Diagnostic aspects of invasive Aspergillus infections in allogeneic BMT recipients

Abstract

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

Protective role of interleukin-10 promoter gene polymorphism in the pathogenesis of invasive pulmonary aspergillosis after allogeneic stem cell transplantation

“…In patients with focal pulmonary lesions, a radiologically guided fine-needle biopsy was used as the first-line diagnostic procedure. 19 The diagnosis of IPA was performed using EORTC/ MSG diagnostic criteria as follows. 20 A proven diagnosis of IPA was based on the demonstration of hyphae with microscopy from tissue samples taken with or without a positive culture for Aspergillus sp.…”

Central nervous system aspergillosis in allogeneic stem cell transplant recipients

“…Previous studies have indicated that CNS aspergillosis may be found in 40-50% of patients with IA. 2,8 Although several reports on CNS aspergillosis have been published, 9-13 most of them include few allogeneic SCT recipients. [14][15][16][17] We have therefore retrospectively analysed the incidence as well as clinical, radiological, and neuropathological findings of CNS aspergillosis among 455 consecutive allogeneic SCT recipients transplanted during a period of 12 years.…”

Angioinvasive pulmonary aspergillosis after allogeneic bone marrow transplantation: clinical and high-resolution computed tomography findings in 12 cases

“…is the main cause of fungal pneumonia after BMT and its incidence ranges between 4 and 13%. Risk factors described for the development of APA include more than three weeks of corticosteroids therapy, neutropenia and GVHD [4,13]. In the present study, 83% of the patients were in prolonged usage of corticosteroids in the moment of IPA diagnosis, 75% had a confirmed diagnosis of GVHD and 33% were neutropenic.…”