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Klug M, Sobeh T, Green M, Mayer A, Kirshenboim Z, Konen E, Marom EM. Denoised Ultra-Low-Dose Chest CT to Assess Pneumonia in Individuals Who Are Immunocompromised. Radiol Cardiothorac Imaging 2025; 7:e240189. [PMID: 40079757 DOI: 10.1148/ryct.240189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2025]
Abstract
Purpose To evaluate the accuracy of chest ultra-low-dose CT (ULDCT) as compared with normal-dose CT in the evaluation of pneumonia in individuals who are immunocompromised. Materials and Methods This prospective study included 54 adults who were immunocompromised (median age, 62 years [IQR, 47.75-69.25 years]; 34 [63%] male participants) referred for a chest CT scan between September 2020 and December 2022 to evaluate for pneumonia. Each participant underwent two scans: normal-dose CT (120 kVp and automatic current modulation) and ULDCT (100 kVp and constant current of 10 mA). ULDCT images underwent a postprocessing procedure using an artificial intelligence algorithm to reduce image noise. Two radiologists, blinded to all clinical information, examined the images obtained from the three methods (normal-dose CT, ULDCT, and denoised ULDCT) for the presence of pneumonia and associated findings. The normal-dose CT was used as the reference standard, and sensitivity, specificity, positive and negative predictive values, and accuracy were calculated. Results The median effective radiation dose of ULDCT scans (0.12 mSV) was 1.95% of that of the normal-dose CT (6.15 mSV). Ten of the 54 participants were correctly identified as having no pneumonia, with similar accuracy between denoised ULDCT and ULDCT (100% vs 96%-98%, respectively). Both methods allowed for detection of pneumonia and features associated with invasive fungal pneumonia, but accuracy was slightly better with denoised ULDCT (accuracy, 100% vs 91%-98%). Fine details were better visualized in denoised ULDCT images: tree-in-bud pattern (accuracy, 93% vs 78%-80%), interlobular septal thickening (accuracy, 78%-83% vs 61%-67%), and intralobular septal thickening (accuracy, 85%-87% vs 0%). Conclusion Denoised ULDCT imaging showed better accuracy than ULDCT in identifying lungs with or without pneumonia in individuals who were immunocompromised. Keywords: CT, Pulmonary, Lung, Infection, Technology Assessment Supplemental material is available for this article. © RSNA, 2025.
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Affiliation(s)
- Maximiliano Klug
- Division of Diagnostic Imaging, The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan 5265601, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamer Sobeh
- Division of Diagnostic Imaging, The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan 5265601, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Green
- Division of Diagnostic Imaging, The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan 5265601, Israel
| | - Arnaldo Mayer
- Division of Diagnostic Imaging, The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan 5265601, Israel
| | - Zehavit Kirshenboim
- Division of Diagnostic Imaging, The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan 5265601, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Konen
- Division of Diagnostic Imaging, The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan 5265601, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edith Michelle Marom
- Division of Diagnostic Imaging, The Chaim Sheba Medical Center, Tel Hashomer, 2 Derech Sheba St, Ramat Gan 5265601, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wang Y, Cui X, Tian R, Wang P. The epidemiological characteristics of invasive pulmonary aspergillosis and risk factors for treatment failure: a retrospective study. BMC Pulm Med 2024; 24:559. [PMID: 39511508 PMCID: PMC11546561 DOI: 10.1186/s12890-024-03381-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 11/04/2024] [Indexed: 11/15/2024] Open
Abstract
OBJECTIVE The incidence of invasive pulmonary aspergillosis (IPA) is increasing gradually. This study analysed the epidemiological characteristics and prognostic factors of patients with IPA and explored the risk factors affecting prognosis. MATERIALS AND METHODS The clinical data and treatment of 92 patients with IPA were retrospectively analysed, and the patients were followed for 12 weeks. Patients were divided into an effective treatment group and an ineffective treatment group, and the risk factors affecting prognosis were discussed. RESULTS A total of 92 patients met the IPA inclusion criteria, and the most common genus of Aspergillus was Aspergillus fumigatus. The incidence of IPA was highest in patients with malignant tumours. IPA often coexisted with infections caused by other pathogens. We divided the patients into an effective treatment group and an ineffective treatment group according to prognosis. Compared with those in the effective treatment group, the procalcitonin (PCT) level, lactate dehydrogenase-to-albumin ratio (LDH/ALB) and neutrophil-to-lymphocyte ratio (NLR) in the ineffective treatment group were greater, the serum albumin level was lower, and the imaging findings revealed less nodules and bronchial wall thickening (P < 0.05). Among these factors, a decrease in the serum albumin concentration, an increase in the PCT level, coinfection and less bronchial wall thickening on imaging were independent risk factors for aspergillosis treatment failure. CONCLUSION A decreased albumin level, an elevated PCT level, coinfection, and less bronchial wall thickening were independent risk factors for treatment failure in patients with IPA. Attention should be given to the albumin level, coinfection status and imaging findings of patients.
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Affiliation(s)
- Yun Wang
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Xiaoman Cui
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Ruixin Tian
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Ping Wang
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
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Wurster S, Cho SY, Allos H, Franklin A, Axell-House DB, Jiang Y, Kontoyiannis DP. Concordance of Chest Radiography and Chest Computed Tomography Findings in Patients with Hematologic Malignancy and Invasive Mucormycosis: What Are the Prognostic Implications? J Fungi (Basel) 2024; 10:703. [PMID: 39452655 PMCID: PMC11508256 DOI: 10.3390/jof10100703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 10/04/2024] [Accepted: 10/06/2024] [Indexed: 10/26/2024] Open
Abstract
Invasive pulmonary mucormycosis (IPM) is a deadly opportunistic mold infection in patients with hematological malignancies (HM). Radiologic imaging is essential for its timely diagnosis. Here, we compared IPM lesions visualized by chest computed tomography (CCT) and chest X-ray (CXR) and determined the prognostic significance of discordant imaging. Therefore, we reviewed 44 consecutive HM patients with probable/proven IPM at MD Anderson Cancer Center in 2000-2020 who had concurrent CCT and CXR studies performed. All 44 patients had abnormal CCTs and 39 (89%) had anormal CXR findings at IPM diagnosis. However, only 26 patients (59%) showed CCT-matching IPM-suspicious lesions on CXR. Acute Physiology and Chronic Health Evaluation II score > 18 at IPM diagnosis and breakthrough infection to Mucorales-active antifungals were the only independent risk factors for 42-day and/or 84-day mortality. Absence of neutropenia at IPM diagnosis, neutrophil recovery in neutropenic patients, and surgical revision of mucormycosis lesions were protective factors. Although not reaching significance on multivariable analysis, visualization of CCT-matching lesions on CXR was associated with significantly increased 84-day mortality (log-rank test, p = 0.033), possibly as a surrogate of extensive lesions and tissue necrosis. This observation supports the exploration of radiologic lesion kinetics as a prognostic staging tool in IPM patients.
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Affiliation(s)
- Sebastian Wurster
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.W.); (S.-Y.C.); (H.A.); (A.F.); (Y.J.)
| | - Sung-Yeon Cho
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.W.); (S.-Y.C.); (H.A.); (A.F.); (Y.J.)
- Division of Infectious Diseases, Department of Internal Medicine, Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Catholic Hematology Hospital, Seoul St. Mary’s Hospital, Seoul 06591, Republic of Korea
| | - Hazim Allos
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.W.); (S.-Y.C.); (H.A.); (A.F.); (Y.J.)
| | - Alexander Franklin
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.W.); (S.-Y.C.); (H.A.); (A.F.); (Y.J.)
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Dierdre B. Axell-House
- Division of Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston, TX 77030, USA;
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.W.); (S.-Y.C.); (H.A.); (A.F.); (Y.J.)
| | - Dimitrios P. Kontoyiannis
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.W.); (S.-Y.C.); (H.A.); (A.F.); (Y.J.)
