Prediction of invasive pulmonary aspergillosis from colonisation of lower respiratory tract before marrow transplantation

Einsele, Hermann; Quabeck, K.; Kd, Müller; Hebart, Holger; Rothenhöfer, I.; Löffler, Jürgen; Uw, Schaefer

doi:10.1016/s0140-6736(05)61265-2

Cited by 78 publications

(46 citation statements)

References 4 publications

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“…Detection of ASP DNA in BAL fluid theoretically enables early diagnosis and early guided optimal therapy that is expected eventually to improve the outcome of IPA in high-risk patients. [6][7][8][9][10][11] In our hands, the turnaround time for PCR-based detection of aspergillus DNA from BAL sampling until delivery of the results is approximately 1-2 working days, with the molecular diagnostic procedure lasting for about 6 h. This study evaluated the contribution of ASP DNA detection to the diagnostic workup of immune-compromised patients with IPA by comparing the mortality rates during two different time periods, with and without the addition of ASP PCR testing. In-hospital mortality was chosen as the outcome variable, despite the fact that nowadays the disease, especially in allogeneic BMT recipients, can present in the community long after transplantation, because in our hospital the standard of care was to admit patients suspected of having IPA, and treat them in hospital for this diagnosis, even a long time after the BMT.…”

Section: Discussionmentioning

confidence: 99%

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Impact of PCR-based diagnosis of invasive pulmonary aspergillosis on clinical outcome

Hardak

Yigla

Avivi

et al. 2009

Bone Marrow Transplant

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Section: Discussionmentioning

confidence: 99%

“…PCR-based ASP DNA detection in bronchoalveolar lavage (BAL) fluid theoretically enables earlier and more frequent diagnosis of IPA. [8][9][10][11] The implication of this test on the outcome of affected patients had not been studied as yet.…”

Section: Introductionmentioning

confidence: 99%

Impact of PCR-based diagnosis of invasive pulmonary aspergillosis on clinical outcome

Hardak

Yigla

Avivi

et al. 2009

Bone Marrow Transplant

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“…Four of these patients had a prior history of invasive fungal infection, a group of patients likely to be colonized and to reactivate fungal infection during a subsequent neutropenic episode (Einsele et al, 1998;Offner et al, 1998). Four of the 11 patients developed proven or probable invasive fungal infection and two received empirical antifungal therapy for febrile neutropenia not responding to broad spectrum antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

Prospective screening by a panfungal polymerase chain reaction assay in patients at risk for fungal infections: implications for the management of febrile neutropenia

et al. 2000

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Summary. Invasive fungal infections are a major cause of mortality in neutropenic cancer patients. To determine whether a polymerase chain reaction (PCR)-based assay enabled the identification of patients at risk for invasive fungal infections, a prospective monitoring once per week was performed during 92 neutropenic episodes in patients receiving chemotherapy for acute leukaemia or high-dose therapy followed by allogeneic or autologous stem cell transplantation, with the investigators blinded to clinical and microbiological data. PCR positivity was documented in 34 out of 92 risk episodes. All patients developing proven invasive fungal infection were found PCR positive, and PCR was found to be the earliest indicator of invasive fungal infection preceding clinical evidence by a mean of 5´75 d (range 0±14 d). In febrile neutropenic patients without a prior history of invasive fungal infection, a sensitivity of 100% and a specificity of 73% of the PCR assay for the development of proven or probable invasive fungal infection was documented. In conclusion, panfungal PCR performed prospectively once a week enabled the identification of patients at high risk for invasive fungal infections.

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“…[58][59][60][61][62][63], and the 401-bp fragment in the ribosomal deoxyribonucleic acid (rDNA) complex of A. fumigatus [64]. Several methods including real time PCR, nested PCR, and two step PCR have been described [58][59][60][61][62][63][64][65][66]. A differentiation of the subspecies of Aspergillus spp.…”

Section: Laboratory Studiesmentioning

confidence: 99%

Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenic patients

et al. 2001

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Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenic patients. F. Reichenberger, J.M. Habicht, A. Gratwohl, M. Tamm. #ERS Journals Ltd 2002. ABSTRACT: Invasive pulmonary aspergillosis is a major cause of morbidity and mortality in neutropenic patients.Microbiological and serological tests are of limited value. The diagnosis should be considered in neutropenic patients with fever not responding to antibiotics, and typical findings on thoracic computed tomography scan. Whenever possible, diagnosis should be confirmed by tissue examination. Newer techniques, such as polymerase chain reaction may change the current diagnostic approach.Therapeutic strategies consist of prophylaxis in risk groups and the early application of antifungal agents in suspected or probable disease. Amphotericin B as desoxycholate or lipid formulation is the current standard medication in invasive infection, although it has major side effects. Its role is challenged by the new azole derivates, such as itraconazole and voriconazole, and the new echinocandins. Additional therapies with cytokines, such as granulocyte macrophage colony stimulating factor and interferon-c, and with granulocyte transfusions are under evaluation. In selected cases lung resection is of proven diagnostic and therapeutic value.This paper analyses the current understanding of the pathogenesis and epidemiology of invasive aspergillosis and reviews the actual diagnostic and therapeutic strategies for invasive pulmonary aspergillosis in neutropenic patients.

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Prediction of invasive pulmonary aspergillosis from colonisation of lower respiratory tract before marrow transplantation

Cited by 78 publications

References 4 publications

Impact of PCR-based diagnosis of invasive pulmonary aspergillosis on clinical outcome

Impact of PCR-based diagnosis of invasive pulmonary aspergillosis on clinical outcome

Prospective screening by a panfungal polymerase chain reaction assay in patients at risk for fungal infections: implications for the management of febrile neutropenia

Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenic patients

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