We assessed Calcofluor white staining, Aspergillus polymerase chain reaction, and a galactomannan enzyme immunoassay for diagnosis of fungal infection with use of computed tomography-guided percutaneous lung biopsy specimens obtained from 61 patients. The sensitivity and specificity of computerized tomography, Aspergillus polymerase chain reaction, and galactomannan enzyme immunoassay were 100% and 50%, 100% and 86%, and 88% and 94%, respectively.Invasive aspergillosis (IA) is a major cause of morbidity and mortality among immunosuppressed patients. Case-fatality rates range from 30% to 80% among neutropenic patients, and death results, at least in part, from difficulties in obtaining a reliable diagnosis in the early stage of disease [1]. No method has proven to be sufficiently sensitive and specific to allow adequate diagnosis.The use of CT allows diagnosis early in the course of pulmonary IA and helps to improve the overall survival rate among febrile, neutropenic patients [2]. Previous studies reported that the CT finding of a halo sign is indicative of pulmonary aspergillosis in neutropenic patients [3]. Thus far, it is impossible to distinguish Aspergillus species from other fungi on the basis of clinical signs [4]. However, identification of the causative organisms is highly warranted in the clinical context to deter- mine adequate therapy. Zygomycetes have in vivo and in vitro resistance to the newer antifungals, such as voriconazole and caspofungin [5]. The number of infections due to zygomycetes have increased in our hospital and in other health care centers, indicating the need for a powerful means of diagnosis [6].We evaluated the utility of Calcofluor white staining (CFWS), galactomannan EIA (GM EIA), and Aspergillus PCR of CTguided lung biopsy specimens for diagnosis of rapidly invasive fungal infection in immunosuppressed patients.Methods. A prospective study conducted from October 2003 through September 2006 evaluated 61 patients who had hematologic malignancies (46 patients) or who had undergone solid-organ transplantation (15 patients) and who had CT findings highly suggestive of an invasive fungal infection. The specimens were obtained by CT-guided percutaneous biopsy and were investigated for the presence of fungal elements. All CTguided percutaneous biopsies were performed with an automated biopsy gun that contained a detachable coaxial cutting needle system, as described by Lucidarme et al. [7]. In our study, an outer coaxial needle with a 17-gauge diameter and an inner biopsy needle with an 18-gauge diameter were chosen. Interventions were performed only for patients with platelet counts of 50,000 platelets/mL and with prothrombin and partial thromboplastin times within the normal limits. Lesions that had a diameter 11 cm and that were most easily assessable were chosen for biopsy.Biopsy specimens were transferred to 2 mL of NaCl, minced, and homogenized aseptically. Samples were then vortexed, stored at room temperature for 30 min, and centrifuged. Supernatants and homogenized tissues wer...

A prospective, observational, multicentre study was performed to assess the incidence, diagnosis, epidemiology and outcome of invasive mould infections (IMIs) reported to the Nationwide Austrian Aspergillus Registry. In total, 186 cases were recorded, corresponding to an annual incidence of 42 cases/1000 patients at risk or 2.36 cases/100000 inhabitants. Patients with acute myelogenous leukaemia (34%) and lung transplant recipients (17%) are currently at highest risk for IMI, followed by a mixed population with impaired immunity (14%). In total, 34%, 30% and 36% were proven, probable and possible cases of IMI. Predominant pathogens were Aspergillus spp. (67%), followed by the zygomycetes (28%). Voriconazole was the most frequently administered agent (38%), followed by caspofungin (20%) and posaconazole (19%). Eighty patients (43%) received antifungal prophylaxis for ≥7 days, 30% of whom (24 patients) suffered from a breakthrough infection. The overall crude 12-week mortality was 34%. Multivariate analysis showed that outcome and survival did not correlate with the status of fungal disease, breakthrough infection, fungal species or age (P>0.05). Aspergillosis remains the most commonly identified IMI amongst immunocompromised and/or immunosuppressed patients, but other moulds constitute a significant problem. Survival from IMIs appears to have improved and the main challenge is to overcome breakthrough fungal infections.

Our data suggest that homeopathic treatment may be a useful additional therapeutic measure with a long-term benefit for severely septic patients admitted to the intensive care unit. A constraint to wider application of this method is the limited number of trained homeopaths.

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