An EORTC multicentre prospective survey of invasive aspergillosis in haematological patients: Diagnosis and therapeutic outcome

Denning, David W.; Marinus, A.; Cohen, Jonathan; Spence, David; Herbrecht, Raoul; Pagano, Livio; Kibbler, C; Kcrmery,; Offner, Fritz; Cordonnier, Catherine; Jehn, U.; Ellis, Michael; Collette, Laurence; Sylvester, Richard

doi:10.1016/s0163-4453(98)80173-4

Cited by 232 publications

(152 citation statements)

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“…31 It has been reported that 3-month mortality decreased from 45% in 1990-2001 to 22% in 2002-2004. 9 Moreover, Pagano et al reported a 120-day overall mortality of 33% in AML patients with IA while the 3-month mortality was 38% in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Nicolle¹,

Bénet²,

Thiébaut³

et al. 2011

Haematologica

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BackgroundThe study objectives were: 1) to report on invasive aspergillosis patients in a hematology department; and 2) to estimate its incidence according to the hematologic diagnosis. Design and MethodsA prospective survey of invasive aspergillosis cases was undertaken between January 2004 and December 2009 in the hematology department of a university hospital. Meetings with clinicians, mycologists and infection control practitioners were organized monthly to confirm suspected aspergillosis cases. Demographic characteristics, clinical and complementary examination results were recorded prospectively. Information on hospitalization was extracted from administrative databases. Invasive aspergillosis diagnosis followed the European Organization for Research and Treatment of Cancer criteria, and proven and probable IA cases were retained. A descriptive analysis was conducted with temporal trends of invasive aspergillosis incidence assessed by adjusted Poisson regression. ResultsOverall, 4,073 hospitalized patients (78,360 patient-days) were included in the study. In total, 127 (3.1%) patients presented invasive aspergillosis. The overall incidence was 1.6 per 1,000 patient-days (95% confidence interval: 1.4, 1.9) with a decrease of 16% per year (-1%, -28%). The incidence was 1.9 per 1,000 patient-days (1.5, 2.3) in acute myeloid leukemia patients with a decrease of 20% per year (-6%, -36%). Serum Aspergillus antigen was detected in 89 (71%) patients; 29 (23%) had positive cultures, and 118 (93%), abnormal lung CT scans. One-month mortality was 13%; 3-month mortality was 42%. Mortality tended to decrease between 2004 and 2009. ConclusionsInvasive aspergillosis incidence and mortality declined between 2004 and 2009. Knowledge of invasive aspergillosis characteristics and its clinical course should help to improve the management of these patients with severe disease.Key words: invasive aspergillosis, surveillance, hematologic disease, incidence, hospital. 2004 . Haematologica 2011 96(11):1685-1691. doi:10.3324/haematol.2011 Citation: Nicolle M-C, Bénet T, Thiebaut A, Bienvenu A-L, Voirin N, Duclos A, Sobh M, Cannas G, Thomas X, Nicolini F-E, De Monbrison F, Piens M-A, Picot S, Michallet M, and Vanhems P. Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from

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Section: Discussionmentioning

confidence: 99%

Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Nicolle¹,

Bénet²,

Thiébaut³

et al. 2011

Haematologica

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“…The above aspects seem to differ from the experiences gained in, for example, hematological patients with Aspergillus infections after conventional chemotherapy. 8,24 Few attempts have been made to describe the clinical features of IA in BMT recipients. In our analysis, more than half of the patients were afebrile at diagnosis, thus making clinical suspicion of a potentially fatal infection less likely.…”

Section: Discussionmentioning

confidence: 99%

“…6 Aspergillus infections have been considered difficult to diagnose. [7][8][9] They often present with non-specific symptoms and signs. In the allogeneic setting other opportunistic infections may make the diagnosis of IA even more difficult.…”

mentioning

confidence: 99%

Diagnostic aspects of invasive Aspergillus infections in allogeneic BMT recipients

