Long-Term CT Follow-Up in 40 Non-HIV Immunocompromised Patients with Invasive Pulmonary Aspergillosis: Kinetics of CT Morphology and Correlation with Clinical Findings and Outcome

Brodoefel, Harald; Vogel, Monika; Hebart, Holger; Einsele, Hermann; Vonthein, Reinhard; Claussen, Claus D.; Horger, Marius

doi:10.2214/ajr.05.0513

Cited by 94 publications

(70 citation statements)

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“…In patient 2, the leukemia relapse probably hampered the long-lasting rise of IFN-g-T H 1 and the maintenance of a specific T-cell response (Figure 1c). Furthermore, in patients 1 and 2, the kinetics of the ELISPOT appear to correlate well with the changes of the radiologic signs in IA: 8 an initial increase of the size of the pulmonary lesions associated with a high level of IL-10-T H 2 was followed by stability and gradual reduction of the size of the pulmonary lesion associated with an increasing IFN-g-T H 1 level (Figure 1a and b). The delayed appearance of radiologic signs of reduction of the pulmonary lesion in patient 2 (not shown), compared with patient 1, is likely to be related to the delayed rise of IFN-g-T H 1 in the former (Figure 1a and c).…”

Section: Letters To the Editormentioning

confidence: 61%

Diagnosis of invasive aspergillosis by tracking Aspergillus-specific T cells in hematologic patients with pulmonary infiltrates

et al. 2007

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Section: Letters To the Editormentioning

confidence: 61%

Diagnosis of invasive aspergillosis by tracking Aspergillus-specific T cells in hematologic patients with pulmonary infiltrates

et al. 2007

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“…(1,14,15) When the anatomopathological findings are correlated with the tomographic findings, foci/areas of infarction can present as nodules or as consolidation in the shape of a wedge, with a pleural base. (2,16) Either finding can be accompanied by the halo sign,…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…(1,2) The frequency of IPA ranges between 5% and 15% in patients submitted to BMT, and it is approximately 70% after 34 days of neutropenia in individuals with any kind of hematologic malignancy. (2)(3)(4)(5) In addition to being commonly found in such patients, IPA presents mortality rates as high as 94% according to certain studies. (2,4,6,7) This is probably due, at least in part, to the difficulty in diagnosing the disease in an early phase and, consequently, to the delay in initiating antifungal therapy.…”

Section: Introductionmentioning

confidence: 99%

“…(2)(3)(4)(5) In addition to being commonly found in such patients, IPA presents mortality rates as high as 94% according to certain studies. (2,4,6,7) This is probably due, at least in part, to the difficulty in diagnosing the disease in an early phase and, consequently, to the delay in initiating antifungal therapy. (8) The gold standard for the diagnosis of IPA is the histopathological finding of tissue invasion by the microorganism.…”

Section: Introductionmentioning

confidence: 99%

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Surto de aspergilose pulmonar invasiva em enfermaria de transplante de medula óssea: achados tomográficos