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Chen X, Lin S, Jin Q, Zhang L, Jiang W, Lu X, Wang G, Ge Y. Prevalence, Risk Factors, and Mortality of Invasive Pulmonary Aspergillosis in Patients with Anti-MDA5+ Dermatomyositis: A Retrospective Study in China. J Inflamm Res 2024; 17:3247-3257. [PMID: 38800596 PMCID: PMC11122320 DOI: 10.2147/jir.s460702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
Objective To investigate the prevalence, risk factors and prognosis of invasive pulmonary aspergillosis (IPA) in patients with anti-melanoma differentiation-associated gene 5 positive dermatomyositis (anti-MDA5+ DM). Methods A retrospective analysis was conducted in anti-MDA5+ DM patients diagnosed between January 2016 and March 2023. Patients with lower respiratory tract specimens were categorized into IPA+ and IPA- groups based on the presence of IPA and their clinical characteristics and prognoses then compared. Results Of the 415 patients diagnosed with anti-MDA5+ DM, 28 cases had IPA (prevalence rate of 6.7%) with Aspergillus fumigatus being the most common species. The patients were categorized into IPA+ (n=28) and IPA- (n=98) groups, with no significant age or gender-related differences (P>0.05). The IPA+ group had a lower lymphocyte count, particularly the CD4+ T-cell count, and reduced serum albumin and higher serum ferritin levels (P all<0.05). An elevated bronchoalveolar lavage fluid (BALF) galactomannan level was found to be the sole independent risk factor for the occurrence of IPA (adjusted OR=2.191, P=0.029) with a cut-off value of 0.585 and area under the curve of 0.779. The mortality rate in the IPA+ group was 25%. Compared to survivors, non-survivors in this group exhibited a higher incidence of rapidly progressive interstitial lung disease, lower lymphocyte counts, and increased co-infection with Pneumocystis jirovecii (P all<0.05). Conclusion IPA was not rare in patients with anti-MDA5+ DM, with elevated BALF galactomannan levels being an independent risk factor for IPA occurrence. Clinicians must exercise vigilance to identify patients exhibiting the aforementioned risk factors.
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Affiliation(s)
- Xixia Chen
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
| | - Sang Lin
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Qiwen Jin
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
| | - Lu Zhang
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Wei Jiang
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Xin Lu
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Guochun Wang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, People’s Republic of China
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Yongpeng Ge
- Department of Rheumatology, Key Myositis Laboratories, China-Japan Friendship Hospital, Beijing, People’s Republic of China
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Aitnasser K, Nakkabi I, Amrani HN. Diffuse reversed halo sign in an immunocompetent patient. Radiol Case Rep 2024; 19:1055-1059. [PMID: 38226052 PMCID: PMC10788371 DOI: 10.1016/j.radcr.2023.09.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 01/17/2024] Open
Abstract
The reversed halo sign (RHS) is a specific radiological image observed mostly on computed tomography (CT) scans as a focal round area of ground-glass attenuation surrounded by a crescent or ring of consolidation. It is common to many entities of respiratory diseases and can be found in both infectious, noninfectious inflammatory pathologies and some malignant tumors, including invasive pulmonary fungal infection, tuberculosis (TB), community-acquired pneumonia, granulomatosis, sarcoidosis. It is also seen in pulmonary neoplasms and infarction, and following radiation and radiofrequency. We report the case of an immunocompetent 54-year-old North African male patient, initially hospitalized for chronic cough associated with dysphonia and general symptoms such as weight loss, fever, and night sweats. Radiological exploration surprisingly confirmed the presence of RHS, tuberculosis was confirmed by a postbronchoscopy positive sputum Xpert MTB/RIF essay tuberculosis after we started antibacillary treatment, and the evolution was spectacular with regression of the lesions. The objective of this report is to increase knowledge about RHS and its pathological correlation with TB. Since it is not specific to any disorder, it is important to explore its finding in a clinical and epidemiological manner, especially in endemic countries where the prevalence of tuberculosis is still high.
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Affiliation(s)
- K. Aitnasser
- Pneumo-Phthisiology Department, Souss Massa University Hospital Center, Agadir, Morocco
- Medical and Pharmacological Faculty, Ibn Zohr University, Agadir, Morocco
| | - I. Nakkabi
- Medical and Pharmacological Faculty, Ibn Zohr University, Agadir, Morocco
- ENT and Cervico-Facial Surgery Department, Oued Eddahab Military Hospital, Agadir, Morocco
| | - H. Naji Amrani
- Pneumo-Phthisiology Department, Oued Eddahab Military Hospital, Agadir, Morocco
- Medical and Pharmacological Faculty, Sidi Mohammed Benabdellah University, Fes, Morocco
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Franquet T, Domingo P. Pulmonary Infections in People Living with HIV. Radiol Clin North Am 2022; 60:507-520. [DOI: 10.1016/j.rcl.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Qu J, Liu X, Lv X. Pulmonary Mucormycosis as the Leading Clinical Type of Mucormycosis in Western China. Front Cell Infect Microbiol 2021; 11:770551. [PMID: 34881195 PMCID: PMC8645928 DOI: 10.3389/fcimb.2021.770551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/04/2021] [Indexed: 02/05/2023] Open
Abstract
The aim was to better understand the clinical characteristics of patients with mucormycosis in western China. We retrospectively investigated the clinical, laboratory, radiological and treatment profiles of mucormycosis patients during a 10-year period (2010–2019). As a result, 59 proven mucormycosis were enrolled in this study. It was found that 52.5% of patients had worse clinical outcomes. Pulmonary mucormycosis (PM) was the most common clinical manifestation. The most frequent risk factor was diabetes mellitus (38, 64.4%) for mucormycosis patients. Cough (43, 93.5%), fever (24, 52.2%) and hemoptysis/bloody phlegm (21, 45.7%) were the most common manifestations of PM. There were no differences in clinical manifestations, risk factors and laboratory tests between different clinical outcome groups (P>0.05). Lymph node enlargement (30, 65.2%), patchy shadows (28, 60.9%), cavitation (25, 53.3%) and bilateral lobe involvement (39, 84.8%) were the most common on chest CT. Nodule was more common in good outcome group (P <0.05). A total of 48 cases (81.4%) were confirmed by histopathological examination, 22 cases (37.3%) were confirmed by direct microscopy. PM patients were treated with amphotericin B/amphotericin B liposome or posaconazale had better clinical outcomes (P <0.05). In conclusion, PM was the most common clinical type of mucormycosis in China. Diabetes mellitus was the most common risk factor. PM has diverse imaging manifestations and was prone to bilateral lobes involvement. Early diagnosis and effective anti-mucor treatment contribute to successful treatment.
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Affiliation(s)
- Junyan Qu
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Xijiao Liu
- Radiology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoju Lv
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
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Li J, Yan R, Zhai Y, Qi X, Lei J. Chest CT findings in patients with coronavirus disease 2019 (COVID-19): a comprehensive review. Diagn Interv Radiol 2021; 27:621-632. [PMID: 33135665 PMCID: PMC8480948 DOI: 10.5152/dir.2020.20212] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The objective of this review was to summarize the most pertinent CT imaging findings in patients with coronavirus disease 2019 (COVID-19). A literature search retrieved eligible studies in PubMed, EMBASE, Cochrane Library and Web of Science up to June 1, 2020. A comprehensive review of publications of the Chinese Medical Association about COVID-19 was also performed. A total of 84 articles with more than 5340 participants were included and reviewed. Chest CT comprised 92.61% of abnormal CT findings overall. Compared with real-time polymerase chain reaction result, CT findings has a sensitivity of 96.14% but a low specificity of 40.48% in diagnosing COVID-19. Ground glass opacity (GGO), pure (57.31%) or mixed with consolidation (41.51%) were the most common CT features with a majority of bilateral (80.32%) and peripheral (66.21%) lung involvement. The opacity might associate with other imaging features, including air bronchogram (41.07%), vascular enlargement (54.33%), bronchial wall thickening (19.12%), crazy-paving pattern (27.55%), interlobular septal thickening (42.48%), halo sign (25.48%), reverse halo sign (12.29%), bronchiectasis (32.44%), and pulmonary fibrosis (26.22%). Other accompanying signs including pleural effusion, lymphadenopathy and pericardial effusion were rare, but pleural thickening was common. The younger or early stage patients tended to have more GGOs, while extensive/multilobar involvement with consolidation was prevalent in the older or severe population. Children with COVID-19 showed significantly lower incidences of some ancillary findings than those of adults and showed a better performance on CT during follow up. Follow-up CT showed GGO lesions gradually decreased, and the consolidation lesions first increased and then remained relatively stable at 6-13 days, and then absorbed and fibrosis increased after 14 days. Chest CT imaging is an important component in the diagnosis, staging, disease progression and follow-up of patients with COVID-19.
