Invasive Aspergillosis in Critically Ill Patients without Malignancy

Wouter Meersseman1*, Stefaan J Vandecasteele2, Alexander Wilmer1, Eric Verbeken3, Willy E Peetermans2, and Eric Van Wijngaerden2

1 Department of General Internal Medicine, Medical Intensive Care Unit, University Hospital, Leuven, Leuven, Belgium, 2 Department of General Internal Medicine, Infectious Diseases Unit, University Hospital, Leuven, Leuven, Belgium, 3 Department of Pathology, University Hospital, Leuven, Leuven, Belgium

* To whom correspondence should be addressed. E-mail:


Using criteria designed for invasive aspergillosis (IA) in cancer patients, we aimed to determine the impact of IA in patients without malignancy in a medical ICU. In this retrospective study, 127 patients out of 1850 admissions (6.9%) hospitalized between 2000 and 2003 had microbiological or histopathological evidence of Aspergillus during their ICU stay. There were 89 cases (70%) without hematological malignancy. These patients were classified as proven IA (n=30), probable IA (n=37), possible IA (n=2) or colonization (n=20). In these patients mean SAPS II score was 52 with a predicted mortality of 48%. The observed mortality was 80% (n= 71). Mortality of the proven and the probable IA was 97% and 87%, respectively. Postmortem examination was done in 46 out of 71 patients and 27 autopsies (59%) showed hyphael invasion with Aspergillus. Aspergillus infections occurred in 5 critically ill patients with proven IA who did not have any predisposing factors according to the currently available definitions. Three of these patients had Child C liver cirrhosis. IA is an emerging and devastating infectious disease in ICU patients without malignancy. In those patients, host criteria for probable fungal infections should probably be adapted.