Role of fiberoptic bronchoscopy in the diagnosis of invasive pulmonary aspergillosis in patients with acute leukemia

Albelda, Steven Μ.; Talbot, George H.; Gerson, Stanton L.; Miller, Wallace T.; Cassileth, Peter A.

doi:10.1016/0002-9343(84)90853-2

Cited by 122 publications

(43 citation statements)

References 34 publications

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“…Three episodes of CMV pneumonia were exclusively diagnosed at necropsy, and only one of five cases with Aspergillus pneumonia was diagnosed during lifetime in our study. Whereas new diagnostic tools like shell vial cultures, detection of antigenemia, and CMV deoxyribonucleic acid (DNA) in blood leucocytes by polymerase chain reaction (PCR) have recently significantly improved the diagnostic yield of CMV infection [26], the diagnosis of fungal pneumonia, first of all Aspergillus pneumonia, remains particularly troublesome [24,25,27,28]. Recent approaches in the diagnosis of Aspergillus pneumonia using a CT scan of the chest have shown promising results and may obviate the need for an invasive diagnostic confirmation in a considerable amount of cases [29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary complications in patients with haematological malignancies treated at a respiratory ICU

Ewig¹,

Torres²,

Riquelme³

et al. 1998

Eur Respir J

141

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The treatment of haematological malignancies is frequently associated with pulmonary complications, including infectious and noninfectious aetiologies [1][2][3][4]. The prognosis of these patients worsens significantly when respiratory failure requiring intensive care unit (ICU) treatment and mechanical ventilation occurs [5,6]. Despite adequate diagnostic evaluation and treatment in an ICU, mortality remains so high that the benefits of the use of mechanical ventilation have been seriously questioned. This is especially true for bone-marrow transplant recipients [7][8][9][10][11].We, therefore, report our experience in the treatment of patients with haematologic malignancies and pulmonary complications admitted to our respiratory intensive care unit (RICU). We studied the aetiology of pulmonary compromise and determined the value of different diagnostic tools as well as the information obtained by necropsy. Moreover, we looked for prognostic factors associated with mortality. Materials and methods Patient populationThe clinical charts of all patients with haematological malignancies and pulmonary complications admitted to our ICU between January 1, 1984 and December 31, 1993 were retrospectively recorded. Overall, 89 patients were considered adequate for evaluation. Data collectionIn all cases, the following variables were recorded: age, sex, underlying haematological malignancy, presence or absence of bone marrow transplantation (BMT), allogeneic or autologous BMT and interval from BMT to ICU admission. From the variables available at admission, leucocyte count, platelet count, prothrombin, creatinine, arterial oxygen tension (Pa,O 2 )/inspiratory oxygen fraction (FI,O 2 ) and the type (alveolar, interstitial, mixed), as well as, the distribution of radiographical infiltrates (uni-versus bilateral) were recorded. Chemotherapy and/or radiotherapy received, antimicrobial treatment during hospitalization, the absence or presence of adult respiratory distress syndrome (ARDS; as defined by MURRAY et al. [12]), the requirement of mechanical ventilation, and the duration of mechanical ventilation were retrieved.The aetiology of pulmonary compromise was classified as definitely infectious, noninfectious or undetermined. An aetiology was considered definite in the case of a The outcome in this patient population was uniformly poor. It was worst in bone marrow recipients developing pulmonary complications <90 days after transplantation and requiring mechanical ventilation. Decisions about intensive care unit admission and mech-anical ventilation should seriously consider the dismal prognosis of these patients.

