Invasive Aspergillosis in a Tertiary-Care Hospital in Thailand†
Sasisopin Kiertiburanakul MD*, Chittima Thibbadee MD*, Pitak Santanirand PhD**
Affiliation : † The abstract of this study was presented as a poster at the 44th Annual Meeting of the Infectious Diseases Society of America (Toronto), 2006 * Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University ** Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University
Background : Invasive aspergillosis (IA) is one of the most common and serious fungal infections in immuno-
compromised host. Available data regarding IA among Asian patients are limited.
Objective : To determine patients’ characteristics, clinical presentation, treatment, and outcomes of patients
with IA in a Tertiary-care Hospital in Thailand.
Materials and Methods : The authors retrospectively reviewed medical and laboratory records of adult patients
with IA from January 2000 to December 2005.
Results : Ninety-four patients were identified and classified as proven (n = 35), probable (n = 10), and
possible IA (n = 49) according to the criteria designed for cancer patients (EORTC/MSG). Mean + SD age
was 48 + 19 (range, 17-89) years old and 54 patients (57%) were male. Acute leukemia was the most common
underlying condition (30%). Major predisposing factors were neutropenia (39%), chemotherapy (34%), and
receiving corticosteroid therapy (25%). Common sites of infection were lungs (68%), sinus (17%), and eyes
(8%). Aspergillus fumigatus (67%) was the most frequently isolated species. Amphotericin B followed by
itraconazole was the mainstay of treatment. Thirty-six patients (38%) had complete or partial response to
therapy whereas 44 patients (47%) died due to aspergillosis. Multivariate analysis showed that corticosteroid
therapy [hazard ratio (HR) 10.65; 95% confidence interval (CI) 1.03-110.15, p = 0.047] and pulmonary
infection [HR 18.06; 95% CI 4.28-76.17, p < 0.001] were significant predictive factors of death.
Conclusions : Epidemiology and outcomes of IA among Thai patients were comparable to those in Western
countries. Early diagnosis of IA in patients at risk is still essentially required in order to offer appropriate
therapy, decrease morbidity, and mortality rate.
Keywords : Aspergillosis, Aspergillus spp, Fungus, Thailand