Jantunen

Piilonen

Volin

et al. 2000

Bone Marrow Transplant

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Summary:To investigate diagnostic aspects of invasive aspergillosis (IA) in allogeneic BMT recipients, the charts of 22 consecutive patients with IA transplanted in 1989-1995 were reviewed. IA was diagnosed 69-466 days (median 131 days) post BMT. In 16 patients (73%), a definite or probable diagnosis of IA was made during life. Respiratory symptoms were the presenting feature in half of the patients followed by neurological symptoms (27%). Chest X-ray revealed single or multiple nodular lesions in 10 patients; cavitation was observed in five patients. Tissue biopsy was the most common method of diagnosis (nine patients: lungs 6, liver 1, subcutaneous tissue 1, brain 1). Five IA cases were detected by nine guided fine needle lung biopsies in eight patients and without complications. Bronchoalveolar lavage was performed in 14 patients with findings suggestive of invasive pulmonary aspergillosis in eight cases. Lungs were the most common organ affected (90%) followed by central nervous system (41%). The diagnosis of IA is still difficult, and a large number of patients have advanced infection at diagnosis. Methods for early diagnosis are needed. Patients with a clinical suspicion of IA should be treated vigorously with antifungal agents during the diagnostic work-up. Bone Marrow Transplantation (2000) 25, 867-871. Keywords: Aspergillus infection; allogeneic BMT; diagnosis; radiology; biopsy; bronchoalveolar lavage Invasive aspergillosis (IA) is an important clinical problem in allogeneic BMT recipients. In previous studies, the incidence of IA has ranged from 4 to 10% 1-5 and may be increasing. 6 Aspergillus infections have been considered difficult to diagnose. 7-9 They often present with non-specific symptoms and signs. In the allogeneic setting other opportunistic infections may make the diagnosis of IA even more difficult. Due to frequent colonization of the upper respiratory tract with Aspergillus sp, tissue biopsy is needed for definitive diagnosis. Knowledge of the spectrum of clinical presentation of IA is essential both for raising clinical suspicion and for guiding diagnostic attempts. Furthermore, information on the yield of different diagnostic methods is needed in choosing rational diagnostic strategies. We have therefore analyzed our experience on the diagnostic aspects of IA in a recent cohort of allogeneic BMT recipients. Patients and methods

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“…13 A total of 18 out of 134 (13%) study patients developed IFI. There was no difference in the incidence of IFI according to the different decontamination regimens using a KaplanMeier analysis: seven of 68 (12 Ϯ 3%) patients receiving metronidazole compared to 11 of 66 (17 Ϯ 6%) patients decontaminated without metronidazole developed IFI.…”

Section: Invasive Fungal Infection (Ifi)mentioning

confidence: 99%

Fungal colonization and invasive fungal infections following allogeneic BMT using metronidazole, ciprofloxacin and fluconazole or ciprofloxacin and fluconazole as intestinal decontamination

Trenschel

Peceny

Runde

et al. 2000

Bone Marrow Transplant

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Summary:Invasive fungal infections (IFI) are increasingly diagnosed in patients undergoing allogeneic BMT. We have previously shown that the addition of metronidazole to ciprofloxacin for gastrointestinal bacterial decontamination significantly reduces the incidence of grades II-IV aGVHD by reduction of the anaerobic intestinal bacterial flora. Here, we found that the combined use of ciprofloxacin, metronidazole and fluconazole as antifungal prophylaxis increased intestinal yeast colonization when compared to ciprofloxacin and fluconazole alone (P Ͻ 0.01). Based on the EORTC criteria, a total of 18 out of 134 study patients developed IFI: seven of 68 (10%) patients who received metronidazole compared to 11 of the 66 (17%) patients decontaminated without metronidazole developed IFI (log-rank P = 0.36). Lethal IFI occurred in two of seven patients receiving metronidazole and in four of 11 patients without anaerobic decontamination. In conclusion, bacterial intestinal decontamination using metronidazole as an antibiotic with activity against most anaerobic intestinal bacteria significantly increases the intestinal yeast burden without influencing the incidence of IFI in patients undergoing allogeneic BMT. Bone Marrow Transplantation (2000) 26, 993-997. Keywords: invasive fungal infection; BMT; metronidazole; total gut decontamination; aGVHD Invasive fungal infections (IFI) are increasingly diagnosed in immunocompromised patients after allogeneic stem cell transplantation (SCT). Once a diagnosis of IFI has been made, mortality is high. Prevention of aGVHD is an important factor determining transplant-related morbidity and mortality caused by IFI. 1,2 This is not only due to a decreased administration of immunosuppressive drugs but also to the immunosuppressive effect of aGVHD by itself.Acute GVHD results from an inflammatory process of recipient tissues that is induced by donor T cell clones.

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An EORTC multicentre prospective survey of invasive aspergillosis in haematological patients: Diagnosis and therapeutic outcome

Cited by 232 publications

References 42 publications

Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Diagnostic aspects of invasive Aspergillus infections in allogeneic BMT recipients

Fungal colonization and invasive fungal infections following allogeneic BMT using metronidazole, ciprofloxacin and fluconazole or ciprofloxacin and fluconazole as intestinal decontamination

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