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Affiliation(s)
- Jinkui Li
- Department of Radiology, the First Hospital of Lanzhou University, Intelligent Imaging Medical Engineering Research Center, Accurate Image Collaborative Innovation International Science and Technology Cooperation, Lanzhou, China
| | - Ruifeng Yan
- Department of Radiology, the First Hospital of Lanzhou University, Intelligent Imaging Medical Engineering Research Center, Accurate Image Collaborative Innovation International Science and Technology Cooperation, Lanzhou, China
| | - Yanan Zhai
- Department of Radiology, the First Hospital of Lanzhou University, Intelligent Imaging Medical Engineering Research Center, Accurate Image Collaborative Innovation International Science and Technology Cooperation, Lanzhou, China
| | - Xiaolong Qi
- The first Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Junqiang Lei
- Department of Radiology, the First Hospital of Lanzhou University, Intelligent Imaging Medical Engineering Research Center, Accurate Image Collaborative Innovation International Science and Technology Cooperation, Lanzhou, China
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Obmann VC, Bickel F, Hosek N, Ebner L, Huber AT, Damonti L, Zimmerli S, Christe A. Radiological CT Patterns and Distribution of Invasive Pulmonary Aspergillus, Non-Aspergillus, Cryptococcus and Pneumocystis Jirovecii Mold Infections - A Multicenter Study. ROFO-FORTSCHR RONTG 2021; 193:1304-1314. [PMID: 34034346 DOI: 10.1055/a-1482-8336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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 · Nodules, ground glass opacities, and consolidations are common CT findings in all invasive pulmonary fungal infections.. · There is no pattern that is unique for one specific pathogen, although nodules are more predominant in IANA and Cryptococcus, and ground glass opacities are more predominant in PCP patients.. · Immune status had an impact on CT findings in fungal pneumonia with less consolidation in patients after organ transplantation compared to patients with neutropenia.. · Nodules with a halo sign are associated with a worse outcome.. CITATION FORMAT · Obmann VC, Bickel F, Hosek N et al. Radiological CT Patterns and Distribution of Invasive Pulmonary Aspergillus, Non-Aspergillus, Cryptococcus and Pneumocystis Jirovecii Mold Infections - A Multicenter Study. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1482-8336.
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Affiliation(s)
- Verena C Obmann
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Flurina Bickel
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Nicola Hosek
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Lukas Ebner
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Adrian T Huber
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Lauro Damonti
- Department of Infectious Diseases, Inselspital, University of Bern, Switzerland
| | - Stefan Zimmerli
- Department of Infectious Diseases, Inselspital, University of Bern, Switzerland
| | - Andreas Christe
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
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Dhamija E, Meena P, Ramalingam V, Sahoo R, Rastogi S, Thulkar S. Chemotherapy-induced pulmonary complications in cancer: Significance of clinicoradiological correlation. Indian J Radiol Imaging 2020; 30:20-26. [PMID: 32476746 PMCID: PMC7240883 DOI: 10.4103/ijri.ijri_178_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/23/2019] [Accepted: 01/17/2020] [Indexed: 01/15/2023] Open
Abstract
Chemotherapy while revolutionizing cancer management by improving survival and quality of life; is also associated with several adverse effects. Lung is the most common organ affected in chemotherapy-related complications, due to either drug toxicity or more commonly due to infections caused by immunosuppression and less commonly due to immune-mediated injury. Radiology, when used in combination with clinical and lab data, can help reach the specific diagnosis or narrow down the differentials. The common radiological patterns of drug toxicity include pulmonary interstitial and airway infiltrates, diffuse alveolar damage, nonspecific interstitial pneumonia, eosinophilic pneumonia, cryptogenic organizing pneumonia, pulmonary hemorrhage, edema and hypertension. Cancer patients are immunosuppressed due to the underlying malignancy itself or due to therapy and are prone to a gamut of opportunistic infections including viral, bacterial, fungal and mycobacterial pathogens. Immune reconstitution inflammatory syndrome (IRIS), a well-known complication in HIV, is now being increasingly recognized in non-HIV patients with immunosuppression. Engraftment syndrome is specifically seen following hematopoietic stem cell transplant during neutrophil recovery phase. Pulmonary involvement is frequent, causing a radiological picture of noncardiogenic pulmonary edema. Thus, radiology in combination with clinical background and lab parameters helps in detecting and differentiating various causes of pulmonary complications. This approach can help alter potentially toxic treatment and initiate early treatment depending on the diagnosis.
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Affiliation(s)
- Ekta Dhamija
- Department of Radiodiagnosis, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Meena
- Department of Radiodiagnosis, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vidyasagar Ramalingam
- Department of Radiodiagnosis, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjeet Sahoo
- Department of Medical Oncology, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Department of Medical Oncology, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, Dr B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Yan Y, Shi Y, Wang Y, Yuan X, He W. Pulmonary acute graft-versus-host disease and infections after allogeneic hematopoietic stem cell transplantation in pediatric recipients: A comparative study on CT. Transpl Infect Dis 2020; 22:e13285. [PMID: 32329139 DOI: 10.1111/tid.13285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/09/2020] [Accepted: 03/31/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare the chest CT patterns of acute graft-versus-host disease (aGVHD) and infections within 100 days after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in pediatric recipients to help hematologist make definitive diagnosis as early as possible. METHODS A total of 143 pediatric recipients from January 2015 to June 2019 who were diagnosed pulmonary aGVHD or infections within 100 days after allo-HSCT were enrolled in this study. Two observers evaluated the extent and distribution (unilateral, bilateral) of the CT patterns. The patterns were then classified as ground-glass opacity (GGO) (localized, patchy, diffuse), consolidation (localized, patchy, diffuse), reticulation (localized, patchy, diffuse), nodules (localized, multiple), bronchiectasis, pleural effusion, air trapping, tree-in-bud sign, and pneumomediastinum. The onset time and radiological patterns of the two cohorts were statistically compared. RESULTS The mean onset time of aGVHD (n = 85) and infections group (viral n = 29, bacterial n = 22, fungal n = 7, total n = 58) was 36.89 ± 24.34 (range, 10-99 days) and 23.48 ± 20.65 days (range, 4-94 days) with a significant difference (P = .001). The top three underlying diseases were acute lymphoblastic leukemia (ALL) (n = 49, 57.6%); acute myeloid leukemia (AML) (n = 24, 28.2%); and aplastic anemia (AA) (7.1%) in aGVHD group and hemophagocytic syndrome (HPS) (n = 33, 56.9%); AA (n = 9, 15.5%); and ALL (n = 6, 10.3) in infection group. GGO (41.2%) in aGVHD prevailed on CT, whereas GGO (53.4%) and consolidations (43.1%) were more prevalent in infections. The distribution of GGO showed more diffuse in aGVHD (P = .031) and symmetric while patchier GGO prefers infections (P < .001). No differences were found in the reticulation. Nodules were more common in infections (P = .004) while pleural effusion was more common in aGVHD group (P < .035). CONCLUSION Imaging patterns of aGVHD on CT differ substantially from that of infections. Physicians and radiologists should be aware of such radiological differences in order to give accurate treatment. Notably, definite diagnosis should be made in combination with clinical manifestations, signs, and laboratory tests.
