Invasive mycoses in patients with connective tissue disease from Southern China: clinical features and associated factors
Abstract Background A retrospective study was performed to investigate the clinical features and associated factors of invasive mycoses (IM) in patients with connective tissue disease (CTD) from Southern China. Methods Demographic and clinical data were recorded. Associated factors were analyzed by...
Main Authors: | , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2019-03-01
|
Series: | Arthritis Research & Therapy |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s13075-019-1851-9 |
id |
doaj-9ec8bb66996d4d8bb6548b8b0771935b |
---|---|
record_format |
Article |
spelling |
doaj-9ec8bb66996d4d8bb6548b8b0771935b2020-11-25T02:42:09ZengBMCArthritis Research & Therapy1478-63622019-03-012111910.1186/s13075-019-1851-9Invasive mycoses in patients with connective tissue disease from Southern China: clinical features and associated factorsMinxi Lao0Zhongping Zhan1Fan Su2Hao Li3Zheng Yang4Haihong Chen5Liuqin Liang6Dongying Chen7Department of Rheumatology & Geriatrics, The First Affiliated Hospital of Sun Yat-sen UniversityDepartment of Rheumatology, The First Affiliated Hospital of Sun Yat-sen UniversityDepartment of Rheumatology & Geriatrics, The First Affiliated Hospital of Sun Yat-sen UniversityDepartment of Rheumatology, The First Affiliated Hospital of Sun Yat-sen UniversityDepartment of Pathology, The Seventh Affiliated Hospital of Sun Yat-sen UniversityDepartment of Respirology, The First Affiliated Hospital of Sun Yat-sen UniversityDepartment of Rheumatology, The First Affiliated Hospital of Sun Yat-sen UniversityDepartment of Rheumatology, The First Affiliated Hospital of Sun Yat-sen UniversityAbstract Background A retrospective study was performed to investigate the clinical features and associated factors of invasive mycoses (IM) in patients with connective tissue disease (CTD) from Southern China. Methods Demographic and clinical data were recorded. Associated factors were analyzed by logistic regression analysis. Results A total of 6911 patients with CTD were included. IM was diagnosed in 32 patients (incidence, 0.5%). IM was predominant in patients with ANCA-associated vasculitis (AAV) (incidence, 1.5%, 7/480). Lung was commonly involved (30/32, 93.8%). Aspergillus spp. (81.3%) were the leading strain. The positive rate of fungi detection in sputum culture was 69.0%. Serum galactomannan (GM) test was positive in bronchoalveolar lavage fluid (BALF) from seven (7/10, 70.0%) patients. Ten patients died (31.3%), including three with AAV (42.9%) and seven with SLE (36.8%). Penicillium marneffei was the most fatal (mortality, 100%). Non-survivors had higher prevalence of leukopenia (30.0% vs 4.5%, P = 0.04), lymphopenia (100.0% vs 59.1%, P = 0.02), elevated serum creatinine (70.0% vs 27.3%, P = 0.02), and co-infection (70.0% vs 18.2%, P = 0.004) than survivors. Multivariate logistic regression analysis showed that lymphopenia [odds ratio (OR) = 3.28, 95% confidence interval (CI) 1.29–8.38, P = 0.01] and median-to-high dose of glucocorticoid (GC) [OR = 3.40, 95% CI 1.04–11.13, P = 0.04] were associated with IM in patients with CTD. Conclusions IM tended to develop in patients with AAV, resulting in high mortality. Sputum culture and GM test in BALF were effective methods to distinguish IM. Vigilance against lymphopenia, impaired kidney function, and co-infection improved the prognosis of IM.http://link.springer.com/article/10.1186/s13075-019-1851-9Connective tissue diseaseInvasive mycosisLymphopeniaGlucocorticoidCo-infection |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Minxi Lao Zhongping Zhan Fan Su Hao Li Zheng Yang Haihong Chen Liuqin Liang Dongying Chen |
spellingShingle |
Minxi Lao Zhongping Zhan Fan Su Hao Li Zheng Yang Haihong Chen Liuqin Liang Dongying Chen Invasive mycoses in patients with connective tissue disease from Southern China: clinical features and associated factors Arthritis Research & Therapy Connective tissue disease Invasive mycosis Lymphopenia Glucocorticoid Co-infection |