et al. 2009

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Objective: To evaluate the main aspects on CT scans of six patients hospitalized in a bone marrow transplant ward, diagnosed with invasive pulmonary aspergillosis (IPA), during an in-hospital outbreak of the disease. Methods: We reviewed 10 chest CT scans of six neutropenic or immunocompromised patients hospitalized in the hematology and bone marrow transplant ward of the Hospital São Paulo, in the city of São Paulo, Brazil, who were diagnosed with IPA between April of 2007 and October of 2007. The diagnosis of IPA was confirmed by anatomopathological findings (in 2 cases), culture (in 3 cases) or appropriate treatment response (in 1 case). Results: We evaluated the CT scans of three male and three female patients, ranging from 22 to 58 years of age. The most common tomographic findings were nodules (5/6 cases) and areas of consolidation (2/6 cases). The nodules were more often multiple (3/5 cases), with irregular contours (4/5 cases) and accompanied by the halo sign (3/5 cases). One case presented multiple, centrally distributed areas of consolidation, and another presented an isolated, peripheral area of consolidation. Areas of ground-glass attenuation and septal thickening were found in three and two patients, respectively. Bilateral pleural effusion occurred in three cases. Conclusions: Consolidation, nodules, septal thickening, pleural effusion and ground-glass opacities were the principal tomographic findings in the six patients hospitalized in the abovementioned ward during the IPA outbreak. The nodules were often (in 67% of the cases) accompanied by the halo sign, a classically described finding in patients with IPA.Keywords: Aspergillosis; Lung diseases, fungal; Neutropenia; Bone marrow transplantation; Tomography, X-Ray computed. ResumoObjetivo: Avaliar os principais aspectos encontrados na TC de seis pacientes internados em uma enfermaria de transplante de medula óssea, diagnosticados com aspergilose pulmonar invasiva (API) durante um surto intra-hospitalar da doença. Métodos: Foram revisadas 10 TC de tórax de seis pacientes internados na enfermaria de hematologia e transplante de medula óssea do Hospital São Paulo em São Paulo (SP) entre abril de 2007 e outubro de 2007, neutropênicos ou imunossuprimidos, que evoluíram com API. O diagnóstico de API foi comprovado por exames anatomopatológicos (2 casos), cultura (3 casos) ou por resposta terapêutica adequada (1 caso). Resultados: Foram avaliadas imagens tomográficas de três homens e três mulheres com idades variando de 22 a 58 anos. Nódulos (5/6 casos) e áreas de consolidação (2/6 casos) foram os achados tomográficos mais comuns. Os nódulos eram mais frequentemente múltiplos (3/5 casos), de contornos irregulares (3/5 casos) e com sinal do halo (3/5 casos). Foram encontradas consolidações múltiplas e de distribuição central em um caso e consolidação isolada e periférica em outro. Áreas de atenuação em vidro fosco e espessamento septal foram achados, respectivamente, em três e dois pacientes. Derrame pleural bilateral ocorreu em três casos. Concl...

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Current Algorithms in Fungal Diagnosis in the Immunocompromised Host

Lehrnbecher

Becker

Groll

2016

Methods in Molecular Biology

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Invasive fungal diseases (IFDs) are a major cause of morbidity and mortality in immunocompromised patients such as patients with hematological malignancies or allogeneic hematopoietic stem cell transplant recipients. Whereas the definite diagnosis of IFD requires invasive diagnostic procedures, imaging and noninvasive diagnostic assays may help in decision making with regard to the institution and the choice of antifungal agents, the duration of therapy, surgical intervention, and monitoring of fungal manifestations.Unfortunately, signs and symptoms of IFD are often nonspecific in the immunocompromised patient. Therefore, in immunocompromised patients with suspected IFD, all samples collected need to be cultured for fungi, and, in the case of specimens obtained by invasive diagnostic procedures, also microscopically examined. For high sensitivity of the cultural and microscopic approaches, specific media and stains, respectively, are crucial. Non-culture based method such as the detection of galactomannan or ß-d-glucan and molecular tools such as polymerase chain reaction may help in the early diagnosis of IFD. Imaging studies may be indicative for IFD, but invasive diagnostics such as bronchoalveolar lavage and/or biopsy should be pursued in order to identify the causative pathogen. This chapter summarizes the current knowledge on diagnosing IFD and proposes practical help in the use of diagnostic tools.

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Long-Term CT Follow-Up in 40 Non-HIV Immunocompromised Patients with Invasive Pulmonary Aspergillosis: Kinetics of CT Morphology and Correlation with Clinical Findings and Outcome

Cited by 94 publications

References 33 publications

Diagnosis of invasive aspergillosis by tracking Aspergillus-specific T cells in hematologic patients with pulmonary infiltrates

Diagnosis of invasive aspergillosis by tracking Aspergillus-specific T cells in hematologic patients with pulmonary infiltrates

Surto de aspergilose pulmonar invasiva em enfermaria de transplante de medula óssea: achados tomográficos

Current Algorithms in Fungal Diagnosis in the Immunocompromised Host

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