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Corticosteroids, IVIG, antibiotics, and mechanical ventilation are associated with higher odds of invasive pulmonary aspergillosisCorticosteroids and IVIG Linked to Higher Risk of Lung Infection

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Key Takeaway
Note that corticosteroid, IVIG, antibiotic, and mechanical ventilation are associated with higher odds of SAPA in SFTS patients.

This systematic review and meta-analysis synthesized data from 10 articles to evaluate the risk of invasive pulmonary aspergillosis (SAPA) in patients with severe fever with thrombocytopenia syndrome (SFTS). The analysis identified a 27.4% incidence of SAPA in this population, though high heterogeneity was noted (I2 = 95.60%).

The meta-analysis reported significant associations between several clinical interventions and higher odds of SAPA. Specifically, corticosteroid therapy was associated with an OR of 3.104 (95% CI: 2.410–3.998), while intravenous immunoglobulin (IVIG) showed an OR of 3.952 (95% CI: 1.876–8.326). Antibiotic use was associated with a substantially higher odds of SAPA (OR = 16.419; 95% CI: 8.489–31.756), and mechanical ventilation was associated with an OR of 6.456 (95% CI: 4.362–9.554, p = 0.169).

Patients with SAPA demonstrated a significantly higher mortality risk compared to non-SAPA patients (OR = 5.381; 95% CI: 3.666–7.899). The authors note high heterogeneity in the incidence of SAPA. These findings suggest that clinicians should maintain a high index of suspicion for SAPA and consider early diagnostic testing and timely antifungal therapy in patients with SFTS receiving these treatments.

How this fits prior evidence

This meta-analysis addresses a gap regarding the risk of invasive pulmonary aspergillosis (SAPA) in patients with severe fever with thrombocytopenia syndrome (SFTS). While previous evidence noted that corticosteroid and cyclophosphamide exposure are associated with higher mortality in SLE patients, this study focuses on the association between corticosteroids, IVIG, antibiotics, and mechanical ventilation specifically with SAPA incidence. It does not relate to prior findings regarding antibiotic-related gastrointestinal cancer risk or reduced gut microbial diversity.

A review of 10 studies looked at patients with severe fever with thrombocytopenia syndrome (SFTS). Researchers specifically looked for signs of invasive pulmonary aspergillosis, which is a serious fungal infection of the lungs. The study found that about 27.4% of these patients developed this lung infection.

The analysis found that several common treatments were linked to higher odds of developing the lung infection. These included corticosteroids, intravenous immunoglobulin (IVIG), antibiotics, and mechanical ventilation. Patients who did develop the lung infection also faced a significantly higher risk of death compared to those who did not.

It is important to note that these findings show an association between certain treatments and the infection, but they do not prove that the treatments caused the infection. Because this was a review of several different studies with high variation in results, the evidence is not definitive. Doctors should still use these findings as a reason to monitor patients closely for lung infections during treatment.

What this means for you:
Certain treatments like corticosteroids and IVIG are linked to higher odds of lung infection in SFTS patients.

Common questions

What is the risk of lung infection for SFTS patients?

The study found that approximately 27.4% of patients with severe fever with thrombocytopenia syndrome (SFTS) developed invasive pulmonary aspergillosis, which is a serious lung infection.

Are certain medications linked to this lung infection?

The study found that corticosteroid therapy, intravenous immunoglobulin (IVIG), antibiotics, and mechanical ventilation were all associated with higher odds of developing the lung infection in patients with SFTS.

Is there a higher risk of death for those with this lung infection?

Yes, the data showed that patients who developed the lung infection had a significantly higher mortality risk compared to patients who did not have the infection.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
BackgroundIn 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.MethodsEffect estimates were expressed as incidence of SAPA, odds ratio (OR) and 95% confidence intervals (CI).ResultsAccording 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.ConclusionOur 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 registrationCRD420261343968.
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