Prevalence of the reversed halo sign in neutropenic patients compared with non‐neutropenic patients: Data from a single‐centre study involving 27 patients with pulmonary mucormycosis (2003‐2016)

Abstract

Pulmonary mucormycosis (PM) is a life-threatening infection and the diagnosis can be challenging. The objective was to retrospectively explore the value of the RHS in our cohort of 27 patients with mucormycosis and its relation to neutropenia. This was a retrospective study including all patients with a diagnosis of probable or proven invasive PM according to the 2008 EORTC/MSG criteria between September 2003 to April 2016. Fisher's exact test and Mann-Whitney test, with a P-value statistically significant under .05 (P<.05), were used to compare neutropenic and non-neutropenic groups. 27 patients were eligible. The RHS could be identified in 78% of cases in the neutropenic group, and was less common in the non-neutropenic group (31%) (P<.05). Reticulations inside ground-glass opacity in case of RHS were present in 13 out of 15 patients (87%). Mucorales DNA detection by PCR on serum provided, a median time to the first PCR-positive sample of 3 days (-33 to +60 days) before diagnosis was confirmed. Six patients had IPA co-infection. In conclusion, RHS is more frequent in case of PM in neutropenic patients compare to non-neutropenic patients. Its presence in immunocompromised patients should be sufficient to promptly start Mucorales-active antifungal treatment, while its absence especially in non-neutropenic cases should not be sufficient to exclude the diagnosis.

Quantitative PCR (qPCR) Detection of Mucorales DNA in Bronchoalveolar Lavage Fluid To Diagnose Pulmonary Mucormycosis

“…Only one of the 6 infections had been detected using the culture method. The higher detection rate of mixed infections (about 20%) when PCR assays are used was previously highlighted in other studies that used Mucorales PCR (9,23).…”

Recent advances in the understanding and management of mucormycosis

“…However, when studied very early and on serial follow-up, sequential morphologic changes could be observed as (i) reversed halo sign ( Figure 2 ) followed by (ii) consolidation or nodule or mass with halo sign and, finally, (iii) central necrosis and air-crescent sign. For pulmonary mucormycosis, a recent study showed that there was a significant increase in the prevalence of reversed halo sign in neutropenic (79%) and non-neutropenic (31%) patients ( P <0.05) 25 .…”

Mucormycosis in lung transplant recipients: A systematic review of the literature and a case series

“…We found reports on 121 cases of mucormycosis in LTR. Data regarding infection site and outcome were available for 53 patients (Figure ), whereas detailed clinical and therapeutic data were available for 34 patients, for which the data regarding our series were also added, to total 40 patients (Table ) . Thirty‐four of the 121 published cases referred to airway colonization with Mucorales without clinical, radiological, or histological evidence of invasive disease; however, some cases affected management, leading to reduced immunosuppression or to initiation of antifungal therapy .…”

“…Since histological differentiation between Aspergillus and Mucorales is sometimes unreliable and may affect treatment, we believe that molecular‐based diagnostic techniques are important for obtaining an early correct diagnosis, thus improving the outcome. Our literature search revealed only two published cases in which mucormycosis in LTR was diagnosed by PCR methods, in addition to culture and histology . Commercial availability of molecular diagnostic assays, as well as their standardization, may allow the widespread use of such methods in the future.…”