Invasive Aspergillus Rhinosinusitis in Patients with Acute Leukemia

Talbot, George H.; Huang, Anna; Provencher, Mary

doi:10.1093/clinids/13.2.219

Cited by 127 publications

(75 citation statements)

References 87 publications

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“…The median length of neutropenia was 18 days (range 5-33). Eighteen of 28 patients had AML with a median neutropenic length of 20 days (range 5-33), and 10/18 patients had ALL with a median neutropenic period of 13 days (range [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Section: Time Framesmentioning

confidence: 99%

“…Prolonged neutropenia has been the major risk factor for invasive aspergillosis [1,2]. In the immunocompromised or neutropenic host, invasive pulmonary aspergillosis (IPA) characterized by hyphal invasion and destruction of pulmonary tissue is the most common manifestation of an aspergillus infection, although local infections also occur in the sinuses, the skin, or intravenous catheter sites [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters

et al. 2001

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during extensive hospital construction and indoor renovation, a nosocomial outbreak of invasive pulmonary aspergillosis occurred in acute leukemia patients treated in a regular ward that has only natural ventilation. The observed infection rate was 50%. Chemoprophylaxis with intravenous continuous low-dose amphotericin B was then instituted as a preventive measure. During the next 18 months invasive pulmonary aspergillosis developed in 43% of acute leukemia patients. After that period a new hematology ward was opened with an air filtration system through high-efficiency particulate air filtration (HEPA) filters, and a bone marrow transplantation program was started on the hematology service. During the following three years, none of the acute leukemia or bone marrow transplantation patients who were hospitalized exclusively in the hematology ward developed invasive pulmonary aspergillosis, although 29% of acute leukemia patients who were housed in a regular ward, because of shortage of space in the new facility, still contracted invasive pulmonary aspergillosis. Overall, 31 patients were diagnosed with invasive pulmonary aspergillosis during almost five years: 74% of patients recovered from invasive pulmonary aspergillosis, and 42% are long-term survivors; 26% of patients died of resistant leukemia with aspergillosis, but no one died of invasive pulmonary aspergillosis alone. In conclusion, during an on-going construction period, an extremely high incidence rate of invasive pulmonary aspergillosis in acute leukemia patients undergoing intensive chemotherapy was observed. Institution of low-dose intravenous amphotericin B prophylaxis marginally reduced the incidence rate of invasive pulmonary aspergillosis. Keeping patients in a special ward with air filtration through a HEPA system eliminated invasive pulmonary aspergillosis completely. Among patients who developed invasive pulmonary aspergillosis, early diagnosis and treatment are probably the explanation for the favorable outcome. Am. J. Hematol. 66:257-262, 2001.

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Section: Time Framesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters

et al. 2001

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“…The skin is a rare site of infection, 8 and cutaneous infections are most often found at the entry site of Hickman catheters. 4,7,9,10 Cutaneous aspergillosis is a poorly described entity …”

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confidence: 99%

“…4 The overall mortality is up to 82% and reflects the clinical importance of Aspergillus infection in immunosuppressed or neutropenic patients. 5 Solitary extrapulmonary Aspergillus infection occurs most frequently in the maxillary sinuses 6,7 and colonization of the nasal sinuses can lead to endogenous spread to the lungs causing invasive pulmonary aspergillosis. The skin is a rare site of infection, 8 and cutaneous infections are most often found at the entry site of Hickman catheters.…”

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confidence: 99%

Skin involvement as the first manifestation of systemic aspergillosis in patients after allogeneic hematopoietic cell transplantation