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Affiliation(s)
- Yuchun Yan
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Radiology, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Yuzhu Shi
- Department of Radiology, Beijing Ludaopei Hospital, Beijing, China.,Beijing Ludaopei Institute of Hematology, Beijing, China
| | - Yao Wang
- Department of Radiology, Beijing Jingdu Children's Hospital, Beijing, China
| | - Xinyu Yuan
- Department of Radiology, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Wen He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Closing the Gap in Surveillance and Audit of Invasive Mold Diseases for Antifungal Stewardship Using Machine Learning. J Clin Med 2019; 8:jcm8091390. [PMID: 31491944 PMCID: PMC6780614 DOI: 10.3390/jcm8091390] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 12/22/2022] Open
Abstract
Clinical audit of invasive mold disease (IMD) in hematology patients is inefficient due to the difficulties of case finding. This results in antifungal stewardship (AFS) programs preferentially reporting drug cost and consumption rather than measures that actually reflect quality of care. We used machine learning-based natural language processing (NLP) to non-selectively screen chest tomography (CT) reports for pulmonary IMD, verified by clinical review against international definitions and benchmarked against key AFS measures. NLP screened 3014 reports from 1 September 2008 to 31 December 2017, generating 784 positives that after review, identified 205 IMD episodes (44% probable-proven) in 185 patients from 50,303 admissions. Breakthrough-probable/proven-IMD on antifungal prophylaxis accounted for 60% of episodes with serum monitoring of voriconazole or posaconazole in the 2 weeks prior performed in only 53% and 69% of episodes, respectively. Fiberoptic bronchoscopy within 2 days of CT scan occurred in only 54% of episodes. The average turnaround of send-away bronchoalveolar galactomannan of 12 days (range 7–22) was associated with high empiric liposomal amphotericin consumption. A random audit of 10% negative reports revealed two clinically significant misses (0.9%, 2/223). This is the first successful use of applied machine learning for institutional IMD surveillance across an entire hematology population describing process and outcome measures relevant to AFS. Compared to current methods of clinical audit, semi-automated surveillance using NLP is more efficient and inclusive by avoiding restrictions based on any underlying hematologic condition, and has the added advantage of being potentially scalable.
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Radiologische Diagnostik von Thorax und Abdomen bei immunkompromittierten Patienten. Med Klin Intensivmed Notfmed 2019; 114:526-532. [DOI: 10.1007/s00063-017-0331-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 11/25/2022]
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14
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Shroff GS, Marom EM, Wu CC, Truong MT, Godoy MCB. Imaging of Pneumonias and Other Thoracic Complications After Hematopoietic Stem Cell Transplantation. Curr Probl Diagn Radiol 2018; 48:393-401. [PMID: 30122314 DOI: 10.1067/j.cpradiol.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/15/2018] [Accepted: 07/17/2018] [Indexed: 01/15/2023]
Abstract
Hematopoietic stem cell transplantation (HSCT) is used in the treatment of various oncologic and hematologic diseases. After HSCT, patients are immunocompromised and are at risk for a wide variety of infectious and noninfectious complications. CT is routinely used when pulmonary complications are suspected after HSCT. In this article, we review the CT appearance of pulmonary complications that occur in the post-transplantation period with special emphasis on opportunistic infections, many of which are life-threatening.
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Affiliation(s)
- Girish S Shroff
- The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Edith M Marom
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.
| | - Carol C Wu
- The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Mylene T Truong
- The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Myrna C B Godoy
- The University of Texas MD Anderson Cancer Center, Houston, TX.
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Severe infections in critically ill solid organ transplant recipients. Clin Microbiol Infect 2018; 24:1257-1263. [PMID: 29715551 DOI: 10.1016/j.cmi.2018.04.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/13/2018] [Accepted: 04/19/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Severe infections are among the most common causes of death in immunocompromised patients admitted to the intensive care unit. The epidemiology, diagnosis and treatment of these infections has evolved in the last decade. AIMS We aim to provide a comprehensive review of these severe infections in this population. SOURCES Review of the literature pertaining to severe infections in critically ill solid organ transplant recipients. PubMed and Embase databases were searched for documents published since database inception until November 2017. CONTENT The epidemiology of severe infections has changed in the immunocompromised patients. This population is presenting to the intensive care unit with specific transplantation procedure-related infections, device-associated infections, a multitude of opportunistic viral infections, an increasing number of nosocomial infections and bacterial diseases with a more limited therapeutic armamentarium. Both molecular diagnostics and imaging techniques have had substantial progress in the last decade, which will, we hope, translate into faster and more precise diagnoses, as well as more optimal empirical treatment de-escalation. IMPLICATIONS The key clinical elements to improve the outcome of critically ill solid organ transplant recipients depend on the knowledge of geographic epidemiology, specific surgical procedures, net state of immunosuppression, hospital microbial ecology, aggressive diagnostic strategy and search for source control, rapid initiation of antimicrobials and minimization of iatrogenic immunosuppression.
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Clinical characteristics and treatment outcomes of pulmonary invasive fungal infection among adult patients with hematological malignancy in a medical centre in Taiwan, 2008-2013. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 53:106-114. [PMID: 29449166 DOI: 10.1016/j.jmii.2018.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND/PURPOSE This study was aimed to investigate clinical characteristics and treatment outcomes of pulmonary invasive fungal infection (IFI) among patients with hematological malignancy. METHODS All patients with hematological malignancy who were treated at a medical centre from 2008 to 2013 were evaluated. Pulmonary IFI was classified according to the European Organization for Research and Treatment of Cancer 2008 consensus. RESULTS During the study period, 236 (11.3%) of 2083 patients with hematological malignancy were diagnosed as pulmonary IFI, including 41 (17.4%) proven, 75 (31.8%) probable, and 120 (50.8%) possible cases. Among the 116 patients of proven and probable cases of pulmonary IFI, aspergillosis alone (n = 90, 77.6%) was predominant, followed by cryptococcosis alone (n = 9, 7.8%), and mucormycosis (n = 4, 3.4%). The overall incidence of patients with pulmonary IFI was 5.9 per 100 patient-years. The highest incidence (per 100 patient-year) was found in patients with acute myeloid leukaemia (13.7) followed by acute lymphoblastic leukaemia (11.3), and myelodysplastic syndrome/severe aplastic anaemia (6.7). Fourteen (5.9%) of the 236 patients with pulmonary IFI died within 12 weeks after diagnosis of pulmonary IFI. Univariate analysis revealed that elderly age (>65 years) (P = 0.034), lack of response to anti-fungal treatment (P < 0.001), and admission to the intensive care unit (ICU) (P < 0.001) were predictors of poor prognosis. However, only admission to the ICU was an independent predictor of poor prognosis for 12-week mortality (P = 0.022) based on multivariate analysis. CONCLUSION Patients with acute leukaemia and myelodysplastic syndrome/severe aplastic anaemia were at high risk of pulmonary IFI.
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Morphological characteristics of the reversed halo sign that may strongly suggest pulmonary infarction. Clin Radiol 2017; 73:503.e7-503.e13. [PMID: 29273224 DOI: 10.1016/j.crad.2017.11.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/20/2017] [Indexed: 01/15/2023]
Abstract
AIM To analyse the morphological characteristics of the reversed halo sign (RHS) on unenhanced chest computed tomography (CT), which raise suspicion of pulmonary infarction (PI) associated with pulmonary embolism (PE), and to compare these characteristics with those observed in the RHS caused by other diseases. MATERIAL AND METHODS CT images of 145 patients (250 RHSs) were reviewed retrospectively. Sixty-four patients had the RHS due to PI; in 81 immunocompetent patients, the RHS was caused by alternative pulmonary diseases. All PIs secondary to PE were confirmed at CT angiography. Other diagnoses were confirmed using published criteria. Two independent thoracic radiologists, who were blinded patient demographics, clinical data, and final diagnoses, analysed the morphological CT features of the RHSs. RESULTS Seventy-four RHSs were found in the PI group and 176 RHSs in the group of other diseases. Single RHSs were associated more frequently with PI compared with the group without PIs; three or more lesions were seen only in patients with other diseases. Low-attenuation areas inside the RHS, with or without reticulation, were observed in 94.59% of PI-associated lesions, and in no patient in the group without PI (p<0.001). Subpleural involvement (p<0.001) and lower-lung predominance (p=0.001) were also associated more frequently with PI. Pleural effusion was observed in 64.06% of patients with PI and in only 6.17% of those with other diseases (p<0.001). CONCLUSIONS A single RHS with low-attenuation areas inside the halo, with or without reticulation, is highly suggestive of PI. Lower-lung predominance and pleural effusion also suggest PI.
