Tuberc Respir Dis > Volume 84(4); 2021 > Article
Pulmonary Infection
Tuberculosis and Respiratory Diseases 2021;84(4):326-332.
DOI: https://doi.org/10.4046/trd.2021.0029    Published online June 24, 2021.
Differences in Clinical Characteristics of Invasive Tracheobronchial Aspergillosis according to the Presence of Invasive Pulmonary Aspergillosis
Chuiyong Pak, M.D.1  , Woori Jo, M.D.1, Jin Hyoung Kim, M.D.1, Jae Uk Im, M.D.1, Joseph Jeong, M.D., Ph.D.2, Hee Jeong Cha, M.D., Ph.D.3, Eun-Young Choi, M.D., Ph.D.4, Seung Won Ra, M.D., Ph.D.1 
1Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
2Department of Laboratory Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
3Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
4Department of Internal Medicine, Yeungnam University Medical Center, University of Yeungnam College of Medicine, Daegu, Republic of Korea
Correspondence:  Seung Won Ra, Tel: 82-52-250-7029, Fax: 82-52-250-7048, 
Email: docra@uuh.ulsan.kr
Received: 15 February 2021   • Revised: 8 June 2021   • Accepted: 23 June 2021
Abstract
Background
The association of invasive tracheobronchial aspergillosis (ITBA) with invasive pulmonary aspergillosis (IPA) is not well established. We aimed to compare clinical characteristics between patients who exhibited ITBA with IPA and those who exhibited isolated ITBA (iITBA). Additionally, the usefulness of serum or bronchial galactomannan (GM) tests in diagnosing ITBA was evaluated.
Methods
This retrospective single-center case-control study was conducted over a period of 4 years. Fifteen patients were enrolled after confirming the presence of ITBA using bronchoscopy-guided biopsy (iITBA, 7 vs. ITBA+IPA, 8). Clinical characteristics of patients and results obtained from serum or bronchial GM tests were compared between the two groups. Mortality was assessed using data collected from a 6-month follow-up period.
Results
The ITBA+IPA group showed a higher prevalence of hematologic malignancy (75% vs. 14%, p=0.029), a greater number of patients with multiple bronchial ulcers (75% vs. 14%, p=0.029), lower platelet counts (63,000/μL vs. 229,000/μL, p<0.001), and a mortality rate which was significantly higher (63% vs. 0%, p=0.026) than the iITBA group. In the ITBA+IPA group, 57% of patients tested positive according to the serum GM assay, whereas in the iITBA group, all patients tested negative (p=0.070). The bronchial GM level was high in both groups, but there was no significant difference between them.
Conclusion
Patients with ITBA+IPA had a greater number of hematologic malignancies with lower platelet counts and a poorer prognosis than patients diagnosed with iITBA. Findings obtained from bronchoscopy and bronchial GM tests were more useful in diagnosing ITBA than the serum GM test results.
Key Words: Aspergillosis, Galactomannan, Bronchoscopy, Mortality


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