The impact of different therapies on invasive pulmonary aspergillosis in patients with severe fever and thrombocytopenia syndrome: a systematic review and meta-analysis.

BACKGROUND

In recent years, a growing number of studies have reported that patients with severe fever with thrombocytopenia syndrome (SFTS)-associated invasive pulmonary aspergillosis (SAPA) patients exhibit a relatively high incidence and mortality rate. However, the conclusions vary considerably and SFTS patients frequently receive immunosuppressive therapies such as corticosteroid therapy, and the influence on the incidence of SAPA remains uncertain. Therefore, this study intends to conduct a comprehensive systematic review and meta-analysis to consolidate existing evidence.

METHODS

Effect estimates were expressed as incidence of SAPA, odds ratio (OR) and 95% confidence intervals (CI).

RESULTS

According to the search strategy, a comprehensive search was carried out in the PubMed, Web of Science, and Embase databases. After a detailed assessment, 10 articles met the inclusion criteria and were included in this study. The results indicate that the incidence of SAPA in SFTS patients is 27.4% (95% CI: 18.9-35.9%, I2 = 95.60%). The mortality risk among SAPA patients was significantly higher than that among non-SAPA patients: OR = 5.381 (95% CI: 3.666-7.899, I2 = 0.00%). Therapies including corticosteroid (OR = 3.104, 95% CI: 2.410-3.998, I2 = 35.70%), intravenous immunoglobulin (IVIG) (OR = 3.952, 95% CI: 1.876-8.326, I2 = 77.70%), antibiotics (OR = 16.419, 95% CI: 8.489-31.756), and mechanical ventilation (OR = 6.456, 95% CI: 4.362-9.554, I2 = 43.80%, p = 0.169) are associated with higher odds of SAPA.

CONCLUSION

Our study indicates that the incidence of SAPA and the associated mortality risk are relatively high. Moreover, therapies including corticosteroids, IVIG, antibiotics, and mechanical ventilation are associated with higher odds of SAPA. Clinicians should maintain a high index of suspicion for SAPA and consider early diagnostic testing and timely antifungal therapy when SAPA is suspected or confirmed.

SYSTEMATIC REVIEW REGISTRATION: CRD420261343968.