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Pergam SA. Fungal Pneumonia in Patients with Hematologic Malignancies and Hematopoietic Cell Transplantation. Clin Chest Med 2017; 38:279-294. [PMID: 28477639 DOI: 10.1016/j.ccm.2016.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Invasive fungal infections, which occur primarily as a consequence of prolonged neutropenia and immunosuppression, are a life-threatening complication seen among patients with hematologic malignancies. The routine use of triazole antifungal prophylaxis, enhanced diagnostics, and newer antifungal agents have led to improvements in the care of fungal pneumonias, but invasive fungal infections remain a major cause of morbidity and mortality. This article covers risk factors for major fungal infections, diagnostic approaches, and treatment options for specific fungal pathogens, including Aspergillus and Mucorales species, and discusses current approved strategies for prevention of common and uncommon fungal pneumonias.
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Affiliation(s)
- Steven A Pergam
- Vaccine & Infectious Disease Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, E4-100, Seattle, WA 98109, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, E4-100, Seattle, WA 98109, USA; Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA; Infection Prevention, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, Seattle, WA 98109, USA.
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Harris B, Geyer AI. Diagnostic Evaluation of Pulmonary Abnormalities in Patients with Hematologic Malignancies and Hematopoietic Cell Transplantation. Clin Chest Med 2017; 38:317-331. [PMID: 28477642 PMCID: PMC7172342 DOI: 10.1016/j.ccm.2016.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pulmonary complications (PC) of hematologic malignancies and their treatments are common causes of morbidity and mortality. Early diagnosis is challenging due to host risk factors, clinical instability, and provider preference. Delayed diagnosis impairs targeted treatment and may contribute to poor outcomes. An integrated understanding of clinical risk and radiographic patterns informs a timely approach to diagnosis and treatment. There is little prospective evidence guiding optimal modality and timing of minimally invasive lung sampling; however, a low threshold for diagnostic bronchoscopy during the first 24 to 72 hours after presentation should be a guiding principle in high-risk patients.
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Affiliation(s)
- Bianca Harris
- Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Alexander I Geyer
- Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
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Sheela S, Ito S, Strich JR, Manion M, Montemayor-Garcia C, Wang HW, Oetjen KA, West KA, Barrett AJ, Parta M, Gea-Banacloche J, Holland SM, Hourigan CS, Lai C. Successful salvage chemotherapy and allogeneic transplantation of an acute myeloid leukemia patient with disseminated Fusarium solani infection. Leuk Res Rep 2017; 8:4-6. [PMID: 28794968 PMCID: PMC5536877 DOI: 10.1016/j.lrr.2017.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/01/2017] [Accepted: 07/17/2017] [Indexed: 12/12/2022] Open
Abstract
Disseminated Fusarium infection is associated with high mortality in immunocompromised patients. Patients with acute myeloid leukemia (AML) often have an extended duration of neutropenia during intensive induction chemotherapy, consolidation chemotherapy, and hematopoietic stem cell transplantation (SCT). There is no consensus regarding management of invasive disseminated Fusarium infections in the setting of prolonged neutropenia (Tortorano et al., 2014) [1]. We report a case of disseminated Fusarium in a patient with relapsed AML who underwent successful chemotherapy and haplo-identical allogeneic SCT with administration of granulocyte colony stimulating factor (G-CSF) and granulocyte infusions.
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Affiliation(s)
- Sheenu Sheela
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sawa Ito
- Stem Cell Allogeneic Transplantation Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeffrey R Strich
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Maura Manion
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Celina Montemayor-Garcia
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Hao-Wei Wang
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Karolyn A Oetjen
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kamile A West
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Austin J Barrett
- Stem Cell Allogeneic Transplantation Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Parta
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, MD 21702, USA
| | - Juan Gea-Banacloche
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Steven M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Christopher S Hourigan
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Catherine Lai
- Myeloid Malignancies Section, Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Lal H, Asmita, Mangla L, Prasad R, Gautam M, Nath A. Imaging features of pulmonary infection in post renal transplant recipients: A review. INDIAN JOURNAL OF TRANSPLANTATION 2017. [DOI: 10.1016/j.ijt.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Pretransplant chest computed tomography screening in asymptomatic patients with leukemia and myelodysplastic syndrome. Bone Marrow Transplant 2016; 52:476-479. [PMID: 27941772 DOI: 10.1038/bmt.2016.309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Vallipuram J, Dhalla S, Bell CM, Dresser L, Han H, Husain S, Minden MD, Paul NS, So M, Steinberg M, Vallipuram M, Wong G, Morris AM. Chest CT scans are frequently abnormal in asymptomatic patients with newly diagnosed acute myeloid leukemia. Leuk Lymphoma 2016; 58:834-841. [DOI: 10.1080/10428194.2016.1213825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Brownback KR. When is a nodule more than a nodule? Eur J Haematol 2016; 96:3-4. [PMID: 25873325 DOI: 10.1111/ejh.12564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kyle R Brownback
- Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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26
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Karhu JM, Ala-Kokko TI, Ahvenjärvi LK, Rauvala E, Ohtonen P, Syrjälä HPT. Early chest computed tomography in adult acute severe community-acquired pneumonia patients treated in the intensive care unit. Acta Anaesthesiol Scand 2016; 60:1102-10. [PMID: 27272897 DOI: 10.1111/aas.12749] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/17/2016] [Accepted: 05/06/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND The value of early chest computed tomography (CT) was evaluated among severe community-acquired pneumonia (SCAP) patients. METHODS The study population consisted of 65 of 457 SCAP patients with concomitant chest CT and radiograph performed within 48 h of ICU admission. Each image pair was re-evaluated by two radiologists. The type of pneumonia, the presence of pleural fluid and atelectasis were assessed. Therapeutic and diagnostic procedures induced by CT results were analysed together with clinical, microbiological and outcome data. RESULTS Alveolar pneumonia was observed in 72.3% of patients by radiograph and in 75.4% of patients by CT. Pleural fluid was detected via chest radiograph and CT in 17 (26.2%) and 41 cases (63.1%), (P < 0.001) and atelectasis in 10 (15.4%) and 22 cases (33.8%), (P = 0.002), respectively. In 34 patients (52.3%), the CT revealed 38 new findings (58.5%) not shown in plain chest radiograph. Out of these 34 patients, therapeutic interventions or procedures were performed in 26 (76.5%). The number of infected lobes correlated negatively with the lowest PaO2 /FiO2 ratio (ρ = -0.326, P = 0.008) for chest CT scans. CONCLUSION Compared with chest radiograph, chest CT generated new findings in nearly 60% of SCAP patients, leading to new procedures or changes in medical treatment in nearly 75% of those patients. Chest CT better describes the pulmonary involvement and severity of oxygenation disorder compared to a plain chest radiograph.
