Invasive pulmonary aspergillosis in heart transplant recipients: Two radiologic patterns with a different prognosis

Muñóz, Patricia; Cerón, Inés; Valerio, Maricela; Palomo, Jesús; Guinea, Jesús; Escribano, Pilar; Martínez‐Sellés, Manuel; Bouza, Emilio

doi:10.1016/j.healun.2014.05.003

Cited by 35 publications

(21 citation statements)

References 35 publications

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“…This latter criterion responds to previous clinical experiences suggesting that IPA in SOT recipients may be accompanied by lung infiltrates (i.e. peribronchial consolidation or tree‐in‐bud pattern) that differ from the typical signs observed in hematological patients . The microbiological criteria included the recovery of Aspergillus spp.…”

Section: Methodsmentioning

confidence: 90%

Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: A Multinational Cohort Study

López‐Medrano

Fernández‐Ruiz

Silva

et al. 2016

American Journal of Transplantation

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The prognostic factors and optimal therapy for invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT) remain poorly studied. We included in this multinational retrospective study 112 recipients diagnosed with probable (75.0% of cases) or proven (25.0%) IPA between 2000 and 2013. The median interval from transplantation to diagnosis was 230 days. Cough, fever, and expectoration were the most common symptoms at presentation. Bilateral pulmonary involvement was observed in 63.6% of cases. Positivity rates for the galactomannan assay in serum and bronchoalveolar lavage samples were 61.3% and 57.1%, respectively. Aspergillus fumigatus was the most commonly identified species. Six- and 12-week survival rates were 68.8% and 60.7%, respectively, and 22.1% of survivors experienced graft loss. Occurrence of IPA within the first 6 months (hazard ratio [HR]: 2.29; p-value = 0.027) and bilateral involvement at diagnosis (HR: 3.00; p-value = 0.017) were independent predictors for 6-week all-cause mortality, whereas the initial use of a voriconazole-based regimen showed a protective effect (HR: 0.34; p-value = 0.007). The administration of antifungal combination therapy had no apparent impact on outcome. In conclusion, IPA entails a dismal prognosis among KT recipients. Maintaining a low clinical suspicion threshold is key to achieve a prompt diagnosis and to initiate voriconazole therapy.

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Section: Methodsmentioning

confidence: 90%

Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: A Multinational Cohort Study

López‐Medrano

Fernández‐Ruiz

Silva

et al. 2016

American Journal of Transplantation

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“…49,54 In heart transplantation patients, the authors of one study report about 37% of invasive aspergillus infections to be related to AIA, and patients have worse prognosis than counterparts with ANG. 55 Mucormycosis also affects immunocompromised patients, with a higher incidence of rhinocerebral involvement than with invasive aspergillosis, and leads to peribronchial opacities on CT. 56 Paracoccidiodomycosis, also known as South American blastomycosis, is the most common endemic fungal infection in South America. 57 Funari et al describe that 78% of their patients have peribronchovascular thickening and 34% ground-glass opacities with consolidations, cavitation, and nodules.…”

Section: Organizing Pneumoniamentioning

confidence: 99%

“…In one study, AIA is reported as having a higher number of patients with peribronchial distribution, while ANG had more cavitary nodules. 55 A halo of ground-glass opacity around a nodule is a sign of ANG in the early phase. Subsequent development of a crescent of air (air-crescent sign) occurs within the lesion often, once the immunity of the affected patient is restored and a white-cell response to the infection can occur.…”

Section: Organizing Pneumoniamentioning

confidence: 99%

Approach to Peribronchovascular Disease on CT

Girvin

Moore

et al. 2019

Seminars in Ultrasound, CT and MRI

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“…Many cases are relatively indolent and the condition progresses over weeks rather than over days. Lack of angioinvasion on imaging was associated with more protracted clinical course and delayed diagnosis in heart transplant recipients 4. Consequently, diagnosis is often not suspected because of the non-specific symptoms and imaging.…”

Section: Invasive Aspergillosismentioning

confidence: 99%

Republished: The clinical spectrum of pulmonary aspergillosis

Kosmidis

Denning

2015

Postgraduate Medical Journal

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The clinical presentation of Aspergillus lung disease is determined by the interaction between fungus and host. Invasive aspergillosis develops in severely immunocompromised patients, including those with neutropenia, and increasingly in the non-neutropenic host, including lung transplant recipients, the critically ill patients and patients on steroids. A high index of suspicion is required in patients without the classical risk factors as early presentation is usually silent and non-specific, pyrexia uncommon and timely treatment is crucial for survival. Invasive aspergillosis has also been diagnosed in normal hosts after massive exposure to fungal spores. Chronic pulmonary aspergillosis affects patients without obvious immune compromise, but with an underlying lung condition such as COPD or sarcoidosis, prior or concurrent TB or non-tuberculous mycobacterial disease. Aspergillus bronchitis may be responsible for persistent respiratory symptoms in patients with Aspergillus detected repeatedly in sputum without evidence of parenchymal Aspergillus disease, especially in patients with bronchiectasis and cystic fibrosis. Allergic bronchopulmonary aspergillosis affects patients with asthma and cystic fibrosis, and is important to recognise as permanent lung or airways damage may accrue if untreated. Changes in the classification of Aspergillus allergic lung disease have been proposed recently. Cases of extrinsic allergic alveolitis and chronic pulmonary aspergillosis have been observed after Aspergillus exposure. Asymptomatic colonisation of the respiratory tract needs close monitoring as it can lead to clinical disease especially with ongoing immunosuppression. The various syndromes should be viewed as a semicontinuous spectrum of disease and one form may evolve into another depending on the degree of ongoing immunosuppression.

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Invasive pulmonary aspergillosis in heart transplant recipients: Two radiologic patterns with a different prognosis

Cited by 35 publications

References 35 publications

Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: A Multinational Cohort Study

Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: A Multinational Cohort Study

Approach to Peribronchovascular Disease on CT

Republished: The clinical spectrum of pulmonary aspergillosis

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