Computed Tomography in Invasive Pulmonary Aspergillosis

Potente, G

doi:10.3109/02841858909174720

Cited by 5 publications

(4 citation statements)

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“…Interestingly, of the 11 patients with possible IFD due to abnormal chest CT results, none had fungi detected by cfDNA NGS and nine (82%) of these patients received antifungal therapy for >1 week. While certain radiographic findings can be suggestive of IFD, an image‐guided diagnostic approach is often nonspecific and can lead to overdiagnosis of IFD in febrile neutropenic patients . Comparing abnormal imaging results to a noninvasive reliable blood test might help establish fungal pathogens as the causal agents.…”

Section: Discussionmentioning

confidence: 99%

Cell‐free DNA next‐generation sequencing successfully detects infectious pathogens in pediatric oncology and hematopoietic stem cell transplant patients at risk for invasive fungal disease

Armstrong

Rossoff

Hollemon³

et al. 2019

Pediatric Blood & Cancer

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Background We sought to determine if next‐generation sequencing (NGS) of microbial cell‐free DNA (cfDNA) in plasma would detect pathogens in pediatric patients at risk for invasive fungal disease (IFD). Procedures Pediatric hematology, oncology, and stem cell transplant patients deemed at risk for new IFD had blood samples drawn at three time‐points separated by 1‐month intervals. The primary outcome measure was detection of fungal pathogens compared to standard clinical testing. Secondary outcomes included identification of other infectious pathogens, relationship to European Organization for Research and Treatment of Cancer's Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases’ Mycoses Study Group (EORTC/MSG) guidelines, and assessment of antifungal therapy. Results NGS identified fungal pathogens in seven of 40 at‐risk patients for IFD and results were identical in four of six proven cases, including Aspergillus fumigatus by lung biopsy, Candida albicans by blood or pancreatic pseudocyst cultures, and Rhizopus delemar by skin biopsy. Rhizopus oryzae identified on skin biopsy and A. fumigatus isolated on day 27 of 28 of culture from lung biopsy were not detected by cfDNA NGS, possibly due to lack of bloodstream penetration and questionable pathogenicity, respectively. Numerous DNA viruses were detected in patients with prolonged febrile neutropenia or abnormal imaging. Extended antifungal therapy was used in 73% of patients. Follow‐up cfDNA sequencing in patients who were positive at enrollment was negative at 1 and 2 months. Conclusions cfDNA NGS detected fungal pathogens from blood confirming its potential to guide treatment decisions in pediatric patients at risk for IFD and limit excessive empiric antifungal use. Future studies are needed to better understand the sensitivity and specificity of this approach.

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Section: Discussionmentioning

confidence: 99%

Cell‐free DNA next‐generation sequencing successfully detects infectious pathogens in pediatric oncology and hematopoietic stem cell transplant patients at risk for invasive fungal disease

Armstrong

Rossoff

Hollemon³

et al. 2019

Pediatric Blood & Cancer

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“…the halo sign), or associated with cavitation (i.e. the air‐crescent sign) are highly associated with IFI of the lungs 3–5 . These radiological findings have been incorporated into criteria that are employed to define probable or possible IFI diagnosis 6 .…”

Section: Introductionmentioning

confidence: 99%

“…the air-crescent sign) are highly associated with IFI of the lungs. [3][4][5] These radiological findings have been incorporated into criteria that are employed to define probable or possible IFI diagnosis. 6 However, it is well known that IFI may present with other radiological findings and other infectious or non-infectious aetiologies can also give similar radiological appearances.…”

Section: Introductionmentioning

confidence: 99%

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

Lin

Schaenman

et al. 2010

Mycoses

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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.

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“…It has been estimated that up to 10% of immunocompromised patients with acute lung disease have normal chest roentgenograms (3). Chest CT is a non‐invasive diagnostic test with high utility for early detection of IPA in the appropriate clinical context (2, 6, 7, 13, 15, 19, 20, 22, 24, 25).…”

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confidence: 99%

Early chest radiography and CT in the diagnosis, management and outcome of invasive pulmonary aspergillosis

Hauggaard¹,

Ellis²,

Ekelund³

2002

Acta Radiologica

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Computed Tomography in Invasive Pulmonary Aspergillosis

Cited by 5 publications

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Cell‐free DNA next‐generation sequencing successfully detects infectious pathogens in pediatric oncology and hematopoietic stem cell transplant patients at risk for invasive fungal disease

Cell‐free DNA next‐generation sequencing successfully detects infectious pathogens in pediatric oncology and hematopoietic stem cell transplant patients at risk for invasive fungal disease

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

Early chest radiography and CT in the diagnosis, management and outcome of invasive pulmonary aspergillosis

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