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Affiliation(s)
- J. M. Karhu
- Division of Intensive Care; Department of Anaesthesiology; Oulu University Hospital and Medical Research Center Oulu; Oulu University; Oulu Finland
| | - T. I. Ala-Kokko
- Division of Intensive Care; Department of Anaesthesiology; Oulu University Hospital and Medical Research Center Oulu; Oulu University; Oulu Finland
| | - L. K. Ahvenjärvi
- Department of Radiology; Oulu University Hospital and Medical Research Center Oulu; Oulu University; Oulu Finland
| | - E. Rauvala
- Department of Radiology; Oulu University Hospital and Medical Research Center Oulu; Oulu University; Oulu Finland
| | - P. Ohtonen
- Departments of Anaesthesiology and Surgery; Oulu University Hospital and Medical Research Center Oulu; Oulu University; Oulu Finland
| | - H. P. T. Syrjälä
- Department of Infection Control; Oulu University Hospital and Medical Research Center Oulu; Oulu University; Oulu Finland
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Sassi C, Stanzani M, Lewis RE, Vianelli N, Tarsi A, Poerio A, Cavo M, Battista G. Radiologic findings of Fusarium pneumonia in neutropenic patients. Mycoses 2016; 60:73-78. [DOI: 10.1111/myc.12538] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/23/2016] [Accepted: 07/02/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Claudia Sassi
- Division of Radiology; Department of Experimental; Diagnostic and Specialty Medicine (DIMES); S. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Marta Stanzani
- Department of Hematology and Oncology; Institute of Hematology “Lorenzo e Ariosto Seràgnoli”; S. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Russell E. Lewis
- Department of Internal Medicine Geriatrics and Nephrologic Diseases (DIMEC); Clinic of Infectious Diseases; S. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Nicola Vianelli
- Department of Hematology and Oncology; Institute of Hematology “Lorenzo e Ariosto Seràgnoli”; S. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Andrea Tarsi
- Division of Radiology; Department of Experimental; Diagnostic and Specialty Medicine (DIMES); S. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Antonio Poerio
- Division of Radiology; Department of Experimental; Diagnostic and Specialty Medicine (DIMES); S. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Michele Cavo
- Department of Hematology and Oncology; Institute of Hematology “Lorenzo e Ariosto Seràgnoli”; S. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Giuseppe Battista
- Division of Radiology; Department of Experimental; Diagnostic and Specialty Medicine (DIMES); S. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
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Improved Radiographic Imaging of Invasive Fungal Disease: The Cornerstone to Antifungal Stewardship in the Hematology Units? CURRENT FUNGAL INFECTION REPORTS 2016. [DOI: 10.1007/s12281-016-0258-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Arıkan Akdağlı S, Azap A, Başaran Demirkazık F, Ener B, Aşcıoğlu Hayran S, Özdemir Kumbasar Ö, Metan G, Odabaşı Z, Uzun Ö, Akan H. Diagnosis of Invasive Fungal Diseases in Hematological Malignancies: A Critical Review of Evidence and Turkish Expert Opinion (TEO-2). Turk J Haematol 2015; 31:342-56. [PMID: 25541650 PMCID: PMC4454048 DOI: 10.4274/tjh.2014.0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
One of the most problematic issues in hematological malignancies is the diagnosis of invasive fungal diseases. Especially, the difficulty of mycological diagnosis and the necessity of immediate intervention in molds have led to the adoption of “surrogate markers” that do not verify but rather strongly suggest fungal infection. The markers commonly used are galactomannan (GM), beta-glucan, and imaging methods. Although there are numerous studies on these diagnostic approaches, none of these markers serve as a support for the clinician, as is the case in human immunodeficiency virus (HIV) or cytomegalovirus (CMV) infections. This paper has been prepared to explain the diagnostic tests. As molecular tests have not been standardized and are not used routinely in the clinics, they will not be mentioned here.
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van Diepeningen AD, Brankovics B, Iltes J, van der Lee TAJ, Waalwijk C. Diagnosis of Fusarium Infections: Approaches to Identification by the Clinical Mycology Laboratory. CURRENT FUNGAL INFECTION REPORTS 2015; 9:135-143. [PMID: 26301000 PMCID: PMC4537702 DOI: 10.1007/s12281-015-0225-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Infections caused by the genus Fusarium have emerged over the past decades and range from onychomycosis and keratitis in healthy individuals to deep and disseminated infections with high mortality rates in immune-compromised patients. As antifungal susceptibility can differ between the different Fusarium species, identification at species level is recommended. Several clinical observations as hyaline hyphae in tissue, necrotic lesions in the skin and positive blood tests with fungal growth or presence of fungal cell wall components may be the first hints for fusariosis. Many laboratories rely on morphological identification, but especially multi-locus sequencing proves better to discriminate among members of the species complexes involved in human infection. DNA-based diagnostic tools have best discriminatory power when based on translation elongation factor 1-α or the RNA polymerase II second largest subunit. However, assays based on the detection of other fusarial cell compounds such as peptides and cell wall components may also be used for identification. The purpose of this review is to provide an overview and a comparison of the different tools currently available for the diagnosis of fusariosis.
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Affiliation(s)
| | - Balázs Brankovics
- />CBS-KNAW Fungal Biodiversity Centre, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
- />Institute of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
| | - Jearidienne Iltes
- />CBS-KNAW Fungal Biodiversity Centre, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
| | - Theo A. J. van der Lee
- />Plant Research International Wageningen UR, Droevendaalsesteeg 1, 6708 PB Wageningen, The Netherlands
| | - Cees Waalwijk
- />Plant Research International Wageningen UR, Droevendaalsesteeg 1, 6708 PB Wageningen, The Netherlands
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Godoy MC, Marom EM, Carter BW, Sorensen J, Truong MT, Abbott GF. Computed Tomography Imaging of Lung Infection in the Oncologic Setting: Typical Features and Potential Pitfalls. Semin Roentgenol 2015; 50:192-6. [DOI: 10.1053/j.ro.2015.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
Thoracic imaging is widely used to detect lower respiratory tract infections, identify their complications, and aid in differentiating infectious from noninfectious thoracic disease. Less commonly, the combination of imaging findings and a clinical setting can favor infection with a specific organism. This confluence can occur in cases of bronchiectatic nontuberculous mycobacterial infections in immune-competent hosts, invasive fungal disease among neutropenic patients, Pneumocystis jiroveci pneumonia in patients with AIDS, and in cytomegalovirus infections in patients with recent hematopoietic cell transplantation. These specific diagnoses often depend on computed tomography scanning rather than chest radiography alone.
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Desai SR, Hedayati V, Patel K, Hansell DM. Chronic Aspergillosis of the Lungs: Unravelling the Terminology and Radiology. Eur Radiol 2015; 25:3100-7. [PMID: 25791639 DOI: 10.1007/s00330-015-3690-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 02/17/2015] [Accepted: 02/23/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED The propensity for Aspergillus spp. to cause lung disease has long been recognised but the satisfactory classification of these disorders is challenging. The problems caused by invasive disease in severely neutropenic patients, saprophytic infection of pre-existing fibrotic cavities and allergic reactions to Aspergillus are well documented. In contrast, a more chronic form of Aspergillus-related lung disease that has the potential to cause significant morbidity and mortality is under-reported. The symptoms of this form of Aspergillus infection may be non-specific and the radiologist may be the first to suspect a diagnosis of chronic pulmonary aspergillosis. The current review considers the classification conundrums in diseases caused by Aspergillus spp. and discusses the typical clinical and radiological profile of patients with chronic pulmonary aspergillosis. KEY POINTS • The classification of Aspergillus -related lung disease is mired in confusion. • The chronic form of Aspergillus infection is associated with significant morbidity and mortality. • Progressive consolidation and cavitation with intracavitary material is the radiological hallmark.
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Affiliation(s)
- S R Desai
- The Department of Radiology, King's Health Partners, King's College London, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK,
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Martinez D, Ananda-Rajah MR, Suominen H, Slavin MA, Thursky KA, Cavedon L. Automatic detection of patients with invasive fungal disease from free-text computed tomography (CT) scans. J Biomed Inform 2014; 53:251-60. [PMID: 25460203 DOI: 10.1016/j.jbi.2014.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 11/05/2014] [Accepted: 11/17/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Invasive fungal diseases (IFDs) are associated with considerable health and economic costs. Surveillance of the more diagnostically challenging invasive fungal diseases, specifically of the sino-pulmonary system, is not feasible for many hospitals because case finding is a costly and labour intensive exercise. We developed text classifiers for detecting such IFDs from free-text radiology (CT) reports, using machine-learning techniques. METHOD We obtained free-text reports of CT scans performed over a specific hospitalisation period (2003-2011), for 264 IFD and 289 control patients from three tertiary hospitals. We analysed IFD evidence at patient, report, and sentence levels. Three infectious disease experts annotated the reports of 73 IFD-positive patients for language suggestive of IFD at sentence level, and graded the sentences as to whether they suggested or excluded the presence of IFD. Reliable agreement between annotators was obtained and this was used as training data for our classifiers. We tested a variety of Machine Learning (ML), rule based, and hybrid systems, with feature types including bags of words, bags of phrases, and bags of concepts, as well as report-level structured features. Evaluation was carried out over a robust framework with separate Development and Held-Out datasets. RESULTS The best systems (using Support Vector Machines) achieved very high recall at report- and patient-levels over unseen data: 95% and 100% respectively. Precision at report-level over held-out data was 71%; however, most of the associated false-positive reports (53%) belonged to patients who had a previous positive report appropriately flagged by the classifier, reducing negative impact in practice. CONCLUSIONS Our machine learning application holds the potential for developing systematic IFD surveillance systems for hospital populations.
