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Janssens E, Huygens S, Moors I, Delie A, Kerre T, Vande Weygaerde Y, Van Braeckel E, Boelens J, Morbée L, Schauwvlieghe A. Baseline chest computed tomography for diagnosis of invasive aspergillosis in patients with acute myeloid leukaemia treated with intensive chemotherapy: A retrospective single-centre cohort study. Mycoses 2024; 67:e13715. [PMID: 38477367 DOI: 10.1111/myc.13715] [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: 08/01/2023] [Revised: 12/11/2023] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Invasive pulmonary aspergillosis (IPA) is a relatively common infection in patients with acute myeloid leukaemia (AML), and is associated with high mortality rates. Optimising early detection is key to reduce the burden of IPA in this population. In this retrospective cohort study, we evaluated the added value of baseline chest CT before start of classical induction chemotherapy. METHODS Adult patients receiving first-line intensive chemotherapy for AML were included if a baseline chest CT scan was available (±7 days). Data were collected from the electronic health record. IPA was classified using the EORTC/MSGERC 2020 consensus definitions. RESULTS Between 2015 and 2019, 99 patients were included. During first-line treatment, 29/99 (30%) patients developed a probable IPA. Baseline chest CT was abnormal in 61/99 (62%) and 14/61 (23%) patients had typical radiological signs for IPA. An abnormal scan showed a trend towards higher risk for IPA (hazard ratio (HR): 2.12; 95% CI 0.95-4.84). Ground glass opacities were a strong predictor for developing IPA (HR 3.35: 95% CI 1.61-7.00). No probable/proven IPA was diagnosed at baseline; however, a bronchoalveolar lavage (BAL) at baseline was only performed in seven patients. Twelve-week mortality was higher in patients with IPA (7/26, 27% vs. 5/59, 8%; p = .024). CONCLUSION Baseline chest CT scan could be an asset in the early diagnosis of IPA and contribute to risk estimation for IPA. In patients with an abnormal baseline CT, performing a BAL should be considered more frequently, and not only in patients with radiological findings typical for IPA.
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Affiliation(s)
- Emilie Janssens
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - Sammy Huygens
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Ine Moors
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - Anke Delie
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | - Tessa Kerre
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
| | | | - Eva Van Braeckel
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Respiratory Infection and Defense lab (RIDL), Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Jerina Boelens
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Alexander Schauwvlieghe
- Department of Hematology, Ghent University Hospital, Ghent, Belgium
- Department of Hematology, AZ Sint-Jan, Bruges, Belgium
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Siopi M, Karakatsanis S, Roumpakis C, Korantanis K, Eldeik E, Sambatakou H, Sipsas NV, Pagoni M, Stamouli M, Tsirigotis P, Meletiadis J. Evaluation of the Dynamiker® Fungus (1–3)-β-d-Glucan Assay for the Diagnosis of Invasive Aspergillosis in High-Risk Patients with Hematologic Malignancies. Infect Dis Ther 2022; 11:1161-1175. [PMID: 35404009 PMCID: PMC9124273 DOI: 10.1007/s40121-022-00627-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Maria Siopi
- Clinical Microbiology Laboratory, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece
| | - Stamatis Karakatsanis
- Department of Hematology and Lymphoma-Unit of Bone Marrow Transplantation, Evangelismos General Hospital, 10676, Athens, Greece
| | - Christoforos Roumpakis
- 2nd Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Konstantinos Korantanis
- Pathophysiology Department, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Elina Eldeik
- 2nd Department of Internal Medicine, Hippokration General Hospital, 11527, Athens, Greece
| | - Helen Sambatakou
- 2nd Department of Internal Medicine, Hippokration General Hospital, 11527, Athens, Greece
| | - Nikolaos V Sipsas
- Pathophysiology Department, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Maria Pagoni
- Department of Hematology and Lymphoma-Unit of Bone Marrow Transplantation, Evangelismos General Hospital, 10676, Athens, Greece
| | - Maria Stamouli
- 2nd Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Panagiotis Tsirigotis
- 2nd Department of Internal Medicine, Hematology Unit, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462, Athens, Greece.
