Baseline Chest Computed Tomography for Early Diagnosis of Invasive Pulmonary Aspergillosis in Hemato-oncological Patients: A Prospective Cohort Study

Bitterman, Roni; Hardak, Emília; Raines, Marina; Stern, Anat; Zuckerman, Tzila; Ofran, Yishai; Lavi, Noa; Guralnik, Ludmila; Frisch, Avraham; Nudelman, Olga; Oren, Ilana

doi:10.1093/cid/ciz194

Cited by 24 publications

(33 citation statements)

References 7 publications

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“…The median estimated IPA rates appeared to be higher with BCT in this survey, a finding that is in line with previous single center studies, but also underlying relatively small sample size and comprising the inherent bias of diagnosing more IPA episodes than without BCT [14,15]. The higher IPA rate suggest BCT as being likely beneficial for early diagnosis, also if asymptomatic.…”

Section: Discussionsupporting

confidence: 89%

“…BCT was defined as the performance of a CT scan upon admission or at diagnosis of the above-mentioned underlying conditions according to the two above-mentioned studies [14,15]. These two groups may overlap.…”

Section: Methodsmentioning

confidence: 99%

“…A study that was conducted in Israel found abnormal BCT in 31% (n = 295) of patients; of these, 5% were diagnosed with IPA on admission and another 10% subsequently during hospital stay. In the subgroup of patients with de novo acute myeloid leukemia (AML), 55% of IPA were detected by BCT [15]. However, none of this has been the subject of randomized, controlled trials, yet complicating the impact assessment of BCT on mortality and follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Baseline Chest Computed Tomography as Standard of Care in High-Risk Hematology Patients

Stemler

Bruns

Mellinghoff

et al. 2020

JoF

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Baseline chest computed tomography (BCT) in high-risk hematology patients allows for the early diagnosis of invasive pulmonary aspergillosis (IPA). The distribution of BCT implementation in hematology departments and impact on outcome is unknown. A web-based questionnaire was designed. International scientific bodies were invited. The estimated numbers of annually treated hematology patients, chest imaging timepoints and techniques, IPA rates, and follow-up imaging were assessed. In total, 142 physicians from 43 countries participated. The specialties included infectious diseases (n = 69; 49%), hematology (n = 68; 48%), and others (n = 41; 29%). BCT was performed in 57% (n = 54) of 92 hospitals. Upon the diagnosis of malignancy or admission, 48% and 24% performed BCT, respectively, and X-ray was performed in 48% and 69%, respectively. BCT was more often used in hematopoietic cell transplantation and in relapsed acute leukemia. European centers performed BCT in 59% and non-European centers in 53%. Median estimated IPA rate was 8% and did not differ between BCT (9%; IQR 5–15%) and non-BCT centers (7%; IQR 5–10%) (p = 0.69). Follow-up computed tomography (CT) for IPA was performed in 98% (n = 90) of centers. In high-risk hematology patients, baseline CT is becoming a standard-of-care. Chest X-ray, while inferior, is still widely used. Randomized, controlled trials are needed to investigate the impact of BCT on patient outcome.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Baseline Chest Computed Tomography as Standard of Care in High-Risk Hematology Patients

Stemler

Bruns

Mellinghoff

et al. 2020

JoF

Self Cite

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“…No baseline study has been performed to assess the incidence of this synchronous process fully. In a single-center study, Bitterman et al [ 11 ] found that 5% (15 of 295) of high-risk HM patients were diagnosed with invasive pulmonary aspergillosis (IPA) on admission baseline chest computed tomography (CT), with an additional 9.8% diagnosed later during hospitalization. These 15 patients were older and more likely to have a new HM (11 of 15) compared with those who developed IPA at a later point [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Invasive Fungal Infections at Presentation of Untreated Hematologic Malignancies: Rare and Elusive

Spallone

Hicklen

Kontoyiannis

2020

Open Forum Infectious Diseases

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“…Screening for presence of IMI in at‐risk patients upon admission and prior to chemotherapy could be another area of application for the mould‐reactive lymphocyte assay. Besides enabling initiation of earliest possible treatment even before signs and symptoms of IMI are present, this could allow further insight into prevalence of unapparent IMI in at‐risk patients …”

Section: Discussionmentioning

confidence: 99%

Mould‐reactive T cells for the diagnosis of invasive mould infection—A prospective study

Steinbach

Cornely

Wisplinghoff

et al. 2019

Mycoses

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Summary Invasive mould infections (IMI) in immunocompromised patients are difficult to diagnose. Early and targeted treatment is paramount, but minimally invasive tests reliably identifying pathogens are lacking. We previously showed that monitoring pathogen‐specific CD4+T cells in peripheral blood using upregulation of induced CD154 positive lymphocytes can be used to diagnose acute IMI. Here, we validate our findings in an independent patient cohort. We stimulated peripheral blood cells from at‐risk patients with Aspergillus spp. and Mucorales lysates and quantitated mould‐reactive CD4/CD69/CD154 positive lymphocytes via flow cytometry. Mould‐reactive lymphocytes were quantitated in 115 at‐risk patients. In 38 (33%) patients, the test was not evaluable, mainly due to low T cell counts or non‐reactive positive control. Test results were evaluable in 77 (67%) patients. Of these, four patients (5%) had proven IMI and elevated mould‐reactive T cell signals. Of 73 (95%) patients without proven IMI, 59 (81%) had mould‐reactive T cell signals within normal range. Fourteen (19%) patients without confirmed IMI showed elevated T cell signals and 11 of those received antifungal treatment. The mould‐reactive lymphocyte assay identified presence of IMI with a sensitivity of 100% and specificity of 81%. The mould‐reactive lymphocyte assay correctly identified all patients with proven IMI. Assay applicability is limited by low T cell counts during bone marrow suppression. The assay has the potential to support diagnosis of invasive mould infection to facilitate tailored treatment even when biopsies are contraindicated or cultures remain negative.

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Baseline Chest Computed Tomography for Early Diagnosis of Invasive Pulmonary Aspergillosis in Hemato-oncological Patients: A Prospective Cohort Study

Cited by 24 publications

References 7 publications

Baseline Chest Computed Tomography as Standard of Care in High-Risk Hematology Patients

Baseline Chest Computed Tomography as Standard of Care in High-Risk Hematology Patients

Invasive Fungal Infections at Presentation of Untreated Hematologic Malignancies: Rare and Elusive

Mould‐reactive T cells for the diagnosis of invasive mould infection—A prospective study

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