The strategy for the diagnosis of invasive pulmonary aspergillosis should depend on both the underlying condition and the leukocyte count of patients with hematologic malignancies

Abstract

The identification of the causative organism in invasive pulmonary aspergillosis (IPA) is recommended. We investigated whether a mycologic diagnostic strategy could be optimized based on patient characteristics. Fifty-five patients were enrolled in a prospective study. The presence of Aspergillus in respiratory samples occurred more frequently in non-acute leukemia (AL) patients than in AL patients (P ‫؍‬ .0003), and in patients with leukocyte counts more than 100/mm 3 (P ‫؍‬ .002). In a logistic regression model, these 2 factors appeared to be independent, with an adjusted odds ratio of 7.14 (95% confidence interval, 1.40-36.5) for non-AL patients and an adjusted odds ratio of 6.97 (95% confidence interval, 1.33-36.5) for patients with leukocyte counts more than 100/mm 3 . A positive mycologic result was also more frequent among patients with lung CT scan signs of airway-invasive disease than among other patients (P ‫؍‬ .043). Airway-invasive signs were more frequent among non-AL patients (P ‫؍‬ .049), whereas angioinvasive disease was more frequent among both AL patients (P ‫؍‬ .01) and patients with leukocyte counts less than 100/mm 3 (P ‫؍‬ .001). A concomitant pulmonary infection was identified more frequently among non-AL patients (P ‫؍‬ .005 vs allogeneic hematopoietic stem cell transplant and P ‫؍‬ .048 vs others). Our results suggest that different strategies for diagnosing IPA should be considered based on the underlying condition. (Blood. 2012;119(8):1831-1837) Continuing Medical Education onlineThis activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and the American Society of Hematology. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at http://www.medscape.org/journal/blood; and (4) view/print certificate. For CME questions, see

A comprehensive diagnostic approach using galactomannan, targeted β‐d‐glucan, baseline computerized tomography and biopsy yields a significant burden of invasive fungal disease in at risk haematology patients

“…We found baseline CT abnormalities in 38% of study patients with both EORTC and non-EORTC signs that were associated with increased risk of IFD. The overall incidence rate of 21% and 18% for IFD and IMD respectively, in our cohort is higher than reported by some previous studies (Kontoyiannis et al, 2010;Pagano et al, 2010;Wingard et al, 2010;Marks et al, 2011;Bergeron et al, 2012) but closer to post-mortem data by Chamilos et al (2006) who found an IFD incidence of 31%. This high incidence may be due to several factors.…”

“…Prolonged monocytopenia, especially in concert with neutropenia renders the affected patients bereft of the necessary phagocytic function required to combat inhaled spores and thus prevent invasive disease. Concomitant bacterial and fungal infection is not uncommon (Bergeron et al, 2012) and reflects the state of the underlying immune paresis in these patients.…”

Novel Tests for Diagnosis of Invasive Aspergillosis in Patients with Underlying Respiratory Diseases

“…Although the performance of serum GM testing seems to be promising only in neutropenic patients, who usually develop angioinvasive forms of IPA (1,16), bronchoalveolar lavage (BAL) fluid (BALF) GM seems the method of choice in nonneutropenic patients who tend to develop airway-invasive forms (17)(18)(19). This was confirmed in a study evaluating patients with underlying structural damage of the lung tissue (e.g., COPD, emphysema, bronchiectasis), which found that only one out of 65 patients with COPD with IPA had a positive serum GM test (8).…”

Infections fongiques sévères en réanimation

“…Une imagerie cérébrale (idéalement par IRM) est indiquée dans le bilan d'extension. Selon le contexte clinique, deux profi ls d'aspergillose pulmonaire invasive se dessinent [59] : chez le sujet neutropénique, l'atteinte est le plus souvent angio-invasive, se manifestant initialement (jusqu'à j5) par un nodule entouré de verre dépoli (signe du halo, refl étant l'infarctus hémorragique), puis par une condensation aspécifi que (de j6 à j10), puis à la sortie de neutropénie (de j11 à j20) par une cavitation (signe du croissant). Chez le sujet non neutropénique, l'atteinte est de type airwayinvasive, traduite par des micronodules avec arbres en bourgeon, témoins d'une bronchopneumopathie plus ou moins associée à une bronchiolite.…”