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Sousa C, Pasini RA, Pasqualotto A, Marchiori E, Altmayer S, Irion K, Mançano A, Hochhegger B. Imaging Findings in Aspergillosis: From Head to Toe. Mycopathologia 2023; 188:623-641. [PMID: 37380874 DOI: 10.1007/s11046-023-00766-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/16/2023] [Indexed: 06/30/2023]
Abstract
Aspergillosis is a mycotic infection induced by airborne fungi that are ubiquitous. Inhalation of Aspergillus conidia results in transmission through the respiratory tract. The clinical presentation is dependent on organism and host specifics, with immunodeficiency, allergies, and preexisting pulmonary disease constituting the most important risk factors. In recent decades, the incidence of fungal infections has increased dramatically, due in part to the increased number of transplants and the pervasive use of chemotherapy and immunosuppressive drugs. The spectrum of clinical manifestations can range from an asymptomatic or mild infection to a swiftly progressive, life-threatening illness. Additionally, invasive infections can migrate to extrapulmonary sites, causing infections in distant organs. Recognition and familiarity with the various radiological findings in the appropriate clinical context are essential for patient management and the prompt initiation of life-saving treatment. We discuss the radiological characteristics of chronic and invasive pulmonary aspergillosis, as well as some of the typically unexpected extrapulmonary manifestations of disseminated disease.
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Affiliation(s)
- Célia Sousa
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | - Alessandro Pasqualotto
- Radiology Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Edson Marchiori
- Radiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Klaus Irion
- Radiology Department, University of Florida, Gainesville, FL, USA
| | | | - Bruno Hochhegger
- Radiology Department, University of Florida, Gainesville, FL, USA.
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Grover SB, Grover H, Antil N, Patra S, Sen MK, Nair D. Imaging Approach to Pulmonary Infections in the Immunocompromised Patient. Indian J Radiol Imaging 2022; 32:81-112. [PMID: 35722641 PMCID: PMC9205686 DOI: 10.1055/s-0042-1743418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pulmonary infections are the major cause of morbidity and mortality in immunocompromised patients and almost one-third of intensive care unit patients with pulmonary infections belong to the immunocompromised category. Multiple organisms may simultaneously infect an immunocompromised patient and the overwhelming burden of mixed infections further predisposes critically ill patients to acute hypoxemic respiratory failure. Notwithstanding that lung ultrasound is coming into vogue, the primary imaging investigation is a chest radiograph, followed by thoracic CT scan. This review based on our experience at tertiary care teaching hospitals provides insights into the spectrum of imaging features of various pulmonary infections occurring in immunocompromised patients. This review is unique as, firstly, the imaging spectrum described by us is categorized on basis of the etiological infective agent, comprehensively and emphatically correlated with the clinical setting of the patient. Secondly, a characteristic imaging pattern is emphasized in the clinical setting-imaging-pattern conglomerate, to highlight the most likely diagnosis possible in such a combination. Thirdly, the simulating conditions for a relevant differential diagnosis are discussed in each section. Fourthly, not only are the specific diagnostic and tissue sampling techniques for confirmation of the suspected etiological agent described, but the recommended pharmaco-therapeutic agents are also enumerated, so as to provide a more robust insight to the radiologist. Last but not the least, we summarize and conclude with a diagnostic algorithm, derived by us from the characteristic illustrative cases. The proposed algorithm, illustrated as a flowchart, emphasizes a diagnostic imaging approach comprising: correlation of the imaging pattern with clinical setting and with associated abnormalities in the thorax and in other organs/systems, which is comprehensively analyzed in arriving at the most likely diagnosis. Since a rapid evaluation and emergent management of such patients is of pressing concern not only to the radiologist, but also for the general physicians, pulmonologists, critical care specialists, oncologists and transplant surgery teams, we believe our review is very informative to a wide spectrum reader audience.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology, VMMC and Safdarjung Hospital, New Delhi (Former and source of this work)
- Department of Radiology and Imaging, Sharda School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India (Current)
| | - Hemal Grover
- Department of Radiology and Imaging, Icahn School of Medicine at Mount Sinai West, New York, New York, United States
| | - Neha Antil
- Department of Radiology and Imaging, Stanford University, California, United States
| | - Sayantan Patra
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Manas Kamal Sen
- Department of Pulmonary Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Deepthi Nair
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Karaosmanoglu AD, Uysal A, Onder O, Hahn PF, Akata D, Ozmen MN, Karcaaltıncaba M. Cross-sectional imaging findings of splenic infections: is differential diagnosis possible? Abdom Radiol (NY) 2021; 46:4828-4852. [PMID: 34047800 PMCID: PMC8160561 DOI: 10.1007/s00261-021-03130-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 01/31/2023]
Abstract
The spleen plays an important role in the immunological homeostasis of the body. Several neoplastic and non-neoplastic diseases may affect this organ, and imaging is of fundamental importance for diagnosis. Infectious diseases of the spleen can be encountered in daily radiology practice, and differential diagnosis may sometimes be challenging. Infectious involvement of the spleen can be primary or secondary to a different source outside the spleen. Despite the fact that different infectious diseases may cause similar imaging findings, we believe that differential diagnosis between different causes may also be possible in certain patients with imaging. Early diagnosis may potentially enhance patients’ treatment and outcome. In this review, we aimed to increase imaging specialists’ awareness of splenic infections by describing the multimodality imaging features of common and atypical infections of the spleen with their differential diagnoses.