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Section: Discussionmentioning

confidence: 99%

Pulmonary complications in patients with haematological malignancies treated at a respiratory ICU

Ewig¹,

Torres²,

Riquelme³

et al. 1998

Eur Respir J

141

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“…The sensitivity and specificity of a positive result of BAL fluid are about 50% and 97%, respectively, but this diagnostic yield of BAL in the diagnosis of IPA is not consistent, and much lower yields have been reported [66,68,[82][83][84][85][86]. However, BAL is still a safe and useful tool in high-risk patients suspected to have IPA.…”

Section: Diagnosismentioning

confidence: 96%

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

586

596

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Aspergillus is a mould which may lead to a variety of infectious, allergic diseases depending on the host's immune status or pulmonary structure. Invasive pulmonary aspergillosis occurs primarily in patients with severe immunodeficiency. The significance of this infection has dramatically increased with growing numbers of patients with impaired immune state associated with the management of malignancy, organ transplantation, autoimmune and inflammatory conditions; critically ill patients and those with chronic obstructive pulmonary disease appear to be at an increased risk. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has resulted in lower mortality rates associated with this infection. Chronic necrotising aspergillosis is a locally invasive disease described in patients with chronic lung disease or mild immunodeficiency. Aspergilloma is usually found in patients with previously formed cavities in the lung, whereas allergic bronchopulmonary aspergillosis, a hypersensitivity reaction to Aspergillus antigens, is generally seen in patients with atopy, asthma or cystic fibrosis. This review provides an update on the evolving epidemiology and risk factors of the major manifestations of Aspergillus lung disease and the clinical manifestations that should prompt the clinician to consider these conditions. Current approaches for the diagnosis and management of these syndromes are discussed.

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“…During flexible bronchoscopy examination, some mucosal lesions might be present and thus biopsies can be obtained (fig 1). The yield of such biopsies has been reported to be as high as 47% in patients with proven or probable IPA [135,136]. Furthermore, transbronchial lung biopsies can be performed ( fig.…”

Section: Fibreoptic Bronchoscopymentioning

confidence: 99%

“…Furthermore, transbronchial lung biopsies can be performed ( fig. 4) but the yield is ,25% [79,135]. Unfortunately, despite its usefulness, performance of flexible bronchoscopy in COPD patients is sometimes difficult due to their poor lung status and function.…”

Section: Fibreoptic Bronchoscopymentioning

confidence: 99%

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

Bulpa¹,

Dive²,

Sibille³

2007

European Respiratory Journal

313

200

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Aspergillus spp. cultured in specimens from the airways of chronic obstructive pulmonary disease (COPD) patients are frequently considered as a contaminant. However, growing evidence suggests that severe COPD patients are at higher risk of developing invasive pulmonary aspergillosis (IPA), although IPA incidence in this population is poorly documented. Some data report that COPD is the underlying disease in 1% of patients with IPA.Definitive diagnosis of IPA in COPD patients is often difficult as tissue samples are rarely obtained before death. Diagnosis is therefore usually based on a combination of clinical features, radiological findings (mostly thoracic computed tomography scans), microbiological results and, sometimes, serological information.Of 56 patients with IPA reported in the literature, 43 (77%) were receiving corticosteroids on admission to hospital. Breathlessness was always a feature of disease and excess wheezing was present in 79% of patients. Fever (.38uC) was present in only 38.5%. Chest pain and haemoptysis were uncommon. Six out of 33 (18%) patients had tracheobronchitis observed during bronchoscopy. The median delay between symptoms and diagnosis was 8.5 days. The mortality rate was high: 53 out of 56 (95%) patients died despite invasive ventilation and antifungal treatment in 43 (77%) of them.In chronic obstructive pulmonary disease patients, invasive pulmonary aspergillosis currently carries a very poor prognosis. Outcome could perhaps be improved by more rapid diagnosis and prompt therapy with voriconazole.

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Role of fiberoptic bronchoscopy in the diagnosis of invasive pulmonary aspergillosis in patients with acute leukemia

Cited by 122 publications

References 34 publications

Pulmonary complications in patients with haematological malignancies treated at a respiratory ICU

Pulmonary complications in patients with haematological malignancies treated at a respiratory ICU

Pulmonary aspergillosis: a clinical review

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease

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