Aggressive surgical management in localized pulmonary mycotic and nonmycotic infections for neutropenic patients with acute leukemia: Report of eighteen cases

Baron, Oliver; Guillaume, Bois; Moreau, Philippe; Germaud, P.; Despins, Philippe; Lajartre, A. Y. De; Michaud, J L

doi:10.1016/s0022-5223(98)70443-x

Cited by 62 publications

(33 citation statements)

References 29 publications

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“…It should also be considered in cases of massive haemoptysis, pulmonary lesions close to the great blood vessels or pericardium, or residual localised pulmonary lesions in patients with continuing immunosuppression or those who are expected to have immunosuppressive therapy in the future. Several reports have shown the relative efficacy and safety of surgical intervention, in addition to antifungal therapy, in these situations [75,[157][158][159][160][161][162].…”

Section: Treatmentmentioning

confidence: 99%

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

586

596

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Aspergillus is a mould which may lead to a variety of infectious, allergic diseases depending on the host's immune status or pulmonary structure. Invasive pulmonary aspergillosis occurs primarily in patients with severe immunodeficiency. The significance of this infection has dramatically increased with growing numbers of patients with impaired immune state associated with the management of malignancy, organ transplantation, autoimmune and inflammatory conditions; critically ill patients and those with chronic obstructive pulmonary disease appear to be at an increased risk. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has resulted in lower mortality rates associated with this infection. Chronic necrotising aspergillosis is a locally invasive disease described in patients with chronic lung disease or mild immunodeficiency. Aspergilloma is usually found in patients with previously formed cavities in the lung, whereas allergic bronchopulmonary aspergillosis, a hypersensitivity reaction to Aspergillus antigens, is generally seen in patients with atopy, asthma or cystic fibrosis. This review provides an update on the evolving epidemiology and risk factors of the major manifestations of Aspergillus lung disease and the clinical manifestations that should prompt the clinician to consider these conditions. Current approaches for the diagnosis and management of these syndromes are discussed.

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Section: Treatmentmentioning

confidence: 99%

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

586

596

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“…To obviate IPA relapse, some authors have suggested the resection of residual lesion(s) in addition to medical therapy. This was suggested in patients suffering from haematological malignancies [18,[172][173][174][175][176][177][178][179][180][181]. In this setting, surgery was proposed when the lesions were close to pulmonary vessels to avoid life-threatening haemorrhage in the neutrophils' recovery period [18], or in case of diagnostic procedure.…”

Section: Surgerymentioning

confidence: 99%

“…Although surgery could theoretically be considered in selected cases, both because it could be the only way to be fully curative and because minimal resection, such as wedge resection, might limit the functional defect [176,180,182], no recent study has been published to support this strategy.…”

Section: Surgerymentioning

confidence: 99%

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

Bulpa¹,

Dive²,

Sibille³

2007

European Respiratory Journal

313

200

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Aspergillus spp. cultured in specimens from the airways of chronic obstructive pulmonary disease (COPD) patients are frequently considered as a contaminant. However, growing evidence suggests that severe COPD patients are at higher risk of developing invasive pulmonary aspergillosis (IPA), although IPA incidence in this population is poorly documented. Some data report that COPD is the underlying disease in 1% of patients with IPA.Definitive diagnosis of IPA in COPD patients is often difficult as tissue samples are rarely obtained before death. Diagnosis is therefore usually based on a combination of clinical features, radiological findings (mostly thoracic computed tomography scans), microbiological results and, sometimes, serological information.Of 56 patients with IPA reported in the literature, 43 (77%) were receiving corticosteroids on admission to hospital. Breathlessness was always a feature of disease and excess wheezing was present in 79% of patients. Fever (.38uC) was present in only 38.5%. Chest pain and haemoptysis were uncommon. Six out of 33 (18%) patients had tracheobronchitis observed during bronchoscopy. The median delay between symptoms and diagnosis was 8.5 days. The mortality rate was high: 53 out of 56 (95%) patients died despite invasive ventilation and antifungal treatment in 43 (77%) of them.In chronic obstructive pulmonary disease patients, invasive pulmonary aspergillosis currently carries a very poor prognosis. Outcome could perhaps be improved by more rapid diagnosis and prompt therapy with voriconazole.

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“…However, about 20% of patients who underwent surgery did not have IPA. 4,5 IPA has to be considered if antibiotic resistant fever develops in neutropenic patients, with infiltrates on the chest X-ray. Typical thoracic computed tomography (CT) changes include the halo-sign, air crescent sign, or cavitary lesions.…”

mentioning

confidence: 99%

“…5 CT scan has a diagnostic sensitivity of 72-82% in patients with histologically proven IPA. 4,5 Bronchoscopy with bronchoalveolar lavage is an established method for the diagnosis of infectious pulmonary complications in neutropenic patients. 7 Respiratory tract cultures for IPA are regarded as highly specific, but rather low in sensitivity.…”

mentioning

confidence: 99%

Diagnostic yield of bronchoscopy in histologically proven invasive pulmonary aspergillosis

Reichenberger

Habicht

Matt

et al. 1999

Bone Marrow Transplant

133

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Summary:Invasive pulmonary aspergillosis (IPA) is a life-threatening infectious complication in neutropenic patients after high-dose chemotherapy or hematopoietic stem cell transplantation. Its diagnosis is mainly based on clinical symptoms, and radiological signs on thoracic CT scan. The value of bronchoscopy is controversial. We analyzed the diagnostic yield of bronchoscopy in 23 consecutive patients with histologically proven invasive pulmonary aspergillosis. In seven patients (30%) bronchoscopically obtained specimens were diagnostic for pulmonary fungal infection. Typical hyphae were detected by cytology in six patients and fungal cultures were positive in four cases. Patients with a positive bronchoscopic result presented more often with multiple changes on thoracic CT scan (71%; 5/7), but had received a lower median cumulative dose of amphotericine B (300 mg; 168-3010 mg) compared to patients with non-diagnostic bronchoscopy (25% multiple lesions (4/16); amphotericine dose 1100 mg, 260-2860 mg). The diagnostic yield of bronchoscopy was not associated with clinical symptoms or duration of neutropenia. Bronchoscopy allows the diagnosis of IPA in about one third of patients. Fungal cultures and cytological examination of intrabronchial specimens obtained during bronchoscopy have a high specificity, but its sensitivity is low. It is advisable to perform diagnostic bronchoscopy before starting antifungal therapy. Better diagnostic tools are urgently needed.

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Aggressive surgical management in localized pulmonary mycotic and nonmycotic infections for neutropenic patients with acute leukemia: Report of eighteen cases

Abstract: Aggressive surgical management radically improves the prognosis of invasive pulmonary aspergillosis, even if the surgical indications include some nonmycotic infections because of the difficulty in establishing the clinical diagnosis.

Cited by 62 publications

References 29 publications

Pulmonary aspergillosis: a clinical review

Pulmonary aspergillosis: a clinical review

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

Diagnostic yield of bronchoscopy in histologically proven invasive pulmonary aspergillosis

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