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Siopi M, Karakatsanis S, Roumpakis C, Korantanis K, Eldeik E, Sambatakou H, Sipsas NV, Tsirigotis P, Pagoni M, Meletiadis J. Performance, Correlation and Kinetic Profile of Circulating Serum Fungal Biomarkers of Invasive Aspergillosis in High-Risk Patients with Hematologic Malignancies. J Fungi (Basel) 2021; 7:jof7030211. [PMID: 33805751 PMCID: PMC7999040 DOI: 10.3390/jof7030211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 12/15/2022] Open
Abstract
As conventional microbiological documentation of invasive aspergillosis (IA) is difficult to obtain, serum fungal biomarkers are important adjunctive diagnostic tools. Positivity rates and the kinetic profiles of galactomannan (GM), 1,3-β-D-glucan (BDG) and Aspergillus DNA (PCR) were studied in high-risk patients with hematologic malignancies. GM, BDG and PCR data from serial serum specimens (n = 240) from 93 adult hematology patients with probable (n = 8), possible (n = 25) and no (n = 60) IA were retrospectively analyzed. Positivity rates and sensitivity/specificity/positive/negative predictive values (NPV) of each fungal biomarker alone and in combination were estimated. The three markers were compared head-to-head and correlated with various biochemical, demographic and patient characteristics. The positivity rates for patients with probable/possible/no IA were 88%/8%/0% for GM (X2 = 55, p < 0.001), 62%/46%/35% for BDG (X2 = 2.5, p = 0.29), 62%/33%/27% for PCR (X2 = 3.9, p = 0.15), 50%/4%/0% for GM + BDG and GM + PCR (X2 = 31, p < 0.001), 50%/8%/22% for BDG + PCR (X2 = 6.5, p = 0.038) and 38%/4%/0% for GM + BDG + PCR (X2 = 21, p < 0.001). Higher agreement (76%) and negative correlation (rs = −0.47, p = 0.0017) was found between GM index and PCR Ct values. The sensitivity and NPV was 45–55% and 90–92% when biomarkers assessed alone and increased to 75–90% and 93–97%, respectively when combined. Weak significant correlations were found between GM, PCR and BDG results with renal/liver function markers (r = 0.11–0.57) with most GM+ and PCR+ samples found in the first and second week of clinical assessment, respectively and BDG later on. Different positivity rates, time profiles and performances were found for the three biomarkers advocating the combination of GM with PCR for the early diagnosis of IA, whereas the high NPV of combined biomarkerscould help excluding IA.
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Affiliation(s)
- Maria Siopi
- Clinical Microbiology Laboratory, “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Stamatis Karakatsanis
- Unit of Bone Marrow Transplantation, Department of Hematology and Lymphoma, “Evangelismos” General Hospital, 10676 Athens, Greece; (S.K.); (M.P.)
| | - Christoforos Roumpakis
- Hematology Unit, 2nd Department of Internal Medicine, “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (C.R.); (P.T.)
| | - Konstantinos Korantanis
- Pathophysiology Department, “Laiko” General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (K.K.); (N.V.S.)
| | - Elina Eldeik
- 2nd Department of Internal Medicine, “Hippokration” General Hospital, 11527 Athens, Greece; (E.E.); (H.S.)
| | - Helen Sambatakou
- 2nd Department of Internal Medicine, “Hippokration” General Hospital, 11527 Athens, Greece; (E.E.); (H.S.)
| | - Nikolaos V. Sipsas
- Pathophysiology Department, “Laiko” General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (K.K.); (N.V.S.)
| | - Panagiotis Tsirigotis
- Hematology Unit, 2nd Department of Internal Medicine, “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; (C.R.); (P.T.)
| | - Maria Pagoni
- Unit of Bone Marrow Transplantation, Department of Hematology and Lymphoma, “Evangelismos” General Hospital, 10676 Athens, Greece; (S.K.); (M.P.)
