Early diagnosis of invasive pulmonary aspergillosis in hematologic patients: an opportunity to improve the outcome

Nucci, Márcio; Nouér, Simone Aranha; Cappone, Domenico; Anaissie, Elias

doi:10.3324/haematol.2013.094359

Cited by 59 publications

(46 citation statements)

References 20 publications

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“…Early diagnosis of Aspergillus infection has been shown to significantly increase the survival rate of the patient (Nucci et al, 2013). However, so far, universally validated diagnostic assays that enable rapid and accurate detection of this potentially deadly fungus have not yet found their way in routine diagnosis of aspergillosis.…”

Section: General Conclusion and Unanswered Questionsmentioning

confidence: 99%

Ecology of aspergillosis: insights into the pathogenic potency of Aspergillus fumigatus and some other Aspergillus species

Paulussen

Hallsworth

Álvarez‐Pérez

et al. 2016

Microbial Biotechnology

279

175

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SummaryFungi of the genus Aspergillus are widespread in the environment. Some Aspergillus species, most commonly Aspergillus fumigatus, may lead to a variety of allergic reactions and life‐threatening systemic infections in humans. Invasive aspergillosis occurs primarily in patients with severe immunodeficiency, and has dramatically increased in recent years. There are several factors at play that contribute to aspergillosis, including both fungus and host‐related factors such as strain virulence and host pulmonary structure/immune status, respectively. The environmental tenacity of Aspergilllus, its dominance in diverse microbial communities/habitats, and its ability to navigate the ecophysiological and biophysical challenges of host infection are attributable, in large part, to a robust stress‐tolerance biology and exceptional capacity to generate cell‐available energy. Aspects of its stress metabolism, ecology, interactions with diverse animal hosts, clinical presentations and treatment regimens have been well‐studied over the past years. Here, we synthesize these findings in relation to the way in which some Aspergillus species have become successful opportunistic pathogens of human‐ and other animal hosts. We focus on the biophysical capabilities of Aspergillus pathogens, key aspects of their ecophysiology and the flexibility to undergo a sexual cycle or form cryptic species. Additionally, recent advances in diagnosis of the disease are discussed as well as implications in relation to questions that have yet to be resolved.

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Section: General Conclusion and Unanswered Questionsmentioning

confidence: 99%

Ecology of aspergillosis: insights into the pathogenic potency of Aspergillus fumigatus and some other Aspergillus species

Paulussen

Hallsworth

Álvarez‐Pérez

et al. 2016

Microbial Biotechnology

279

175

View full text Add to dashboard Cite

show abstract

“…60 Early treatment is likely responsible for improved outcomes in IA. 83 The kinetics of s-GMI are critical for monitoring response because they correlate with outcome, 62,84,85 with rapid and solid response predicted when s-GMI normalizes within 1 week after seroconversion, 63 and for distinguishing progressive aspergillosis from other infections or PIRIS.…”

Section: 78mentioning

confidence: 99%

How we treat invasive fungal diseases in patients with acute leukemia: the importance of an individualized approach

Nucci

Anaissie

2014

Blood

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Invasive fungal diseases (IFDs) represent an important cause of treatment failure in adults with acute leukemia. Because of leukemia’s heterogeneity, the risk for IFDs is highly variable. We therefore apply a risk-adapted antifungal strategy with strong emphasis on pretreatment and day-15 posttreatment to allow earlier and more individualized interventions. We determine pretreatment risks for IFDs based on 4 factors: (1) host fitness for standard therapy (ie, fit, unfit, or frail); (2) leukemia resistance (high vs low probability of achieving complete remission [CR]); (3) anticipated treatment-related toxicity such as neutropenia, mucositis, and steroid-induced immunosuppression; and (4) patient exposure to opportunistic fungi. Accordingly, we stratify patients as high, intermediate, or low risk for IFDs and apply risk-adapted antifungal strategies, including primary or secondary prophylaxis and diagnostic-based preemptive or empiric therapy. Prevention of IFDs also relies on optimizing organ function, decreasing exposure to opportunistic fungi, and improving net state of immunosuppression with use of better-tolerated and investigational agents for unfit patients and those with adverse leukemia biology. Novel targeted and safe therapies that can achieve higher rates of sustained CR among patients with adverse genetics offer the best promise for reducing the burden of IFDs in these patients.

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“…Despite the availability of new antifungal drugs, the mortality rate for IA remains high, partly due to the difficulty and delay of diagnosis based on clinical, radiological, and mycological methods (1). Because culture-based diagnostic methods have limited performance, non-culture-based methods are increasingly being used.…”

mentioning

confidence: 99%

Use and Limits of (1-3)-β- d -Glucan Assay (Fungitell), Compared to Galactomannan Determination (Platelia Aspergillus), for Diagnosis of Invasive Aspergillosis

et al. 2014

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f This study was undertaken to examine the performance of the Fungitell ␤-glucan (BG) assay, to compare it with that of the galactomannan (GM) test for the diagnosis of invasive aspergillosis (IA) in patients with hematological malignancies, and to examine the rates of false-positive BG and GM test results due to ␤-lactam antibiotics among sera of patients with Gram-positive or Gram-negative bacteremia and selected sera with false-positive results from the GM test. Serum samples from 105 patients with proven (n ‫؍‬ 14) or probable (n ‫؍‬ 91) IA, 97 hematology patients at risk for invasive fungal infections, 50 healthy blood donors, and 60 patients with bacteremia were used to study the sensitivities and specificities of the assays. The GM test was more specific than the BG assay (97% versus 82%, respectively; P ‫؍‬ 0.0001) and the BG assay was more sensitive than the GM test (81% versus 49%, respectively; P < 0.0001) for IA diagnosis. The study of 49 separate batches of ␤-lactam antibiotics showed high and very similar rates of false-positive results for the GM and BG assays (29 and 33%, respectively; P ‫؍‬ 0.82) but with an almost complete lack of concordance between the 2 assays. For patients with bacteremia, the rate of false-positive results was much higher with the BG test than with the GM test (37% versus 2%, respectively; P < 0.0001), with no significant difference between Gram-positive and Gram-negative bacteremia. In conclusion, the BG test may be useful for the diagnosis of IA because of its high sensitivity in comparison with the GM test, but the overall benefit of this assay remains limited because of its inadequate specificity and its cost.

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Early diagnosis of invasive pulmonary aspergillosis in hematologic patients: an opportunity to improve the outcome

Cited by 59 publications

References 20 publications

Ecology of aspergillosis: insights into the pathogenic potency of Aspergillus fumigatus and some other Aspergillus species

Ecology of aspergillosis: insights into the pathogenic potency of Aspergillus fumigatus and some other Aspergillus species

How we treat invasive fungal diseases in patients with acute leukemia: the importance of an individualized approach

Use and Limits of (1-3)-β- d -Glucan Assay (Fungitell), Compared to Galactomannan Determination (Platelia Aspergillus), for Diagnosis of Invasive Aspergillosis

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