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Volume 31, Number 5—May 2025
CME ACTIVITY - Synopsis

Features of Invasive Aspergillosis Caused by Aspergillus flavus, France, 2012–2018

Lise Bertin-Biasutto, Olivier Paccoud, Dea Garcia-Hermoso, Blandine Denis, Karine Boukris-Sitbon, Olivier Lortholary, Stéphane Bretagne, Maud Gits-Muselli, Raoul Herbrecht, Valérie Letscher-Bru, François Danion, Sophie Cassaing, Florent Morio, Céline Nourrisson, Marc Pihet, Milène Sasso, Guillaume Desoubeaux, Marie-Fleur Durieux, Julie Bonhomme, Elisabeth Chachaty, Taieb Chouaki, Nicole Desbois-Nogard, Alexandre Alanio1, Jean-Pierre Gangneux1, and Fanny LanternierComments to Author 
Author affiliation: Hopital Necker-Enfants Malades, Paris, France (L. Bertin-Biasutto, O. Paccoud, O. Lortholary, F. Lanternier); Université de Paris, Paris (L. Bertin-Biasutto, O. Lortholary, F. Lanternier); Institut Pasteur, Paris (D. Garcia-Hermoso, K. Boukris-Sitbon, O. Lortholary, S. Bretagne, A. Alanio, F. Lanternier); Hôpital Saint Louis, Paris (B. Denis, S. Bretagne, M. Gits-Muselli, A. Aliano); Institut de Cancérologie de Strasbourg, Strasbourg, France (R. Herbrecht); Hôpitaux Universitaires de Strasbourg, Strasbourg (V. Letscher-Bru, F. Danion); Toulouse University Hospital, Toulouse, France (S. Cassaing); Nantes University Hospital, Nantes, France (F. Morio); CHU Clermont-Ferrand, Clermont-Ferrand, France (C. Nourrisson); CHU d'Angers, Angers, France (M. Pihet); CHU Nîmes and Université de Montpellier, Nîmes, France (M. Sasso); Hôpital Bretonneau, Tours, France (G. Desoubeaux); Limoges University, Limoges, France (M.-F. Durieux); Unicaen Université Normandie, Caen, France (J. Bonhomme); Gustave Roussy, Villejuif, France (E. Chachaty); CHU Amiens-Picardie, Amiens, France (T. Chouaki); Inserm U1285, University of Lille, Lille, France (T. Chouaki); Centre Hospitalier Universitaire de Martinique, Fort-de-France, France (N. Desbois-Nogard); Université de Rennes, CHU Rennes, Rennes, France (J.-P. Gangneux); Rennes Teaching Hospital, Rennes (J.-P. Gangneux)

Main Article

Table 3

Characteristics of localized invasive aspergillosis cases caused by Aspergillus flavus, France, 2012–2018*

Characteristics Localized pleuropulmonary infection, n = 33 Localized ENT infection, n = 13 p value
Median age, y (IQR)
 57 (48–67)
 72 (61–74)
 0.03
Originating from Africa
 6/29 (21)
 7/13 (54)
 0.068
Sex
M 16 (48.5) 7 (53.8) >0.999
F
 17 (51.5)
 6 (46.2)
 >0.999
Primary risk factors <0.001
Hemolytic malignancy 23 (69.7) 2 (15.4) 0.001
Solid organ cancer 0 1 (7.7) 0.28
Solid organ transplant 7 (21.2) 1 (7.7) 0.41
Diabetes mellitus 0 8 (61.5) <0.001
Other 2 (6.1) 0 >0.999
No risk factors
 1 (3)
 1 (7.7)
 0.49
Clinical signs and symptoms
Fever 22 (66.7) 5 (38.5) 0.1
Dyspnea 18 (54.5) 0 <0.001
Cough 11 (33.3) 0 0.02
Hemoptysis 4 (12.1) 0 0.09
Otalgia, otorrhea 0 8 (61.5) <0.001
Chemosis, exophthalmia 2 (6.1) 2 (15.4) 0.56
Facial nerve palsy, headache 2 (6.1) 3 (23.1) 0.13
No symptoms
 1 (3)
 0
 >0.999
Imaging features
Nodules, mass lesion 17 (51.5) 0 0.11
Alveolar consolidation, ground-glass opacities 32 (96.9) 0 <0.001
Pleural effusion 18 (54.5) 0 0.11
Sinus opacification 4 (12.1) 12 (92.3) <0.001
Sinus or mastoids lytic lesions
 2 (6.1)
 9 (69.2)
 <0.001
Median time to diagnosis, d (IQR)
 19 (12–30)
 90 (42–163)
 <0.001
Positive serum galactomannan antigen†
 14/26 (53.8)
 4/7 (57.1)
 1
Diagnostic method‡ >0.999
Smear sputum 9/10 (90) 0 <0.001
BAL direct examination 15/25 (60) NA NA
BAL culture 24/25 (96) NA NA
Biopsy direct examination 5/7 (71) 10 (76.9) >0.999
Biopsy culture
 6/7 (86)
 13 (100)
 0.35
Proven cases
 6 (18)
 13 (100)
 <0.001
Associated localizations
Pulmonary NA 0 NA
Ear, nose, throat 4 (12.1) NA NA
Central nervous system 0 10 (76.9) <0.001
Mediastinal
 1 (3)
 0
 <0.001
Fungal coinfection at same site§ 12 (36.3) 0 0.01
Aspergillus fumigatus 5(15.1) 0 0.31
A. niger 3 (9.1) 0 0.55
Mucorales 4 (12.1) 0 0.31
Pneumocystis jirovecii
 2 (6.1)
 0
 >0.999
Influenza co-infection
 2 (6.1)
 0
 >0.999
First-line antifungal monotherapy¶ 26/30 (86.7) 11/12 (91.7) >0.999
Voriconazole 16/26 (61.5) 8/11 (72.7) 0.71
Other triazole 4/26 (15.3) 3/11 (27.3) 0.40
Echinocandin 2/26 (7.7) 0/11 >0.999
Liposomal amphotericin B
 4/26 (15.4)
 0/11
 0.30
Antifungal combination therapy¶
 4/30 (13.3)
 1/12 (8.3)
 >0.999
Curative surgery
 3 (9.1)
 6 (46.1)
 0.01
Death N = 31 N = 12
30-day case-fatality 14 (45.2) 1 (8.3) 0.03
3-month case-fatality 17 (54.8) 2 (16.7) 0.04

*Values are no. (%) except as indicated. BAL, bronchoalveolar lavage; IQR, interquartile range. †Positive galactomannan antigen in blood with an optical density index cutoff value of >0.5. ‡Values are no. positive/no. tested (%). §13 cases with pulmonary fungal coinfections, including one with more than 1 coinfection. ¶Values are no. positive/no. treated (%).

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1These authors contributed equally contributed to this article.

Page created: March 19, 2025
Page updated: April 29, 2025
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