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, “Attikon” University General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece;
- Correspondence: ; Tel.: +30-210-583-1909; Fax: +30-210-532-6421
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4
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Bitterman R, Hardak E, Guralnik L, Paul M, Oren I. Reply to Nucci. Clin Infect Dis 2020; 70:347-349. [PMID: 31075162 DOI: 10.1093/cid/ciz382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Roni Bitterman
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel
| | - Emilia Hardak
- Pulmonary Medicine, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israeli Institute of Technology, Israel
| | - Luda Guralnik
- Radiology Department, Rambam Health Care Campus, Haifa, Israel
| | - Mical Paul
- Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israeli Institute of Technology, Israel
| | - Ilana Oren
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israeli Institute of Technology, Israel.,Hematology Department and Bone Marrow Transplantation Unit, Rambam Health Care Campus, Haifa, Israel
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Affiliation(s)
- Marcio Nucci
- Department of Internal Medicine, University Hospital, Universidade Federal do Rio de Janeiro, Brazil
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6
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Stemler J, Bruns C, Mellinghoff SC, Alakel N, Akan H, Ananda-Rajah M, Auberger J, Bojko P, Chandrasekar PH, Chayakulkeeree M, Cozzi JA, de Kort EA, Groll AH, Heath CH, Henze L, Hernandez Jimenez M, Kanj SS, Khanna N, Koldehoff M, Lee DG, Mager A, Marchesi F, Martino-Bufarull R, Nucci M, Oksi J, Pagano L, Phillips B, Prattes J, Pyrpasopoulou A, Rabitsch W, Schalk E, Schmidt-Hieber M, Sidharthan N, Soler-Palacín P, Stern A, Weinbergerová B, El Zakhem A, Cornely OA, Koehler P. Baseline Chest Computed Tomography as Standard of Care in High-Risk Hematology Patients. J Fungi (Basel) 2020; 6:jof6010036. [PMID: 32183235 PMCID: PMC7151030 DOI: 10.3390/jof6010036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 12/21/2022] Open
Abstract
Baseline chest computed tomography (BCT) in high-risk hematology patients allows for the early diagnosis of invasive pulmonary aspergillosis (IPA). The distribution of BCT implementation in hematology departments and impact on outcome is unknown. A web-based questionnaire was designed. International scientific bodies were invited. The estimated numbers of annually treated hematology patients, chest imaging timepoints and techniques, IPA rates, and follow-up imaging were assessed. In total, 142 physicians from 43 countries participated. The specialties included infectious diseases (n = 69; 49%), hematology (n = 68; 48%), and others (n = 41; 29%). BCT was performed in 57% (n = 54) of 92 hospitals. Upon the diagnosis of malignancy or admission, 48% and 24% performed BCT, respectively, and X-ray was performed in 48% and 69%, respectively. BCT was more often used in hematopoietic cell transplantation and in relapsed acute leukemia. European centers performed BCT in 59% and non-European centers in 53%. Median estimated IPA rate was 8% and did not differ between BCT (9%; IQR 5–15%) and non-BCT centers (7%; IQR 5–10%) (p = 0.69). Follow-up computed tomography (CT) for IPA was performed in 98% (n = 90) of centers. In high-risk hematology patients, baseline CT is becoming a standard-of-care. Chest X-ray, while inferior, is still widely used. Randomized, controlled trials are needed to investigate the impact of BCT on patient outcome.
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Affiliation(s)
- Jannik Stemler
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; (C.B.); (S.C.M.); (O.A.C.); (P.K.)
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, 50937 Cologne, Germany
- Correspondence: ; Tel.: +49(0)-221-478-32884
| | - Caroline Bruns
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; (C.B.); (S.C.M.); (O.A.C.); (P.K.)
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, 50937 Cologne, Germany
| | - Sibylle C. Mellinghoff
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; (C.B.); (S.C.M.); (O.A.C.); (P.K.)
