Surgical management of invasive pulmonary aspergillosis in immunocompromised patients

Wong, KY; Waters, CM; Walesby, R.K.

doi:10.1016/1010-7940(92)90119-i

Cited by 65 publications

(26 citation statements)

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“…Fears to perform surgery in neutropenic and thrombopenic patients stem from the risk of uncontrollable bleeding and infection. However, the results in patients undergoing lung resection for invasive pulmonary aspergillosis are encouraging [74, 75, 76]. At our institution, 27 neutropenic patients underwent lung resection for suspected invasive pulmonary aspergillosis [77].…”

Section: Fungal Infectionsmentioning

confidence: 99%

The Lung in the Immunocompromised Patient

Tamm

1999

Respiration

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Pulmonary infections decisively contribute to morbidity and mortality in immunocompromised patients. Bacterial, mycobacterial and infections with Pneumocystis carinii have been reviewed in an article in the last issue of Respiration. In this review, viral and fungal pulmonary infections are discussed in HIV-positive patients and in patients treated with high-dose chemotherapy, stem cell or solid-organ transplantation.

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Section: Fungal Infectionsmentioning

confidence: 99%

The Lung in the Immunocompromised Patient

Tamm

1999

Respiration

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“…Resection is performed for therapeutic purposes -to allow cure, to prevent the risk of massive haemoptysis, and to reduce the risk of relapse following subsequent neutropenic episodes or bone marrow transplantation (67,77). It is not possible, however, if the location of the lesion prohibits it or if multiple lobes of one or both lungs are involved.…”

Section: Pulmonary Infectionmentioning

confidence: 99%

Guidelines for the investigation of invasive fungal infections in haematological malignancy and solid organ transplantation

Denning

Evans

Kibbler

et al. 1997

Eur. J. Clin. Microbiol. Infect. Dis.

145

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Invasive fungal infections are increasing in incidence and now affect as many as 50% of neutropenic/bone marrow transplant patients and 5 to 20% of solid organ transplant recipients. Unfortunately, many of the diagnostic tests available have a low sensitivity. The guidelines presented here have been produced by a working party of the British Society for Medical Mycology in an attempt to optimise the use of these tests. The yield of fungi from blood cultures can be increased by ensuring that at least 20 ml of blood are taken for aerobic culture, by using more than one method of blood culture, and by employing terminal subculture if continuous monitoring systems are used with a five-day incubation protocol. Skin lesions in febrile neutropenic patients should be biopsied and cultured for fungi. The detection of galactomannan in blood or urine is of value in diagnosing invasive aspergillosis only if tests are performed at least twice weekly in high-risk patients. Antigen detection tests for invasive candidiasis are less valuable. Computed tomography scanning is particularly valuable in diagnosing invasive pulmonary fungal infection when the chest radiograph is negative or shows only minimal changes. Bronchoalveolar lavage is most useful in patients with diffuse changes on computed tomography scan. The major advances in the diagnosis of invasive fungal infection in patients with haematological malignancy or solid organ transplantation have been in the use of imaging techniques, rather than in the development of new mycological methods in the routine laboratory.

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“…The therapeutic benefit of such surgery, on the other hand, is by no means established [3,4,[11][12][13][14][15][16][17][18], and encouraging results, such as those previously reported by our institution [12], must be treated with caution in view of the lack of randomized trials comparing medical and surgical treatment of IPA.…”

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confidence: 99%

Management of Invasive Pulmonary Aspergillosis in Hematology Patients: A Review of 87 Consecutive Cases at a Single Institution

Yeghen¹,

Kibbler²,

Prentice³

et al. 2000

CLIN INFECT DIS

134

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Eighty-seven patients with hematologic malignancies and invasive pulmonary aspergillosis (IPA) were identified between 1982 and 1995. Of these, 39 underwent lung resection on the basis of radiological detection of at least 1 lesion with imaging suggestive of aspergillosis (LISA). IPA was confirmed histologically in 35. The presence of LISA had 90% positive predictive value for IPA. The actuarial survival at 2 years was 36% for 37 patients treated surgically, 20% for 12 patients with unresected LISA but no cultures of Aspergillus species, and 5% for 21 patients diagnosed only by isolation of Aspergillus from respiratory secretions. Analysis by proportional hazard models showed a significant independent negative association between the radiological appearance of LISA and death from all causes. Relapsed hematologic disease was independently significantly associated with death. Age, sex, surgery, previous bone marrow transplantation, or Aspergillus isolation were not independent predictors of death. IPA presenting as LISA carries a relatively good prognosis, possibly explaining the better survival of patients undergoing surgery for such lesions.

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Surgical management of invasive pulmonary aspergillosis in immunocompromised patients

Cited by 65 publications

References 0 publications

The Lung in the Immunocompromised Patient

The Lung in the Immunocompromised Patient

Guidelines for the investigation of invasive fungal infections in haematological malignancy and solid organ transplantation

Management of Invasive Pulmonary Aspergillosis in Hematology Patients: A Review of 87 Consecutive Cases at a Single Institution

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