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Affiliation(s)
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, Ankara, 06010, Turkey
| | - Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
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Imaging of abdominal and pelvic infections in the cancer patient. Abdom Radiol (NY) 2021; 46:2920-2941. [PMID: 33386914 PMCID: PMC7778421 DOI: 10.1007/s00261-020-02896-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 11/01/2022]
Abstract
Infections are the most commonly encountered complications in patients with cancer. The classical signs and symptoms of infections are often not present in this patient population, which makes the diagnosis more challenging. Host factors play a major role in the development and prognosis of infections in cancer patients; these can be related to the underlying type of malignancy (solid organ versus hematological), tumor burden, anatomic obstruction, altered integrity of barriers (skin or mucosa), treatment-related factors (from chemotherapy, radiation treatment, surgery, interventional procedures, and/or medical device placement) and the degree of immunosuppression. This article reviews common, as well as less common, imaging manifestations of infections and their potential mimics in the abdomen and pelvis in cancer patients and discusses their differentiating features, with the role of imaging in various organs in the abdomen and pelvis taking into consideration relevant clinical background information and the main risk factors.
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Evaluation of Serum Paired MicroRNA Ratios for Differential Diagnosis of Non-Small Cell Lung Cancer and Benign Pulmonary Diseases. Mol Diagn Ther 2019; 22:493-502. [PMID: 29922886 DOI: 10.1007/s40291-018-0341-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To clarify whether there are different expressions between lung cancer and benign pulmonary diseases, we studied seven microRNAs (miRNAs) in serum from patients with non-small cell lung cancer (NSCLC), benign pulmonary nodules and four pulmonary inflammation diseases. METHODS We detected the expression of miRNAs using quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). RESULTS We found that five miRNA ratios-miR-15b-5p/miR-146b-3p, miR-20a-5p/miR-146b-3p, miR-19a-3p/miR-146b-3p, miR-92a-3p/miR-146b-3p, and miR-16-5p/miR-146b-3p-show higher expression in the NSCLC group than the benign pulmonary nodule group, and 13 ratios of miRNAs were significantly upregulated in the NSCLC group compared with the pulmonary inflammation diseases group. Receiver operating characteristic (ROC) curve analysis was performed. For NSCLC and benign pulmonary nodules, the sensitivity and specificity were 0.70 and 0.90, respectively. For NSCLC and pulmonary inflammation diseases, the sensitivity and specificity were 0.81 and 0.71, respectively. CONCLUSION The ratios of miRNAs can be used as potential non-invasive biomarkers for diagnosis of early-stage NSCLC and benign pulmonary diseases.
