Procedures: Procedures |

Tranchobronchial Mucormycosis FREE TO VIEW

Ruoxi He, MD
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Xiangya Hospital, Central South University, Changsha, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A451. doi:10.1016/j.chest.2016.02.469
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SESSION TITLE: Pulmonary Procedures

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Saturday, April 16, 2016 at 09:45 AM - 11:15 AM

PURPOSE: Tranchobronchial mucormycosis (TM) is a rare but distinct form of invasive pulmonary mucormycosis that may involve the tracheobronchial tree. The current knowledge of TM is under-recognized and under-reported. The purpose of this report is to highlight its special presentation, the importance of bronchoscope and suggested management.

METHODS: We reviewed 12 cases of TM diagnosed in our hospital during an 18-year period, as well as 48 cases previously reported in the English literature from 1980 to May 2014. The demographic, clinical, imaging, bronchoscopic, and outcome characteristics of every eligible patient were excerpted, and predictors of inhospital mortality were identified by logistic regression.

RESULTS: 95% patients had underlying disease or immunosuppression. Diabetes mellitus (66.7%), diabetes ketoacidosis (21.7%), corticosteroid therapy (20%), kidney indufficiency (18.3%) were the most common predisposing factors reported. 5.1% cases were asymptomatic at the time of diagnosis. 28.6% had negative physical finding. 44.7% cases had normal blood tests, only 13.2% had neutropenia which mostly among non-diabetic patients (p=0.006). Merely 23.2% large bronchi were involved in imaging studies, single mass was the most form observed (33.9%). Most histopathologic diagnosis had been made by transbronchial biopsy (76.7%). Angioinvasion were found in 35% patients. Rhizopus was the predominant species (66.7%). Primary bronchus were the most frequent location involved (38.2%); the bronchial stenosis and necrotic material form were the most commonly observed (40%,34.5% respectively) and the latter was more frequent in diabetic patients (p = 0.047). There was a predilection for involvement of the upper lobes (51% of cases). The most frequent antifungal therapy were intravenous amphotericin B deoxycholate (AmB) or AmB aerosolized (79.7% totally), surgery (33.3%), and AmB combined surgery (28.3%). Overall inhospital mortality was 52.5%, with hemoptysis (odds ratio (OR)=26.68; p=0.017), dyspnea at presentation (OR=31.47; p=0.022) and angioinvasion (OR=12.21; p=0.03) as independent risk prognostic factors, whereas surgery (OR=0.032; p=0.003) was an independent protection prognostic factor.

CONCLUSIONS: Our analysis of the literature shows that TM is a rare but severe disease with high mortality because of nonspecific presentation and a variable predisposing factor, and combined medical-surgical therapy would improve the survival rate.

CLINICAL IMPLICATIONS: Bronchoscopy appears to be a reliable tool in the early diagnosis of TM.

DISCLOSURE: The following authors have nothing to disclose: Ruoxi He

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