The radiological spectrum of pulmonary aspergillosis

Greene, Reginald E.

doi:10.1080/13693780500064771

Cited by 104 publications

(52 citation statements)

References 47 publications

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“…The halo sign may be found in many other situations: as a result of metastasis, bronchoalveolar carcinoma, bronchiolitis obliterans organising pneumonia, eosinophilic pneumonia or other fungal infection [78]. GREENE [79] found that 94% of 235 patients with a confirmed diagnosis of IPA had at least one nodular region. In another report on HRCT chest findings in febrile neutropenic patients with pneumonia, the findings associated with IPA were ill-defined nodules (67%), groundglass appearance (56%), and consolidation (44%) [80].…”

Section: Diagnosismentioning

confidence: 99%

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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Section: Diagnosismentioning

confidence: 99%

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

586

596

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“…In contrast, the presence of centrilobular micronodules and/or tree-in-bud without any nodule with a halo sign was defined as an airway-invasive disease ( Figure 1B). 7,9,[11][12][13] As consolidations may occur with both aspergillosis-induced hemorrhagic infarctions (ie, angioinvasive disease) and Aspergillus bronchopneumonia (ie, airway-invasive disease), consolidations were not considered when differentiating between the 2 entities. 10,12,13 Fiberoptic bronchoscopy was performed within 24 hours of the baseline HRCT.…”

Section: Lung Ct Scan and Fiberoptic Bronchoscopymentioning

confidence: 99%

“…6 However, up to 40% of patients with IPA do not present with a nodule with a halo sign. 7 Some recent data have shown that other CT scan findings may be the only signs present in non-neutropenic patients with IPA, demonstrating the necessity of considering these less characteristic CT scan features for the diagnosis of IPA. 8,9 In this context, some authors have previously identified 2 different patterns of IPA, relying on correlations between histology and CT scan patterns: angioinvasive pulmonary aspergillosis is characterized by vascular invasion by Aspergillus and a nodule with a halo sign, whereas airway-invasive aspergillosis is characterized by the destruction of the bronchiolar wall by Aspergillus and centrilobular micronodules and tree-in-bud opacities.…”

Section: Introductionmentioning

confidence: 99%

The strategy for the diagnosis of invasive pulmonary aspergillosis should depend on both the underlying condition and the leukocyte count of patients with hematologic malignancies

Bergeron

Porcher

Sulahian

et al. 2012

Blood

124

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The identification of the causative organism in invasive pulmonary aspergillosis (IPA) is recommended. We investigated whether a mycologic diagnostic strategy could be optimized based on patient characteristics. Fifty-five patients were enrolled in a prospective study. The presence of Aspergillus in respiratory samples occurred more frequently in non-acute leukemia (AL) patients than in AL patients (P ‫؍‬ .0003), and in patients with leukocyte counts more than 100/mm 3 (P ‫؍‬ .002). In a logistic regression model, these 2 factors appeared to be independent, with an adjusted odds ratio of 7.14 (95% confidence interval, 1.40-36.5) for non-AL patients and an adjusted odds ratio of 6.97 (95% confidence interval, 1.33-36.5) for patients with leukocyte counts more than 100/mm 3 . A positive mycologic result was also more frequent among patients with lung CT scan signs of airway-invasive disease than among other patients (P ‫؍‬ .043). Airway-invasive signs were more frequent among non-AL patients (P ‫؍‬ .049), whereas angioinvasive disease was more frequent among both AL patients (P ‫؍‬ .01) and patients with leukocyte counts less than 100/mm 3 (P ‫؍‬ .001). A concomitant pulmonary infection was identified more frequently among non-AL patients (P ‫؍‬ .005 vs allogeneic hematopoietic stem cell transplant and P ‫؍‬ .048 vs others). Our results suggest that different strategies for diagnosing IPA should be considered based on the underlying condition. (Blood. 2012;119(8):1831-1837) Continuing Medical Education onlineThis activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and the American Society of Hematology. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at http://www.medscape.org/journal/blood; and (4) view/print certificate. For CME questions, see

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“…Patients with early lesions characterized by pulmonary nodules with halos had higher treatment response rates (52.4% versus 29.1%). 43 Moreover, a survival advantage for voriconazole recipients was observed (70.8% compared to 57.9%, a 22% improvement (χ 2 = 5.063, P = 0.024)). Despite this, response among allogeneic HSCT recipients remained suboptimal (32.4% for voriconazole versus 13.3% for CAB).…”

Section: Primary Therapymentioning

confidence: 92%

Of Yeasts and Hyphae: A Hematologist’s Approach to Antifungal Therapy

Bow¹

2006

Hematology

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Improvements in anticancer treatments, the ability to modify myelosuppression profiles, greater duration and intensity of immunosuppression, and the variety of available antimicrobial therapies have influenced the spectrum of pathogens associated with invasive fungal infection complicating treatment of hematological malignancies and hematopoietic stem cell transplantation. The approaches to the management of these infections encompass strategies of prevention for all those at risk, pre-emptive therapy based upon surrogates of infection before the onset of clinical disease, empirical therapy for patients with clinical evidence of early disease, and directed or targeted therapy for infected patients with established disease. Chemoprophylaxis is effective if applied to the highest risk patients over the duration of the risk. Pre-emptive strategies, while promising, have yet to be validated and linked to reliably predictive nonmicrobiological diagnostic techniques. Empirical antifungal therapy, as it is currently applied, now seems questionable. Patients with probable or proven invasive fungal infection still have suboptimal outcomes despite the availability of promising anti-fungal agents. Strategies examining the concept of dose-intensity and combination regimens require careful study and cannot yet be regarded as an acceptable standard of practice. Changing Epidemiology of Invasive Fungal Infection in Hematological Malignancies and Stem Cell TransplantsInterest in the field of medical mycology has expanded considerably as the numbers of immuno-and myelo-suppressed patients susceptible to opportunistic invasive fungal infections (IFI) increase. While the majority (95-97%) of invasive yeast infections are due to five species, predominantly Candida albicans, followed by C. tropicalis, C. glabrata, C. parapsilosis, and C. krusei, emerging importance of infections due to non-albicans Candida spp. including C. glabrata, C. parapsilosis, and C. krusei in high-risk cancer patients is noteworthy. 1 The remaining 3% to 5% of pathogens include other non-albicans Candida spp.. and non-Candida yeasts such as Trichosporon spp., Cryptococcus spp., Blastoschizomyces spp., and Malassezia spp.. 2,3 The risks for IFI among hematopoietic stem cell transplants (HSCT) increases as the disparity of the donor:recipient pair (autologous HSCT, 0.6%; matched related donor HSCT, 3.7%; mismatched related or unrelated donor HSCT, 5.9%, P < 0.0001). 4 The changing character of the HSCT populations together with effective antiCandida agents contribute to a changing spectrum of opportunistic mycoses. In a comparison of transplant patients with IFI to a more general population of patients at risk, the proportion of Candida infections decreased by approximately 45% (77% to 42%); however, that due to Aspergillus spp. has more than doubled (13% to 29%) and that due to other environmental moulds including Fusarium spp., Scedosporium spp., the zygomycetes, and the less com-

show abstract

The radiological spectrum of pulmonary aspergillosis

Cited by 104 publications

References 47 publications

Pulmonary aspergillosis: a clinical review

Pulmonary aspergillosis: a clinical review

The strategy for the diagnosis of invasive pulmonary aspergillosis should depend on both the underlying condition and the leukocyte count of patients with hematologic malignancies

Of Yeasts and Hyphae: A Hematologist’s Approach to Antifungal Therapy

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