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Affiliation(s)
| | | | - Hanna Suominen
- NICTA and The Australian National University, Canberra, Australia; University of Canberra, Canberra, Australia; University of Turku, Finland.
| | - Monica A Slavin
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Peter MacCallum Cancer Institute, Australia; Infectious Diseases Department, Peter MacCallum Cancer Institute, Australia.
| | - Karin A Thursky
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Peter MacCallum Cancer Institute, Australia; Infectious Diseases Department, Peter MacCallum Cancer Institute, Australia.
| | - Lawrence Cavedon
- School of Computer Science and IT, RMIT University, Melbourne, Australia.
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Facilitating surveillance of pulmonary invasive mold diseases in patients with haematological malignancies by screening computed tomography reports using natural language processing. PLoS One 2014; 9:e107797. [PMID: 25250675 PMCID: PMC4175456 DOI: 10.1371/journal.pone.0107797] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 08/23/2014] [Indexed: 01/22/2023] Open
Abstract
Purpose Prospective surveillance of invasive mold diseases (IMDs) in haematology patients should be standard of care but is hampered by the absence of a reliable laboratory prompt and the difficulty of manual surveillance. We used a high throughput technology, natural language processing (NLP), to develop a classifier based on machine learning techniques to screen computed tomography (CT) reports supportive for IMDs. Patients and Methods We conducted a retrospective case-control study of CT reports from the clinical encounter and up to 12-weeks after, from a random subset of 79 of 270 case patients with 33 probable/proven IMDs by international definitions, and 68 of 257 uninfected-control patients identified from 3 tertiary haematology centres. The classifier was trained and tested on a reference standard of 449 physician annotated reports including a development subset (n = 366), from a total of 1880 reports, using 10-fold cross validation, comparing binary and probabilistic predictions to the reference standard to generate sensitivity, specificity and area under the receiver-operating-curve (ROC). Results For the development subset, sensitivity/specificity was 91% (95%CI 86% to 94%)/79% (95%CI 71% to 84%) and ROC area was 0.92 (95%CI 89% to 94%). Of 25 (5.6%) missed notifications, only 4 (0.9%) reports were regarded as clinically significant. Conclusion CT reports are a readily available and timely resource that may be exploited by NLP to facilitate continuous prospective IMD surveillance with translational benefits beyond surveillance alone.
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Marchiori E, Guimarães MD, Hochhegger B, Zanetti G. Importance of the reversed halo sign for the diagnosis of angioinvasive pulmonary aspergillosis. Respir Med 2014; 108:1238-9. [DOI: 10.1016/j.rmed.2013.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 08/22/2013] [Accepted: 08/27/2013] [Indexed: 11/24/2022]
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The Reversed Halo Sign: Pathognomonic Pattern of Pulmonary Mucormycosis in Leukemic Patients With Neutropenia? Clin Infect Dis 2013; 58:672-8. [DOI: 10.1093/cid/cit929] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Ben-Ami R, Halaburda K, Klyasova G, Metan G, Torosian T, Akova M. A multidisciplinary team approach to the management of patients with suspected or diagnosed invasive fungal disease. J Antimicrob Chemother 2013; 68 Suppl 3:iii25-33. [DOI: 10.1093/jac/dkt390] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Lewis RE, Kontoyiannis DP. Epidemiology and treatment of mucormycosis. Future Microbiol 2013; 8:1163-75. [DOI: 10.2217/fmb.13.78] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Mucormycosis is an uncommon but aggressive opportunistic fungal infection that afflicts patients with severe underlying immunosuppression, uncontrolled hyperglycemia and/or ketoacidosis, patients with iron overload resulting from frequent blood transfusions or blood disorders and occasionally healthy patients who are inoculated with fungal spores through traumatic injuries. The clinical presentation of mucormycosis is initially indistinguishable from other common infections, and if not diagnosed early and aggressively treated, it is almost always fatal. In this article we summarize recent changes in the epidemiology of mucormycosis, discuss diagnostic and clinical clues suggestive of the infection and provide a general strategy for managing the infection in the absence of data from well-controlled, prospective clinical trials.
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Affiliation(s)
- Russell E Lewis
- Clinic of Infectious Diseases, Department of Internal Medicine, Geriatrics & Nephrologic Diseases, S’Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Internal Medicine, Unit 1460, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, 77030, Houston, TX, USA
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Marchiori E, Marom EM, Zanetti G, Hochhegger B, Irion KL, Godoy MCB. Reversed halo sign in invasive fungal infections: criteria for differentiation from organizing pneumonia. Chest 2013; 142:1469-1473. [PMID: 22539645 DOI: 10.1378/chest.12-0114] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The purpose of this study was to identify CT scan findings that differentiate the reversed halo sign (RHS) caused by invasive fungal infection (IFI) from the RHS caused by organizing pneumonia (OP). METHODS We retrospectively reviewed CT scans of patients with RHS caused by IFI or OP. The study included 15 patients with proven or probable IFI (eight men and seven women) and 25 patients with biopsy-proven OP (13 women and 12 men). The CT images were reviewed individually by two chest radiologists who were blinded to the final diagnosis. RESULTS Reticulation inside the RHS was observed in 14 of the 15 patients with IFI (93%) and in no patient with OP. The maximal thickness of the consolidation rim was 2.04 ± 0.85 cm for IFI and 0.50 ± 0.22 cm for OP. Pleural effusion was noted in 11 of the 15 patients with IFI (73%) and in no patient with OP. Other parenchymal abnormalities, such as consolidation and ground-glass and linear opacities, were observed in both groups. The number of lesions showing the RHS did not differentiate IFI and OP. CONCLUSION The presence of reticulation inside the RHS, outer rim thickness > 1 cm, and associated pleural effusion strongly suggest the diagnosis of IFI rather than OP.
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Affiliation(s)
- Edson Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Edith M Marom
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gláucia Zanetti
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Klaus L Irion
- Royal Liverpool and Broadgreen University Hospital NHS, Liverpool, England
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Abstract
PURPOSE OF REVIEW The article aims to indicate the current role of radiological imaging in immune competent and immunocompromised patients with pneumonia. The radiological findings in the most common conditions will be reviewed. RECENT FINDINGS Three basic patterns of radiographic abnormality are recognized: lobar (nonsegmental) pneumonia; bronchopneumonia (lobular pneumonia); and interstitial pneumonia. The chest radiograph remains the initial radiological investigation. Computed tomography (CT) is more sensitive than the chest radiograph. The appearances on CT with certain infections such as mycoplasma, invasive aspergillosis, and pneumocystis, in the appropriate clinical setting, may allow a treatment decision to be made when obtaining fluid or tissue for culture is problematical. MRI technology is advancing and this technique may provide an option for follow-up of chronic disease in younger patients in whom radiation exposure is a concern, but MRI does not yet match CT as a diagnostic test in this field. SUMMARY Radiology retains a key role in diagnosing pneumonia, excluding pneumonia, following up patients to check for resolution and to evaluate potential complications. The chest radiograph remains the initial examination. CT is more sensitive and with certain infections more specific. MRI provides an option for monitoring progress, although cannot yet match CT as an initial diagnostic test.
