Yield of diagnostic procedures for invasive fungal infections in neutropenic febrile patients with chest computed tomography abnormalities

Abstract

Summary Haematological patients with neutropenic fever are frequently evaluated with chest computed tomography (CT) to rule out invasive fungal infections (IFI). We retrospectively analysed data from 100 consecutive patients with neutropenic fever and abnormal chest CT from 1998 to 2005 to evaluate their chest CT findings and the yield of diagnostic approaches employed. For their initial CTs, 79% had nodular opacities, with 24.1% associated with the halo sign. Other common CT abnormalities included pleural effusions (48%), ground glass opacities (37%) and consolidation (31%). The CT findings led to a change in antifungal therapy in 54% of the patients. Fifty-six patients received diagnostic procedures, including 46 bronchoscopies, 25 lung biopsies and seven sinus biopsies, with a diagnostic yield for IFI of 12.8%, 35.0% and 83.3%, respectively. In conclusion, chest CT plays an important role in the evaluation of haematological patients with febrile neutropenia and often leads to a change in antimicrobial therapy. Pulmonary nodules are the most common radiological abnormality. Sinus or lung biopsies have a high-diagnostic yield for IFI as compared to bronchoscopy. Patients with IFI may not have sinus/chest symptoms, and thus, clinicians should have a low threshold for performing sinus/chest imaging, and if indicated and safe, a biopsy of the abnormal areas.

Biopsy Procedures for Molecular Tissue Diagnosis of Invasive Fungal Infections

“…The sensitivity is indicated with 70.6% [23], 80% [22] and 100% [24], respectively. A low diagnostic yield for fungal infections was reported by Ho et al [16] with 29.4% for FNAB. PTLB is commonly performed when the platelet count is at least 50 × 10 9 /l [16,22,23,25].…”

“…A low diagnostic yield for fungal infections was reported by Ho et al [16] with 29.4% for FNAB. PTLB is commonly performed when the platelet count is at least 50 × 10 9 /l [16,22,23,25]. In general, there is a low risk for complications [21], of which pneumothorax [21][22][23][24][25] and haemoptysis [21] are the most frequently mentioned.…”

“…The procedure is relatively safe [16,21,22] and therefore useful in the evaluation of pulmonary lesions, because of its high diagnostic yield, especially for IPA [21]. The sensitivity is indicated with 70.6% [23], 80% [22] and 100% [24], respectively.…”

“…Using standard procedures like cytopathological examinations and cultures the diagnostic yield of BAL is only 12.8-30% [16,17]. As far as galactomannan detection in BAL fluid is concerned, a meta-analysis reports the sensitivity and specificity with 0,90 and 0,94, respectively for proven or probable cases if IA [18].…”

Fever of Unknown Origin: Treatment According to Risk Assessment

“…It can be considered to include paranasal sinuses in CT studies; however, their benefi t for treatment decisions in asymptomatic, persistently febrile neutropenic patients has not been conclusively shown as yet. This is different in patients who show pulmonary infi ltrates at this time, because pathological fi ndings on CT scans of paranasal sinuses may facilitate the diagnosis of invasive fungal infection [ 11 ].…”