Pulmonary Infections after Bone Marrow Transplantation: Clinical and Radiographic Findings

Leung, Ann N.; Gosselin, Marc V.; Napper, Clay H.; Braun, Shaun G.; Hu, Wendy W.; Wong, Ruby M.; Gasman, John D.

doi:10.1148/radiology.210.3.r99mr39699

Cited by 115 publications

(88 citation statements)

References 41 publications

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“…Multiple pulmonary nodules are the most common radiographic manifestation and were present in all our patients. [15][16][17] A cavitating nodule was present in only 1 of our patients but has been described to occur more frequently in this group of patients. Cavitation either may be present either at the time of detection of the nodule or may develop during the infection.…”

Section: Discussionmentioning

confidence: 49%

“…Cavitation either may be present either at the time of detection of the nodule or may develop during the infection. 16,17 Although the computed tomographic halo sign has been proposed as a useful sign in the early diagnosis of IPA, we did not encounter this finding in our patients. This could be due to the small number of patients in our study.…”

Section: Discussionmentioning

confidence: 59%

See 1 more Smart Citation

Invasive Pulmonary Aspergillosis in Heart Transplant Recipients

Küpeli̇

Ulubay²,

S³

et al. 2015

Exp Clin Transplant

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Objectives: Invasive pulmonary aspergillosis is the most common invasive mycosis in heart transplant recipients. Early clinical recognition of this complication is difficult and laboratory data is not specific. Our aim was to study the characteristics of invasive pulmonary aspergillosis infections in heart transplant recipients. Materials and Methods: Between 2007 and 2013, there were 82 patients who underwent heart transplant at our institution, including 6 patients who were diagnosed with invasive pulmonary aspergillosis. Medical records of these patients were reviewed for demographic, clinical, and radiographic features, microbiology data, serum galactomannan levels, antifungal treatment, and overall outcomes. Results: The most common species causing the infection was Aspergillus fumigatus. The infection was encountered irrespective of the duration since the transplant. Bronchoalveolar lavage with positive culture for Aspergillus species and/or abnormal serum galactomannan level was suggestive of invasive pulmonary aspergillosis. Conclusions: In our opinion, empiric antifungal therapy should be commenced as soon as invasive pulmonary aspergillosis is suspected in heart transplant recipients to reduce mortality. Although the duration of antifungal therapy for invasive pulmonary aspergillosis is debatable, heart transplant recipients may require long-term therapy to avoid recurrence.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 59%

Invasive Pulmonary Aspergillosis in Heart Transplant Recipients

Küpeli̇

Ulubay²,

S³

et al. 2015

Exp Clin Transplant

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“…Radiologically, the most common findings are an interstitial pattern with tiny pulmonary nodules and patchy areas of consolidation. 57 The definitive diagnosis is made histologically with presence of intracytoplasmic inclusion bodies seen on lung biopsies. The treatment of choice is ganciclovir with or without CMV immunoglobulins.…”

Section: Viral Pneumoniamentioning

confidence: 99%

Untitled

Diab

ZazaDitYafawi

Soubani³

2016

Exp Clin Transplant

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Both autologous and allogeneic hematopoietic stem cell transplants are important therapeutic options for several benign and malignant disorders. Pulmonary complications, although they have become less frequent, remain a significant cause of morbidity and mortality after hematopoietic stem cell transplant. These complications range from bacterial, fungal, and viral pulmonary infections to noninfectious conditions such as diffuse alveolar hemorrhage and idiopathic pneumonia syndrome. Bronchiolitis obliterans syndrome is the primary chronic pulmonary complication, and treatment of this condition remains challenging. This report highlights the advances in the diagnosis and management of the major pulmonary complications after hematopoietic stem cell transplant. It also underscores the need for prospective and multicenter research to have a better understanding of the mechanisms behind these complications and to obtain more effective diagnostic tool and therapeutic options. Key words: Adverse effects, Lung diseases/etiology, Lung diseases/diagnosis, Respiratory tract infections/etiology, Graft versus host disease IntroductionHematopoietic stem cell transplant (HSCT) is increasingly being used for treatment of a wide range of benign and malignant diseases. About 50 000 to 60 000 HSCTs are done annually. 1 Hematopoietic stem cell transplant can be classified as autologous when the stem cells are harvested from the same patient and reinfused after high-dose chemotherapy, whereas, in allogeneic HSCT, the stem cells are donated by another person. Allogeneic HSCT can be related or unrelated and matched or mismatched. The hematopoietic stem cells might be derived from the bone marrow, umbilical cord, or peripheral blood.Hematopoietic stem cell transplant can be a lifesaving treatment of a wide range of neoplastic and nonneoplastic diseases; however, it is still limited by the development of serious complications. Advances in the preparative regimen using a nonmyeloablative preparative regimen, reduced-intensity conditioning transplants, and posttransplant supportive care have contributed to improved overall survival. Despite these advances, pulmonary complications still occur in about 37% of patient after HSCT 2 and are associated with significant morbidity and mortality. In 1 study, the hazard ratio for death due to pulmonary complications was 30. 1 However, there is evidence that the overall mortality and pulmonary complications after HSCT are improving. A recent review of allogeneic HSCT patients in a large transplant center from 1993 to 2007 showed that the risk of nonrelapse mortality decreased by 60% and overall mortality decreased by 41%. In addition, the risk of acute respiratory failure dropped by 36%, with risk of gram-negative bacterial and invasive mold infections decreasing by 39% and 51%. 3 In this study, we provide an update of the main pulmonary complications (both infectious and noninfectious) after HSCT, including an overview of the diagnostic approach and treatment of these complications. Noninfec...

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“…Typical chest-radiographic findings in viral pneumonia consist of reticulonodular opacities seen in a peribronchial, perivascular distribution. Leung and co-workers [39] assessed radiographic findings of CMV infections after HSCT, the most common findings being parenchymal opacification (90%), multiple nodules smaller than 5 mm (29%), and normal radiographs (10%). Noninfectious processes after the engraftment period include pulmonary edema, DAH, idiopathic pneumonia syndrome (IPS), nonspecific interstitial pneumonitis (NSIP) [40], lymphangitic spread of tumor, and chemoradiation-induced pneumonitis [4].…”

Section: Chest Radiographmentioning

confidence: 99%

Pulmonary complications following hematopoietic stem cell transplantation: Diagnostic approaches

et al. 2005

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Pulmonary complications are a significant cause of morbidity and mortality in hematopoietic stem cell transplant recipients. Pulmonary infiltrates in such patients pose a major challenge for clinicians because of the wide differential diagnosis of infectious and noninfectious conditions. It is rare for the diagnosis to be made by chest radiograph, and commonly these patients will need further invasive and noninvasive studies to confirm the etiology of the pulmonary infiltrates. This review describes the role of the different diagnostic tools available to reach a diagnosis in a timely manner in this patient population. Am.

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Pulmonary Infections after Bone Marrow Transplantation: Clinical and Radiographic Findings

Cited by 115 publications

References 41 publications

Invasive Pulmonary Aspergillosis in Heart Transplant Recipients

Invasive Pulmonary Aspergillosis in Heart Transplant Recipients

Untitled

Pulmonary complications following hematopoietic stem cell transplantation: Diagnostic approaches

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