Increasing Volume and Changing Characteristics of Invasive Pulmonary Aspergillosis on Sequential Thoracic Computed Tomography Scans in Patients With Neutropenia

Caillot, Denis; Couaillier, J.F.; Bernard, Alain; Casasnovas, Olivier; Denning, David W.; Mannone, Lionel; López, José Borges; Couillault, G.; Piard, F; Vagner, O.; Guy, Henri

doi:10.1200/jco.2001.19.1.253

Cited by 538 publications

(382 citation statements)

References 25 publications

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“…It is important to note that agents such as fluconazole will not protect against filamentous fungi (i.e., Aspergillus spp.). In patients experiencing prolonged FUO (>72 h) in whom CMV reactivation has been ruled out as a cause of fever, pulmonary high-resolution or thoracic CT should be performed [4,23]. Early treatment with caspofungin (70 mg loading dose followed by 50 mg QD) or liposomal amphotericin B (3 mg/kg QD) may be clinically warranted [59].…”

Section: Monitoring Prophylaxis and Treatment Of Infectionmentioning

confidence: 99%

“…Empirical treatment should consider frequently isolated pathogens of the hospital environment and their resistances. In patients experiencing prolonged FUO (>48 h), pulmonary high-resolution or spiral CT should be performed [4,23]. Early treatment with caspofungin (70 mg loading dose followed by 50 mg QD) or liposomal amphotericin B (3 mg/kg QD) may be clinically warranted in high-risk patients [59].…”

Section: Treatment Of Infectionsmentioning

confidence: 99%

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Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab

et al. 2008

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International audienceInfection is a significant cause of morbidity and death in patients with chronic lymphocytic leukemia (CLL). Increased infectious events may arise from the multiple courses of immunosuppressive therapy and progressive deterioration of a patient's immune system over the course of disease. The humanized, anti-CD52 monoclonal antibody alemtuzumab (Campath or Campath-1H) has shown notable activity for both untreated and fludarabine-refractory CLL. The antibody not only targets malignant cells but also affects normal, healthy immune cells. The cumulative effects of the malignancy and successive courses of treatments adversely impinge on a patient's defense response to certain bacterial, fungal, and viral infections. In this review article, we provide an overview of common infectious events associated with alemtuzumab therapy in CLL. We also discuss recommendations for effectively monitoring and managing infections in CLL patients

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Section: Monitoring Prophylaxis and Treatment Of Infectionmentioning

confidence: 99%

Section: Treatment Of Infectionsmentioning

confidence: 99%

Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab

et al. 2008

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“…There is still controversy as to whether the information provided by SLB justifies its use on routine basis [13,14]. Furthermore, recent advances in diagnostic studies such as high-resolution CT scan (HRCT), and Cytomegalovirus (CMV) and Aspergillus serology, coupled with better prophylaxis against Pneumocystis carinii and CMV have probably changed the findings of SLB in immunocompromised patients with hematological malignancies or recipients of hematopoietic stem cell transplantation (HSCT) [15][16][17]. Consequently, it is useful to review the findings of SLB and its impact on the management and outcome of these patients.…”

Section: Introductionmentioning

confidence: 99%

Surgical lung biopsy in patients with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: Improved Outcome with specific diagnosis

et al. 2005

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Using a retrospective review of medical records, we sought the findings of surgical lung biopsy (SLB) in patients with hematological malignancy or hematopoietic stem cell transplantation (HSCT) and unexplained pulmonary infiltrates and to determine the impact of this procedure on management and outcome of these patients. Sixty-two patients who underwent SLB were evaluated; 31 patients had underlying hematological malignancy and 31 patients were HSCT recipients; 58% of whom underwent allogeneic HSCT. Thirty-three patients (53%) had focal infiltrates on chest CT scan while 29 (47%) had diffuse infiltrates. Thirteen patients were mechanically ventilated prior to SLB, and 27 (43%) were neutropenic. There were 66 diagnoses in the 62 patients, 44 (67%) were specific and 22 (33%) were nonspecific. The most common specific diagnoses were infection (29%), malignancy (27%), and inflammatory conditions (11%). Aspergillosis was the most common diagnosis of all biopsies (21%). SLB led to a change in therapy in 40% of patients and was associated with complications in 7 patients (11%). Specific diagnosis was more likely to lead to a change in therapy (48% vs. 27%, P = 0.06) and was associated with a lower mortality when compared to a nonspecific finding (30% vs. 59%, P = 0.02). Nonspecific diagnosis, on the other hand, was seen more in patients on mechanical ventilation prior to SLB compared to those off mechanical ventilation (69% vs. 27%, P = 0.02). SLB provides a specific diagnosis in the majority of patients with hematologic malignancy or HSCT recipients and unexplained pulmonary infiltrates. Specific diagnosis is more likely to lead to a change in therapy and is associated with a better outcome. Am. J. Hematol. 78:94-99, 2005. ª 2005 Wiley-Liss, Inc.

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“…The general symptoms, primarily fever refractory to antibacterial therapy, chest pain, cough and dyspnoea, are variable and non-specific. CT of the chest has been advocated for the early diagnosis of IPA as it often shows a 'halo sign' in the early phase of the disease in neutropenic patients with IPA (Caillot et al, 1997(Caillot et al, , 2001Denning et al, 1997). However, the halo sign is not specific for IPA as it is also seen in a number of other entities, including mucormycosis, organizing pneumonia and pulmonary haemorrhage (Won et al, 1998).…”

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confidence: 99%

Galactomannan detection in computerized tomography‐based broncho‐alveolar lavage fluid and serum in haematological patients at risk for invasive pulmonary aspergillosis

Becker¹,

Lugtenburg²,

Cornelissen³

et al. 2003

Br J Haematol

189

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Summary. We determined the value of galactomannan (GM) detection in computerized tomography (CT)-based broncho-alveolar lavage (BAL) fluid and serum for the diagnosis of invasive pulmonary aspergillosis (IPA) in haemato-oncological patients with neutropenia. CT of the thorax and BAL were performed systematically at predefined clinical indications. GM was determined by sandwich enzyme-linked immunosorbent assay; the clinicians were unaware of the results. Of 160 patients, 17 patients (10AE6%) presented with proven, probable or suspected IPA. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of GM detection in CT-based BAL fluid were all 100%. For GM detection in serially sampled serum, the sensitivity was 47%, the specificity 93%, the PPV 73% and the NPV 82%. A non-blinded follow-up study was performed to validate these results. In this study, 22 of 198 patients (11AE1%) presented with IPA, and the sensitivity, specificity, PPV and NPV of GM detection in CT-based BAL fluid were 85%, 100%, 100% and 88% respectively. None of BAL fluids obtained after antifungal treatment of 3 d or more were positive. These results indicate that, when CT is used systematically and at an early stage, GM detection in CT-based BAL fluid has a high PPV for diagnosing IPA early in untreated patients.

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Increasing Volume and Changing Characteristics of Invasive Pulmonary Aspergillosis on Sequential Thoracic Computed Tomography Scans in Patients With Neutropenia

Cited by 538 publications

References 25 publications

Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab

Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab

Surgical lung biopsy in patients with hematological malignancy or hematopoietic stem cell transplantation and unexplained pulmonary infiltrates: Improved Outcome with specific diagnosis

Galactomannan detection in computerized tomography‐based broncho‐alveolar lavage fluid and serum in haematological patients at risk for invasive pulmonary aspergillosis

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