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Schneidawind D, Nann D, Vogel W, Faul C, Fend F, Horger M, Kanz L, Bethge W. Allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia and pulmonary mucormycosis. Transpl Infect Dis 2012; 14:E166-72. [PMID: 23075207 DOI: 10.1111/tid.12019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 06/18/2012] [Accepted: 07/04/2012] [Indexed: 11/28/2022]
Abstract
Mucormycosis is a serious invasive fungal infection in immunocompromised patients. Patients undergoing treatment for hematologic malignancies are predominantly prone to the pulmonary manifestation of mucormycosis. Historically, allogeneic hematopoietic cell transplantation (HCT) in patients suffering from pulmonary mucormycosis (PM) was considered contraindicated owing to mortality rates up to 90%. We present 3 patients with acute myeloid leukemia and PM who were treated with radical surgical debridement combined with high-dose liposomal amphotericin B (LAB), and subsequently underwent successful allogeneic HCT. To date, all 3 patients are in complete remission and show no signs of mucormycosis. Allogeneic HCT in patients with PM seems feasible provided that the infectious focus is completely removed surgically and adequate antifungal pharmacotherapy, such as high-dose LAB or posaconazole, is established.
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Affiliation(s)
- D Schneidawind
- Department of Medicine, University Hospital Tübingen, Tübingen, Germany
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How I manage pulmonary nodular lesions and nodular infiltrates in patients with hematologic malignancies or undergoing hematopoietic cell transplantation. Blood 2012; 120:1791-800. [DOI: 10.1182/blood-2012-02-378976] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abstract
Pulmonary nodules and nodular infiltrates occur frequently during treatment of hematologic malignancies and after hematopoietic cell transplantation. In patients not receiving active immunosuppressive therapy, the most likely culprits are primary lung cancer, chronic infectious or inactive granulomata, or even the underlying hematologic disease itself (especially in patients with lymphoma). In patients receiving active therapy or who are otherwise highly immunosuppressed, there is a wider spectrum of etiologies with infection being most likely, especially by bacteria and fungi. Characterization of the pulmonary lesion by high-resolution CT imaging is a crucial first diagnostic step. Other noninvasive tests can often be useful, but invasive testing by bronchoscopic evaluation or acquisition of tissue by one of several biopsy techniques should be performed for those at risk for malignancy or invasive infection unless contraindicated. The choice of the optimal biopsy technique should be individualized, guided by location of the lesion, suspected etiology, skill and experience of the diagnostic team, procedural risk of complications, and patient status. Although presumptive therapy targeting the most likely etiology is justified in patients suspected of serious infection while evaluation proceeds, a structured evaluation to determine the specific etiology is recommended. Interdisciplinary teamwork is highly desirable to optimize diagnosis and therapy.
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Marchiori E, Zanetti G, Hochhegger B, Irion KL, Carvalho ACP, Godoy MCB. Reversed halo sign on computed tomography: state-of-the-art review. Lung 2012; 190:389-94. [PMID: 22573292 DOI: 10.1007/s00408-012-9392-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 04/23/2012] [Indexed: 01/15/2023]
Abstract
The reversed halo sign (RHS) is a chest computed tomography (CT) pattern defined as a focal round area of ground-glass attenuation surrounded by a crescent or ring of consolidation. The RHS was first described as being relatively specific for cryptogenic organizing pneumonia but was later observed in several other infectious and noninfectious diseases. Although the presence of the RHS on CT may help narrow the range of diseases considered in differential diagnoses, final diagnoses should be based on correlation with the clinical scenario and the presence of additional disease-specific CT findings. However, frequently a biopsy may be needed to establish the diagnosis. Organizing pneumonia is the most frequent cause of the RHS. This is a distinct clinical and pathologic entity that can be cryptogenic or secondary to other known causes. Morphologic aspects of the halo, particularly the presence of small nodules in the wall or inside the lesion, usually indicate an active granulomatous disease (tuberculosis or sarcoidosis) rather than organizing pneumonia. Immunocompromised patients presenting with the RHS on CT examination should be considered to have an infection until further analyses prove otherwise. Pulmonary zygomycosis and invasive pulmonary aspergillosis are typically seen in patients with severe immunosuppression, most commonly secondary to hematological malignancies. Other causes of the RHS include noninvasive fungal infections such as paracoccidioidomycosis, histoplasmosis, and Pneumocystis jiroveci pneumonia. Furthermore, Wegener's granulomatosis, radiofrequency ablation, and lymphomatoid granulomatosis may also lead to this finding. Based on a search of the PubMed and Scopus databases, we review the different diseases that can manifest with the RHS on CT.
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Affiliation(s)
- Edson Marchiori
- Department of Radiology, Federal University of Rio de Janeiro, Rua Thomaz Cameron, 438 Valparaiso, Petrópolis, RJ CEP 25685.120, Brazil.
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Godoy MCB, Viswanathan C, Marchiori E, Truong MT, Benveniste MF, Rossi S, Marom EM. The reversed halo sign: update and differential diagnosis. Br J Radiol 2012; 85:1226-35. [PMID: 22553298 DOI: 10.1259/bjr/54532316] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The reversed halo sign is characterised by a central ground-glass opacity surrounded by denser air-space consolidation in the shape of a crescent or a ring. It was first described on high-resolution CT as being specific for cryptogenic organising pneumonia. Since then, the reversed halo sign has been reported in association with a wide range of pulmonary diseases, including invasive pulmonary fungal infections, paracoccidioidomycosis, pneumocystis pneumonia, tuberculosis, community-acquired pneumonia, lymphomatoid granulomatosis, Wegener granulomatosis, lipoid pneumonia and sarcoidosis. It is also seen in pulmonary neoplasms and infarction, and following radiation therapy and radiofrequency ablation of pulmonary malignancies. In this article, we present the spectrum of neoplastic and non-neoplastic diseases that may show the reversed halo sign and offer helpful clues for assisting in the differential diagnosis. By integrating the patient's clinical history with the presence of the reversed halo sign and other accompanying radiological findings, the radiologist should be able to narrow the differential diagnosis substantially, and may be able to provide a presumptive final diagnosis, which may obviate the need for biopsy in selected cases, especially in the immunosuppressed population.
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Affiliation(s)
- M C B Godoy
- Department of Diagnostic Radiology, University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA.
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Preclinical evaluation of two 68Ga-siderophores as potential radiopharmaceuticals for Aspergillus fumigatus infection imaging. Eur J Nucl Med Mol Imaging 2012; 39:1175-83. [PMID: 22526953 PMCID: PMC3369139 DOI: 10.1007/s00259-012-2110-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 03/02/2012] [Indexed: 01/09/2023]
Abstract
Purpose Invasive pulmonary aspergillosis is mainly caused by Aspergillus fumigatus, and is one of the major causes of morbidity and mortality in immunocompromised patients. The mortality associated with invasive pulmonary aspergillosis remains high, mainly due to the difficulties and limitations in diagnosis. We have shown that siderophores can be labelled with 68Ga and can be used for PET imaging of A. fumigatus infection in rats. Here we report on the further evaluation of the most promising 68Ga-siderophore candidates, triacetylfusarinine (TAFC) and ferrioxamine E (FOXE). Methods Siderophores were labelled with 68Ga using acetate buffer. Log P, protein binding and stability values were determined. Uptake by A. fumigatus was studied in vitro in cultures with high and low iron loads. In vivo biodistribution was determined in normal mice and an infection model was established using neutropenic rats inoculated with A. fumigatus. Static and dynamic μPET imaging was performed and correlated with CT images, and lung infection was evaluated ex vivo. Results 68Ga-siderophores were labelled with high radiochemical purity and specific activity. 68Ga-TAFC and 68Ga-FOXE showed high uptake by A. fumigatus in iron-deficient cultures. In normal mice, 68Ga-TAFC and 68Ga-FOXE showed rapid renal excretion with high metabolic stability. In the rat infection model focal lung uptake was detected by μPET with both compounds and increased with severity of the infection, correlating with abnormal CT images. Conclusion 68Ga-TAFC and 68Ga-FOXE displayed excellent in vitro stability and high uptake by A. fumigatus. Both compounds showed excellent pharmacokinetics, highly selective accumulation in infected lung tissue and good correlation with severity of disease in a rat infection model, which makes them promising agents for A. fumigatus infection imaging. Electronic supplementary material The online version of this article (doi:10.1007/s00259-012-2110-3) contains supplementary material, which is available to authorized users.
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