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Portugal R, Nucci M. Typhlitis (neutropenic enterocolitis) in patients with acute leukemia: a review. Expert Rev Hematol 2017; 10:169-174. [PMID: 28075196 DOI: 10.1080/17474086.2017.1280389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Typhlitis is an abdominal complication of cancer chemotherapy, affecting mostly patients receiving intensive chemotherapeutic regimens with high potential to induce mucosal damage, such as patients with acute leukemia. Despite being relatively frequent, there are no randomized trials or high-quality cohort studies addressing important aspects of the diagnosis and management of the disease. Areas covered: In this review we discuss the gaps in the literature, acknowledging that the evidences for recommendations regarding the management of typhlitis are mostly expert opinion. We performed a computerized search of the MEDLINE database (PubMed version) for appropriate articles published from 1963 through July, 2016 in English language. Thereafter the reference lists of all identified studies were screened, reviewing the abstracts of all potentially pertinent articles for inclusion. Expert commentary: The diagnosis of typhlitis still relies on clinical and radiologic features consisting of fever, abdominal pain and thickness of a segment of the bowel wall, as seen by ultrasonography or CT scan. The treatment consists in antimicrobial therapy with a regimen that covers the most frequent pathogens, taking into consideration the local epidemiology. Other measures include bowel rest, and the use of G-CSF. Surgery is indicated only in selected situations.
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Affiliation(s)
- Rodrigo Portugal
- a Department of Internal Medicine , University Hospital, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Marcio Nucci
- a Department of Internal Medicine , University Hospital, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
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Hadchiti MT, Abdalkader M, Rached L, Mahfoud D, Khoury G, Ghanem H. Disseminated Intra-Abdominal Aspergilloma With Abdominal Wall Invasion in a Patient With Acute Myeloid Leukemia: A Case Report. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15 Suppl:S94-7. [PMID: 26297288 DOI: 10.1016/j.clml.2014.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 12/31/2014] [Accepted: 12/31/2014] [Indexed: 01/03/2023]
Affiliation(s)
| | | | - Linda Rached
- Division of General Surgery, Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut, Lebanon
| | - Daniel Mahfoud
- Division of Radiology, Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut, Lebanon
| | - Georges Khoury
- Division of General Surgery, Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut, Lebanon
| | - Hady Ghanem
- Division of Hematology-Oncology, Lebanese American University Medical Center-Rizk Hospital (LAUMC-RH), Beirut, Lebanon.
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Clinical data and CT findings of pulmonary infection caused by different pathogens after kidney transplantation. Eur J Radiol 2012; 81:1347-52. [DOI: 10.1016/j.ejrad.2011.03.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 03/17/2011] [Accepted: 03/23/2011] [Indexed: 11/21/2022]
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[Disseminated invasive aspergillosis. Answer to July-August e-quid]. ACTA ACUST UNITED AC 2011; 92:945-50. [PMID: 22000620 DOI: 10.1016/j.jradio.2011.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Accepted: 05/21/2011] [Indexed: 11/21/2022]
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Embryonated eggs as an alternative infection model to investigate Aspergillus fumigatus virulence. Infect Immun 2010; 78:2995-3006. [PMID: 20421382 DOI: 10.1128/iai.00268-10] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Infection models are essential tools for studying microbial pathogenesis. Murine models are considered the "gold standard" for studying in vivo infections caused by Aspergillus species, such as A. fumigatus. Recently developed molecular protocols allow rapid construction of high numbers of fungal deletion mutants, and alternative infection models based on cell culture or invertebrates are widely used for screening such mutants to reduce the number of rodents in animal experiments. To bridge the gap between invertebrate models and mice, we have developed an alternative, low-cost, and easy-to-use infection model for Aspergillus species based on embryonated eggs. The outcome of infections in the egg model is dose and age dependent and highly reproducible. We show that the age of the embryos affects the susceptibility to A. fumigatus and that increased resistance coincides with altered chemokine production after infection. The progress of disease in the model can be monitored by using egg survival and histology. Based on pathological analyses, we hypothesize that invasion of embryonic membranes and blood vessels leads to embryonic death. Defined deletion mutant strains previously shown to be fully virulent or partially or strongly attenuated in a mouse model of bronchopulmonary aspergillosis showed comparable degrees of attenuation in the egg model. Addition of nutrients restored the reduced virulence of a mutant lacking a biosynthetic gene, and variations of the infectious route can be used to further analyze the role of distinct genes in our model. Our results suggest that embryonated eggs can be a very useful alternative infection model to study A. fumigatus virulence and pathogenicity.
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