Comparison of computed tomographic findings in pulmonary mucormycosis and invasive pulmonary aspergillosis

Abstract

Because there are no available molecular markers for pulmonary mucormycosis (PM), which has low culture sensitivity, early diagnosis and treatment rely heavily on imaging modes such as computed tomography (CT). However, there are limited data comparing CT findings for PM with those for invasive pulmonary aspergillosis (IPA). Adult patients who met the modified criteria for proven and probable PM (over an 11-year period) and IPA (over a 6-year period, owing to the availability of the galactomannan assay) according to the modified European Organization for Research and Treatment of Cancer/Mycosis Study Group definitions were retrospectively enrolled. IPA cases were selected at a 1 : 4 (PM/IPA) ratio. Thoracic CT scans were reviewed by two experienced radiologists blinded to the patients' demographics and clinical outcomes. A total of 24 patients with PM, including 20 (83%) with proven PM and four (17%) with probable PM, and 96 patients with IPA, including 12 (13%) with proven IPA and 84 (87%) with probable IPA, were eventually analysed. The reverse halo sign was more common in patients with PM (54%) than in those with IPA (6%, p < 0.001), whereas some airway-invasive features, such as clusters of centrilobular nodules, peribronchial consolidations, and bronchial wall thickening, were more common in patients with IPA (IPA 52% vs. PM 29%, p 0.04; IPA 49% vs. PM 21%, p 0.01; IPA 34% vs. PM 4%, p 0.003, respectively). The reverse halo sign was more common, and airway-invasive features were less common, in patients with PM than in those with IPA. These findings may help physicians to initiate Zygomycetes-active antifungal treatment earlier.

Diagnostic performance of immunohistochemistry for the aspergillosis and mucormycosis

“…In the second part of the study, we analysed the clinical characteristics of patients who met the modified EORTC/MSG criteria using IHC results for proven mucormycosis and had serum and/or bronchoalveolar lavage (BAL) fluid GM assay results. As done in our previous study, we used the modified criteria considering the limitation of using histomorphology alone for diagnosing invasive mould infection. Briefly, proven mucormycosis was defined as (a) the recovery of agents of mucormycosis by culture from sterile specimens and/or (b) positive mucormycosis IHC test results.…”

A Localized Macular Rash in an Immunocompromised Patient with Pneumonia and Necrotizing Enterocolitis

“…Risk factors for developing aspergillosis and mucormycosis are similar [3,4]. Pneumonia is the predominant clinical presentation for both infections, and there is significant clinical and radiologic overlap, although dissemination favors mucormycosis [3,4].…”

“…Risk factors for developing aspergillosis and mucormycosis are similar [3,4]. Pneumonia is the predominant clinical presentation for both infections, and there is significant clinical and radiologic overlap, although dissemination favors mucormycosis [3,4]. Given the rarity of isolation via blood culture and absence of serologic markers, tissue biopsy is almost always necessary for definitive diagnosis of mucormycosis; however, this is often challenging in patients with multiple comorbidities.…”

Fungal infection involvement in primary biliary cirrhosis: A review of 2 cases

“…The symptoms of patients with acute disease progress quickly and patients often succumb to the disease within several days or several weeks (30). Chronic infection can be manifested as simple granuloma or pyogenic inflammation and granulomatous mixed inflammation (31,32). Clinical diagnosis is often based on clinical symptoms, susceptible factors, mycological examination and pathological biopsy, of which, locating hypha in pathological tissue is of most diagnostic significance.…”