Schimmelpfennig

Naumann

Zuberbier

et al. 2001

Bone Marrow Transplant

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Summary:Skin involvement due to a systemic infection with Aspergillus species in the course of allogeneic hematopoietic cell transplantation is extremely rare. We report the clinical course of two patients with hematologic malignancies who underwent allogeneic hematopoietic cell transplantation (HCT) and developed disseminated skin involvement as the first clinical symptom of a proven systemic Aspergillus infection. Bone Marrow Transplantation (2001) 27, 753-755. Keywords: cutaneous Aspergillus infection; HCT; BMT; STX; skin infection Aspergillus species are increasingly recognized as major fungal pathogens in severely immunosuppressed or neutropenic patients, particularly after allogeneic hematopoietic cell transplantation (HCT). 1 The risk of developing systemic Aspergillus infection increases with the duration of immunosuppression. The most common manifestation of an Aspergillus infection in these patients is invasive pulmonary aspergillosis characterized by hyphal invasion and destruction of pulmonary tissue. 2,3 Hematogenous dissemination as a secondary event occurs in 20-50% of these patients and most commonly involves the central nervous system and the gastrointestinal tract. 4 The overall mortality is up to 82% and reflects the clinical importance of Aspergillus infection in immunosuppressed or neutropenic patients. 5 Solitary extrapulmonary Aspergillus infection occurs most frequently in the maxillary sinuses 6,7 and colonization of the nasal sinuses can lead to endogenous spread to the lungs causing invasive pulmonary aspergillosis. The skin is a rare site of infection, 8 and cutaneous infections are most often found at the entry site of Hickman catheters. 4,7,9,10 Cutaneous aspergillosis is a poorly described entity Case report No. 1A 50-year-old male with Philadelphia-positive chronic myeloid leukemia in accelerated phase received a non-T cell-depleted bone marrow graft (1.2 × 10 8 MNC/kg BW) from his HLA-identical, MLC-negative brother. He was conditioned with busulfan (10 mg/kg), thiotepa (750 mg/kg) and cyclophosphamide (120 mg/kg) and received methotrexate and cyclosporine as GVHD prophylaxis. On day −1 twice daily prophylactic aerosol inhalation of 10 mg amphotericin B was started. On day +2 he developed fever of unknown origin and was empirically treated with a combination of cefotaxim, piperacillin and vancomycin. Because there was no resolution of the fever, intravenous (i.v.) amphotericin B was started at a dose of 0.8 mg/kg/day on day +4. On day +9 a round warm red swelling resembling a small furuncle appeared on the right thigh. This lesion grew rapidly and was extremely painful. On day +13 this lesion measured approximately 5 cm in diameter and in the centre a circular area of necrosis, 2 cm in diameter, had developed (Figure 1). Until that time microbiological examination of multiple blood cultures had yielded no positive result. Necrotic tissue from the lesion on the right thigh was sent for microbiological culture and histological examination. Both microbiological and histological exa...

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“…Reports of sinusitis by A. flavus in patients with leukemia as described here were already observed with concomitant invasive pulmonary aspergillosis 6 , as well as rhinosinusitis presentation 9 . In fact, in the largest series of fungal sinusitis described in the literature, A. flavus was the main etiologic agent, representing 65% (11/17) of all cases 2 .…”

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confidence: 51%

Invasive Aspergillus flavus sinusitis: case report in a patient with biphenotypic acute leukemia

Xavier

Oliveira

Almeida

et al. 2009

Rev. Inst. Med. trop. S. Paulo

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SUMMARYHere we report a case of invasive pansinusitis with proptosis of the right eye caused by Aspergillus flavus in an immunocompromised patient with acute biphenotypic leukemia without aggressive therapy response. KEYWORDS: Leukemia; Aspergillus flavus; Invasive sinusitis.A 17-year-old white man was diagnosed with acute biphenotypic leukemia and underwent chemotherapy with cytarabine, idarubicin and etoposide (7+3+5) followed by high dose cytarabine. After an initial complete remission of short duration he relapsed and underwent a second course of induction chemotherapy with metoxantrone and etoposide without response. The patient was pancitopenic and with persistence of blasts; biphenotypic acute leukemia (lineages myeloid and T-lymphoid) demonstrated in a bone marrow biopsy.He was being treated for febrile neutropenia when developed a fever of 39 °C and headache. Physical examination showed edema, hyperemia and proptosis in the right eye with periorbital swelling laterally. Computed tomography (CT) scan of the head revealed opacification of the right maxillary, ethmoidal, sphenoidal and frontal sinuses. Bone erosion was also observed in the medial wall of the right maxillary sinus (Fig. 1). Lung CT scan revealed no abnormalities.

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Invasive Aspergillus Rhinosinusitis in Patients with Acute Leukemia

Cited by 127 publications

References 87 publications

Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters

Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters

Skin involvement as the first manifestation of systemic aspergillosis in patients after allogeneic hematopoietic cell transplantation

Invasive Aspergillus flavus sinusitis: case report in a patient with biphenotypic acute leukemia

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