Diagnosis of Fungal Infections. A Systematic Review and Meta-Analysis Supporting American Thoracic Society Practice Guideline

Haydour, Qusay; Hage, Chadi A.; Carmona, Eva M.; Epelbaum, Oleg; Evans, Scott E.; Gabe, Luke; Knox, Kenneth S.; Kolls, Jay K.; Wengenack, Nancy L.; Prokop, Larry J.; Limper, Andrew H.; Murad, M. Hassan

doi:10.1513/annalsats.201811-766oc

Cited by 64 publications

(49 citation statements)

References 56 publications

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“…Interestingly, therapeutic course of antifungal therapy was given to 12 patients in our population with negative BAL cultures, mainly on physicians' discretion and supported by elevated serum (1, 3)-β-D Glucan and Aspergillus galactomannan levels. Previous studies in non-neutropenic patients also suggest a rather low sensitivity of bronchial washing culture for fungal pneumonias [18,23]. However, within the scope of our retrospective study, we are unable to comment further.…”

Section: Discussioncontrasting

confidence: 61%

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The Diagnostic Utility and Clinical Implications of Bronchoalveolar Lavage in Cancer Patients With Febrile Neutropenia and Lung Infiltrates

Khalid

Akram

Butt

et al. 2020

Cureus

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Introduction Febrile neutropenia (FN) is a dreaded complication of cancer chemotherapy and frequently associated with respiratory infections. Flexible bronchoscopy (FB) serves as a useful diagnostic tool in this regard. Objective To determine the diagnostic yield, safety and clinical implications of bronchoalveolar lavage (BAL) in cancer patients with FN, having lung infiltrates on radiographic chest imaging. Methods We reviewed medical records of FN patients who underwent FB at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from July 2015 till July 2018. The culture yield of BAL, resultant change of management and outcome over the subsequent 30 days were retrospectively analysed. Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY) was used for data analysis. Results Ninety FN patients, with mean age 26 ± 18 years and predominantly males (65.6%, n = 59) were included in the study. Seventy-seven (85.6%) had hematological and 13 (14.4%) solid organ malignancy. The mean absolute neutrophil count was 0.20 +/-0.36/ µL. BAL cultures were diagnostic in 40 (44%) patients; the etiology was bacterial, fungal and mixed in 25 (62.5%), 14 (35%) and one (2.5%) patient, respectively. All patients were on empirical antibiotics prior to bronchoscopy: 32 (35.6%) on antibacterial alone and 58 (64.4%) on antibacterial plus antifungal therapy. Change of management occurred in 51 (56.7%) patients after BAL results, including de-escalation from dual antibiotics in 28 (55%) and initiation of new culture sensitive antibiotic in 23 (45%). FB-associated complications developed in three (5.6%) non-intensive care patients (ICU), including transient hypoxia in two and minor hemoptysis in one patient, while five (14.8%) mechanically ventilated patients in ICU experienced worsening of oxygenation parameters within 48 hours. Overall, 24 (26.7%) patients died. Mortality was 3.7% in non-ICU and 69% in ICU setting and significantly higher in patients with fungal pneumonias (p-value 0.01) and with prolonged neutropenia (p-value 0.001).

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Section: Discussioncontrasting

confidence: 61%

“…Additionally, silver staining for Pneumocystis jirovecii pneumonia (PJP) and AFB staining for Nocardia was performed wherever indicated. Positive cultures were diagnostic for bacterial and fungal pneumonias while in selected cases, elevated serum fungal markers {(1,3)-β-D Glucan and Aspergillus galactomannan} were regarded as diagnostic [18].…”

Section: Methodsmentioning

confidence: 99%

The Diagnostic Utility and Clinical Implications of Bronchoalveolar Lavage in Cancer Patients With Febrile Neutropenia and Lung Infiltrates

Khalid

Akram

Butt

et al. 2020

Cureus

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“…This increase in false negative rate and decrease in false positive rate with increasing ODI value should be taken into account when using GM as a diagnostic marker. A more recent systemic review and meta-analysis by Haydour and colleagues demonstrated serum GM had moderate sensitivity of 71% (64-78%, 95% CI) and high specificity of 89% (84-92%, 95% CI) [27]. ODI of 1 was considered to provide optimal sensitivity [79%, (60-91%, 95% CI)] and specificity (88%, 78-94%, 95% CI) [28].…”

Section: Diagnosismentioning

confidence: 99%

“…ODI of 1 was considered to provide optimal sensitivity [79%, (60-91%, 95% CI)] and specificity (88%, 78-94%, 95% CI) [28]. Increased diagnostic accuracy was again demonstrated in BAL GM with overall sensitivity and specificity of 84% (73-91%, 95% CI) and 88% (81-91%, 95% CI) respectively [27].…”

Section: Diagnosismentioning

confidence: 99%

Advances in the Diagnosis and Management of Pulmonary Aspergillosis

Gao

Soubani

2020

Advances in Respiratory Medicine

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Aspergillus is a mould that is ubiquitous in nature and may lead to a variety of infectious and 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 appear to be at an increased risk as well. 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 pulmonary aspergillosis is a locally invasive disease described in patients with chronic lung disease or mild immunodeficiency. Recently, the European Society for Clinical Microbiology and Infectious Diseases provided a more robust sub-classification of this entity that allows for a straightforward approach to diagnosis and management. 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. It also details the role of noninvasive tests in the diagnosis of Aspergillus related lung diseases and advances in the management of these disorders.

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“…Urine and serum antigen detection provides the most rapid and accurate method to diagnose PDH. 56 Antigen levels correlate with severity of the infections 35 and can be used to follow response to therapy as it is expected to decrease with successful treatment. 57 Serology is less sensitive in immunocompromised patients.…”

Section: Diagnosismentioning

confidence: 99%

Endemic Fungi Presenting as Community-Acquired Pneumonia: A Review

Azar

Malo

Hage

2020

Semin Respir Crit Care Med

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AbstractIn endemic areas, dimorphic fungal infections due to Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides posadasii/immitis account for up to 30% of cases of community-acquired pneumonia. Because respiratory manifestations are often indistinguishable from common bacterial causes of pneumonia, the diagnosis of pulmonary histoplasmosis, blastomycosis, and coccidioidomycosis is often delayed and associated with antibiotics overuse. In addition to being highly endemic to certain regions of North America, dimorphic fungi have global significance due to established areas of endemicity in all six inhabited continents, an increasingly interconnected world of travelers and transported goods, and a changing epidemiology as a result of global heating and anthropomorphic land utilization. In this review, we discuss the epidemiology, pathogenesis, clinical presentation, diagnostic modalities, and treatment strategies for histoplasmosis, blastomycosis, and coccidioidomycosis.

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Diagnosis of Fungal Infections. A Systematic Review and Meta-Analysis Supporting American Thoracic Society Practice Guideline

Cited by 64 publications

References 56 publications

The Diagnostic Utility and Clinical Implications of Bronchoalveolar Lavage in Cancer Patients With Febrile Neutropenia and Lung Infiltrates

The Diagnostic Utility and Clinical Implications of Bronchoalveolar Lavage in Cancer Patients With Febrile Neutropenia and Lung Infiltrates

Advances in the Diagnosis and Management of Pulmonary Aspergillosis

Endemic Fungi Presenting as Community-Acquired Pneumonia: A Review

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