Respiratory Fungal Infection: Experience of the Instituto Nacional del Tórax, Santiago of Chile

Abstract

Respiratory fungal infections are infrequent, but serious and potentially lethal diseases, associated with high morbimortality. They mainly affect three groups of patients: immunosuppressed patients, patients in critical units and immunocompetent patients who travel to endemic places. However, little is known about these entities in Chile. The aim of this manuscript is to characterize the population of patients hospitalized in the Instituto Nacional del Tórax with respiratory fungal infections, describe the burden of disease and mortality and to identify risk factors associated with in-hospital mortality. Mycoses of filamentous and non-filamentous agents are included. 
Methods: A retrospective cohort of hospitalized patients which met diagnostic criteria according to European guidelines during the period of time 2014 to 2019, were included. Patients with Allergic Bronchopulmonary Aspergillosis (ABPA) or Pneumocystis jirovecii infection, were excluded. The mean age was 54.4 ± 17.7 years-old and 52% were men. A total of 39 (56.5%) patients were immunocompetent and 54 (78%) required hospitalization in a critical care unit, 61% had bacterial coinfection, the majority due to Gram negatives. The 37% required surgical resolution. Hospital mortality was 13%. The presence of pleural effusion (OR 33.02; 95% CI 1.34-389; p= 0.03) and admission to the ICU (OR 16.3 95% CI 1.41-190.7; p= 0.03) were independent prognostic factors for mortality
Conclusions: Respiratory fungal infections are emerging diseases that are an important factor of morbidity and mortality in critical care and immunocompetent patients.