Radiological CT Patterns and Distribution of Invasive Pulmonary Aspergillus, Non-Aspergillus, Cryptococcus and Pneumocystis Jirovecii Mold Infections – A Multicenter Study

Abstract

Purpose Clinical signs and symptoms related to invasive fungal disease are nonspecific and need to be followed up by appropriate diagnostic procedures. The goal of this study was to analyze CT imaging patterns in invasive fungal infections and their correlation with the immune status and clinical outcome. Materials and Methods We performed a retrospective multicenter study including 85 consecutive patients with invasive pulmonary fungal infection (2011–2014). Lung patterns on computed tomography (CT) scans were classified according to the Fleischner Society glossary. The patients were grouped according to immune status (neutropenia, steroid therapy, organ transplant recipient, and other cause) and outcome (positive outcome, progressive disease, and death). The Chi square test or Fisher exact test was used. Bonferroni correction was applied. Results The total number of patients with invasive Aspergillus and non-Aspergillus infection (IANA), Pneumocystis jirovecii pneumonia (PCP), and Cryptococcus (CRY) was 60, 22, and 3, respectively. Patients with IANA demonstrated significantly more nodules (93 % vs. 59 %, p = 0.001), significantly fewer ground glass opacities (58 % vs. 96 %, p = 0.005), and significantly fewer positive lymph nodes (5 % vs. 41 %, p < 0.001) than patients with PCP. All patients with PCP and CRY had a favorable outcome. Patients with IANA and an adverse outcome demonstrated significantly more nodules with halo sign than patients with IANA and a favorable outcome (42.5 % vs. 15.9 %, p < 0.0001). Interestingly, patients with IANA and a favorable outcome had a higher prevalence of pulmonary infarction than patients with an adverse outcome (8 % vs. 1 %, p = 0.047). Patients with neutropenia showed significantly more consolidations (66 %) than organ transplant recipients (27 %, p = 0.045). Conclusion Patients with IANA showed a higher prevalence of nodules and a lower prevalence of ground glass opacities than patients with PCP. In patients with IANA, nodules with halo sign were associated with an adverse outcome. Patients with neutropenia showed generally more consolidations, but the consolidations were not associated with an adverse outcome. Key Points: Citation Format

Clinical diagnosis, treatment, and medical identification of specific pulmonary infection in naval pilots: Four case reports

“…Therefore, it is necessary to suggest that the annual physical examination of pilots adopt thin-layer chest CT plain scan, especially at the stage of selecting pilots. The chest CT in Case 1 showed multiple patchy shadows, halo sign at the edge, visible air bronchogram, blood vessels passing through the lesions, and small holes in the treatment process, which accorded with the imaging findings of cryptococcal pneumonia[ 4 ]. Case 2 showed multiple patches and nodular changes in the posterior segment of the upper apex with bronchiectasis on CT, and bronchoscopy showed lesions in the bronchial mucosa, which were consistent with tuberculosis[ 5 ].…”

Lung Quantitative Computer Tomography Analysis for Non-HIV Associated Pneumocystis Pneumonia Assessment：An Observational Clinical Cohort Study

“…Traditionally, GGO was regarded as the area of blurred increased attenuation without obscuration of underlying vascular patterns, while consolidation was de ned as an area of increased attenuation with obscuration of underlying vascular markings According to consequences of previous research [13,14] , GGO is the commonest founding in PCP CT scans. GGO is the most common nding in PCP CT scans.…”

“…In our research, the consolidation pattern in the CT scan was associated with NLR, even when taking the interaction with GGO into account. Probably, the radiology consolidation pattern is a steady surrogate marker for PCP severity estimation [13] .…”

Disease-specific gaps within fungal respiratory tract infections: clinical features, diagnosis, and management in critically ill patients

“…The changing epidemiology of invasive fungal respiratory tract infections and differential diagnosis among patients with PJP, Cryptococcus invasive and invasive Aspergillus infection is a significant concern. A recent study [34] showed that patients showed significantly different radiological CT patterns. The presence of more nodules, fewer ground glass opacities and fewer positive lymph nodes were significantly different in patients with invasive Aspergillus infection than in patients with PJP.…”