J Med Assoc Thai Vol. 90 No. 5 2007 895 Correspondence to : Kiertiburanakul S, Department of Medi- cine, Faculty of Medicine Ramathibodi Hospital, Rama 6 Rd, Bangkok 10400, Thailand. Phone: 0-2201-1922, Fax: 0-2201- 2107, E-mail: rasal@mahidol.ac.th Invasive Aspergillosis in a Tertiary-Care Hospital in Thailand † Sasisopin Kiertiburanakul MD*, Chittima Thibbadee MD*, Pitak Santanirand PhD** † The abstract of this study was presented as a poster at the 44th Annual Meeting of the Infectious Diseases Society of America (Toronto), 2006 * Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University ** Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University Background: Invasive aspergillosis (IA) is one of the most common and serious fungal infections in immuno- compromised host. Available data regarding IA among Asian patients are limited. Objective: To determine patients’ characteristics, clinical presentation, treatment, and outcomes of patients with IA in a Tertiary-care Hospital in Thailand. Material and Method: The authors retrospectively reviewed medical and laboratory records of adult patients with IA from January 2000 to December 2005. Results: Ninety-four patients were identified and classified as proven (n = 35), probable (n = 10), and possible IA (n = 49) according to the criteria designed for cancer patients (EORTC/MSG). Mean + SD age was 48 + 19 (range, 17-89) years old and 54 patients (57%) were male. Acute leukemia was the most common underlying condition (30%). Major predisposing factors were neutropenia (39%), chemotherapy (34%), and receiving corticosteroid therapy (25%). Common sites of infection were lungs (68%), sinus (17%), and eyes (8%). Aspergillus fumigatus (67%) was the most frequently isolated species. Amphotericin B followed by itraconazole was the mainstay of treatment. Thirty-six patients (38%) had complete or partial response to therapy whereas 44 patients (47%) died due to aspergillosis. Multivariate analysis showed that corticosteroid therapy [hazard ratio (HR) 10.65; 95% confidence interval (CI) 1.03-110.15, p = 0.047] and pulmonary infection [HR 18.06; 95% CI 4.28-76.17, p < 0.001] were significant predictive factors of death. Conclusions: Epidemiology and outcomes of IA among Thai patients were comparable to those in Western countries. Early diagnosis of IA in patients at risk is still essentially required in order to offer appropriate therapy, decrease morbidity, and mortality rate. Keywords: Aspergillosis, Aspergillus spp, Fungus, Thailand Aspergillus spp., a filamentous fungus, is commonly isolated from soil, organic debris, food, and indoor environment, as well as in the hospital (1,2) . The primary sites of infection are lower respiratory tract and paranasal sinus (1) . There are two major forms of aspergillosis, non-invasive form and invasive form. Invasive aspergillosis (IA) means the invasion of tis- sues of lung or sinuses and/or dissemination through the blood stream (3) . IA is the most common fungal in- fection in severe immuno-compromised patients such as in bone marrow transplant recipients and patients with hematologic malignancy receiving intensive che- motherapy (4,5) . There has been a substantial increase in the number of patients at risk of developing IA dur- ing the past decades because of many reasons, such as an increase in the number of transplantations, the development of new invasive chemotherapy regimen, increased use of immunosuppressive agents, and ac- J Med Assoc Thai 2007; 90 (5): 895-902 Full text. e-Journal: http://www.medassocthai.org/journal