patients. The majority of our patients were middle-aged, women and smokers, people with comorbidity such as DM and chronic lung disease. Therefore, we would like to point out that pulmonary aspergillosis should be kept in mind among differential diagnoses, especially in patients with immunocompetent with comorbidity such as chronic lung disease and DM.

İmmün kompetan Hastalarda Pulmoner Aspergillozis

Amaç: Pulmoner aspergillozis (PA) sıklıkla immün yetmezlikli hastalarda görülse de immün kompetan hastalarda da ortaya çıkabilen en önemli morbidite ve mortaliteye neden olan bir dizi klinik hastalığı tanımlar. Amacımız; immün kompetan hastalarda pulmoner aspergillozisin hastalık paternlerini, demografik ve klinik özelliklerini, tedavi yöntemlerini ve prognozunu araştırmaktı. Yöntemler: Çalışmamız Ocak 2010 ve Aralık 2019 tarihleri arasında hastanemizde PA tanısı alan immün kompetan hasta verilerinin retrospektif olarak değerlendirildiği tanımlayıcı kesitsel bir çalışmadır. 18 yaş üstü PA tanısı alan hastaların demografik verileri, klinik özellikleri, radyolojik bulguları, tanı ve tedavi yöntemleri ile prognozları retrospektif olarak incelendi. Sonuçlar: Hastaların 8’i kadın 3’ü erkek ve yaş ortalaması 61 (53±69)’idi. Hastaların 9'u Kronik pulmoner aspergilloz (KPA) ve ikisi invaziv PA tanısı aldı. KPA tanısı alan hastaların 4’ü kronik kaviter pulmoner aspergilloz, 1’I kronik fibroze pulmoner aspergillozis, 2’si aspergilloma, diğer 2’si aspergillus nodulü idi. En sık saptanan komorbidite diabetes mellitus (%45,4) olup hastaların %72,7’sinde koah-astım, tüberküloz, bronşektazi gibi kronik akciğer hastalığı bulunmaktaydı. Öksürük, balgam ve hemoptizi (sırası ile %90, %72,7, %45,4) en sık görülen semptomlardı. Toraks tomografisinde en sık saptanan radyolojik bulgunun ise hilal belirtisi-kavite (%72,7) olduğu belirlendi. Uygulanan tanı yöntemleri sıklıkla bronkoalveolar lavaj (BAL) ve wedge rezeksiyon/ lobektomi (sırası ile %45,4) olarak saptandı. Tedavide sekiz (%72,7) hastaya vorikonazol verildiği, diğer üç (%27,2) hastaya cerrahi işlem yapıldığı ve bir hastanın ise cerrahi sonrasında kaybedildiği görüldü. Tartışma: Pulmoner aspergilloz daha sık olarak bağışıklığı zayıflamış kanser, solid organ ve hematolojik nakil hastalarında görülmekle birlikte günümüzde immün kompetan hastalarda da görülmeye başlamıştır. Hastalarımızın çoğunluğunu; orta yaş, kadın, sigara içen, altta yatan DM ve kronik akciğer hastalığı gibi bir komorbiditeye sahip kişiler oluşturmaktadır. Bu nedenle özellikle kronik akciğer hastalığı ve DM gibi altta yatan hastalığı olan immün kompetan hastalarda hastalarda pulmoner aspergillozun ayırıcı tanılar arasında akılda tutulması gerektiğine dikkat çekmek istiyoruz.

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