Report of 38 Cases of Tracheobronchitis in Non-immunocompromised Patients with Dual Isolation of Aspergillus in Lower Respiratory Tract Samples

Introduction: Aspergillus tracheobronchitis is an uncommon manifestation of Aspergillus infection. This study retrospectively analysed patients presenting tracheobronchitis among non-neutropenic/non-transplant adult patients with at least two valuable cultures of respiratory samples yielding Aspergillus spp. in Spanish hospitals.

Methods: Clinical records were retrospectively reviewed. Simple tracheobronchitis was considered when the bronchoscopy report described mucosal inflammation and mucus secretions and invasive tracheobronchitis when ulceration and pseudomembrane formation was reported. Cases were considered "proven" (histopathological confirmation) or "probable" aspergillar tracheobronchitis.

Results: A total of 38 cases of tracheobronchitis (26 simple, 12 invasive) were identified, all considered probable aspergillar tracheobronchitis. Patients were elderly (89.5% patients were ≥ 65 years), males (76.3%), presented advanced COPD (GOLD III+IV in 81.3%) and heart insufficiency (55.3%), with higher APACHE II score in those with invasive tracheobronchitis (10.17 ± 7.38 vs. 4.32 ± 4.39, p=0.019). Up to 50% patients were taking steroids (accumulated doses >100 mg in 89.5% of them) and 34.2% antibiotics pre-admission. Antifungals were administered to 60.5% patients (57.7% with simple and 66.6% with invasive tracheobronchitis). Voriconazole was the most frequent antifungal (alone or in combination): 69.6% in the 23 treated patients (60.0% simple and 87.5% invasive tracheobronchitis). Mortality was 23.7% (15.4% in simple and 41.7% in invasive tracheobronchitis).

Conclusions: The results of the present study suggest that aspergillar tacheobronchitis should be considered in the differential diagnosis of non-immunocompromised patients with deteriorating chronic airway limitation.