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MORTALITY

– Generally mortality is very high in IPA
– Mortality reaches 50-60% when IPA occurs during chemotherapy induced neutropenia and could exceed 90%with BMT Denning et al rev inf dis 90
– Mortality: 45% 10/21. Ribrag et al leuk. and lymphoma 93
– Case fatality rate: 99%, 86%, 66% for cerebral, pulm, sinus aspergillosis Denning clinical infect dis 96
– Mortality was 92%(23/25) in-patients with presumed invasive aspergillosis and respiratory insufficiency. Janssen et al intensive care med 96
– Case fatality rate was 58% highest after BMT 86.7%, CNS, and disseminated aspergillosis 88.1%. Lin et al clinical infectious dis 2001
– Mortality was 63% in France Cornet et al J of Hosp Inf 02

PROGNOSTIC FACTORS; in leukemic patients
– The outcome for IPA is dependent not only on intensive anti-fungal Rx but also on the recovery of the underling host defense defect such as resolution of neutropenia.
– Achievement of complete remission is the main prognostic factor in leukemic patients. sibrag et al leuk and lymphoma 93

GENERAL COMMENTS
IPA still possesses a very high mortality. There is a high index of suspicion needed. It is recommended to start antifungal therapy as early as third day of febrile neutropenia not responding to antibiotics, and to consider earlier combination of anti-fungal therapy. The course of treatment depends on the clinical condition and radiological findings and there is a need to consider earlier surgical intervention especially in refractory localized aspergillus, or if there is a question of angioinvasion.

Bibliography on the next page.

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