A study of 152 cases of pulmonary fungal infection: reevaluation of the microbiological spectra

OBJECTIVE: To investigate the microbiological spectra and clinical outcome of patients with pulmonary fungal infections. METHODS: All the cases of clinically diagnosed pulmonary fungal infection from January 2002 to June 2006 were reevaluated according to the definitions of European Organization for Research and Treatment of Cancer/National Institute of Allergy and Infectious Diseases Mycosis Study Group (EORTC/MSG), and the etiology of the patients were analyzed. RESULTS: Pulmonary fungal disease was classified as proven (n = 38), probable (n = 24), possible (n = 35) and colonization (n = 55). In the proven group, the most frequently encountered fungi were Aspergillus species (15/38), followed by Cryptococcus species (13/38), Candida species were rare (2/38). In the probable group, Aspergillus species and Aspergillus species + Candida species were among the most common pathogens; while in the possible group and the colonization group, Candida species were most frequently encountered. The mortality of patients with probable pulmonary fungal infection (58.3%) was higher than that of patients in the possible group (25.7%) or the colonization group (16.4%) (P = 0.001). Univariate analysis showed that only APACHE II score was associated with outcome of patients with "pulmonary Candida infections", and antifungal therapy did not improve the outcome of such patients. CONCLUSION: The most frequently encountered fungi in patients with pulmonary fungal infections were Aspergillus species, followed by Cryptococcus species. Primary Candida pulmonary infections were rare.