author_facet |
Minxi Lao Zhongping Zhan Fan Su Hao Li Zheng Yang Haihong Chen Liuqin Liang Dongying Chen |
author_sort |
Minxi Lao |
title |
Invasive mycoses in patients with connective tissue disease from Southern China: clinical features and associated factors |
title_short |
Invasive mycoses in patients with connective tissue disease from Southern China: clinical features and associated factors |
title_full |
Invasive mycoses in patients with connective tissue disease from Southern China: clinical features and associated factors |
title_fullStr |
Invasive mycoses in patients with connective tissue disease from Southern China: clinical features and associated factors |
title_full_unstemmed |
Invasive mycoses in patients with connective tissue disease from Southern China: clinical features and associated factors |
title_sort |
invasive mycoses in patients with connective tissue disease from southern china: clinical features and associated factors |
publisher |
BMC |
series |
Arthritis Research & Therapy |
issn |
1478-6362 |
publishDate |
2019-03-01 |
description |
Abstract Background A retrospective study was performed to investigate the clinical features and associated factors of invasive mycoses (IM) in patients with connective tissue disease (CTD) from Southern China. Methods Demographic and clinical data were recorded. Associated factors were analyzed by logistic regression analysis. Results A total of 6911 patients with CTD were included. IM was diagnosed in 32 patients (incidence, 0.5%). IM was predominant in patients with ANCA-associated vasculitis (AAV) (incidence, 1.5%, 7/480). Lung was commonly involved (30/32, 93.8%). Aspergillus spp. (81.3%) were the leading strain. The positive rate of fungi detection in sputum culture was 69.0%. Serum galactomannan (GM) test was positive in bronchoalveolar lavage fluid (BALF) from seven (7/10, 70.0%) patients. Ten patients died (31.3%), including three with AAV (42.9%) and seven with SLE (36.8%). Penicillium marneffei was the most fatal (mortality, 100%). Non-survivors had higher prevalence of leukopenia (30.0% vs 4.5%, P = 0.04), lymphopenia (100.0% vs 59.1%, P = 0.02), elevated serum creatinine (70.0% vs 27.3%, P = 0.02), and co-infection (70.0% vs 18.2%, P = 0.004) than survivors. Multivariate logistic regression analysis showed that lymphopenia [odds ratio (OR) = 3.28, 95% confidence interval (CI) 1.29–8.38, P = 0.01] and median-to-high dose of glucocorticoid (GC) [OR = 3.40, 95% CI 1.04–11.13, P = 0.04] were associated with IM in patients with CTD. Conclusions IM tended to develop in patients with AAV, resulting in high mortality. Sputum culture and GM test in BALF were effective methods to distinguish IM. Vigilance against lymphopenia, impaired kidney function, and co-infection improved the prognosis of IM. |
topic |
Connective tissue disease Invasive mycosis Lymphopenia Glucocorticoid Co-infection |
url |
http://link.springer.com/article/10.1186/s13075-019-1851-9 |
work_keys_str_mv |
AT minxilao invasivemycosesinpatientswithconnectivetissuediseasefromsouthernchinaclinicalfeaturesandassociatedfactors AT zhongpingzhan invasivemycosesinpatientswithconnectivetissuediseasefromsouthernchinaclinicalfeaturesandassociatedfactors AT fansu invasivemycosesinpatientswithconnectivetissuediseasefromsouthernchinaclinicalfeaturesandassociatedfactors AT haoli invasivemycosesinpatientswithconnectivetissuediseasefromsouthernchinaclinicalfeaturesandassociatedfactors AT zhengyang invasivemycosesinpatientswithconnectivetissuediseasefromsouthernchinaclinicalfeaturesandassociatedfactors AT haihongchen invasivemycosesinpatientswithconnectivetissuediseasefromsouthernchinaclinicalfeaturesandassociatedfactors AT liuqinliang invasivemycosesinpatientswithconnectivetissuediseasefromsouthernchinaclinicalfeaturesandassociatedfactors AT dongyingchen invasivemycosesinpatientswithconnectivetissuediseasefromsouthernchinaclinicalfeaturesandassociatedfactors |
_version_ |
1724775013962219520 |