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, 50937 Cologne, Germany
| | - Nael Alakel
- Department of Internal Medicine I, University Hospital of Dresden, 01307 Dresden, Germany;
| | - Hamdi Akan
- Hematology Clinical Research Unit, Cebeci Hospital, Ankara University Faculty of Medicine, 06100 Ankara, Turkey;
| | - Michelle Ananda-Rajah
- Dept of Infectious Diseases and General Medical Unit, Alfred Health & Central Clinical School, Monash University, Melbourne 3004, Australia;
| | - Jutta Auberger
- Onkologische Schwerpunktpraxis Freilassing, 83395 Freilassing, Germany;
| | - Peter Bojko
- Department of Hematology and Oncology, Red Cross Hospital Munich, 80634 Munich, Germany;
| | - Pranatharthi H. Chandrasekar
- Division of Infectious Diseases, Wayne State University School of Medicine, Karmanos Cancer Center, Detroit, MI 48201, USA;
| | - Methee Chayakulkeeree
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - José A. Cozzi
- Hematology Department, Hospital Provincial Del Centenario, Rosario 2000, Argentina;
| | - Elizabeth A. de Kort
- Department of Hematology, Radboud University Medical Center, 6500 Nijmegen, The Netherlands;
| | - Andreas H. Groll
- Infectious Disease Research Program, Center for Bone Marrow Transplantation and, Department of Pediatric Hematology and Oncology, University Children’s Hospital, 48149 Münster, Germany;
| | - Christopher H. Heath
- Department of Microbiology (PathWest Laboratory Medicine, WA, FSH Network), Perth 6000, Australia;
- Depts. of Infectious Diseases, Fiona Stanley Hospital & Royal Perth Hospital, Perth 6000, Australia
- Faculty of Health & Medical Sciences, University of Western Australia, Murdoch/Perth, Murdoch 6150, Australia
| | - Larissa Henze
- Department of Medicine, Clinic III – Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, 18057 Rostock, Germany;
| | - Marcos Hernandez Jimenez
- Head of the bone marrow unit, Hospital City Dr. Enrique Tejera, 2001 Valencia, Venezuela;
- Departament of Medicine, Facultad de Ciencias de la Salud, University of Carabobo, 2001 Valencia, Venezuela
| | - Souha S. Kanj
- Division of Infectious Diseases, Infection Control Program, Antimicrobial Stewardship Program, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
| | - Nina Khanna
- Division of Infection Diseases and Hospital Epidemiology, University and University Hospital of Basel, 4031 Basel, Switzerland;
| | - Michael Koldehoff
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany;
| | - Dong-Gun Lee
- Division of infectious Diseases, Department of Internal Medicine, Catholic Hematology Hospital & Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 06591 Seoul, Korea;
| | - Alina Mager
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany;
| | - Francesco Marchesi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi, 53 00144 Rome, Italy;
| | | | - Marcio Nucci
- Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil;
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, 20521 Turku, Finland;
| | - Livio Pagano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico A. Gemelli -IRCCS, 00169 Rome, Italy;
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Bob Phillips
- Leeds Children’s Hospital, Leeds General Infirmary, Leeds Teaching Hospitals, NHS Trust, Leeds LS1 3EX, UK;
- Centre for Reviews and Dissemination, Alcuin College, University of York, York YO10 5DD, UK
| | - Juergen Prattes
- Department of Internal Medicine, Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, 8036 Graz, Austria;
| | | | - Werner Rabitsch
- Department of Internal Medicine I, Bone Marrow Transplant-Unit, Medical University of Vienna, 1090 Vienna, Austria;
| | - Enrico Schalk
- Department of Hematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Center, 39120 Magdeburg, Germany;
| | | | - Neeraj Sidharthan
- Department of Clinical Haematology, Amrita Institute of Medical Sciences, Kochi 682041, India;
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit. Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain;
| | - Anat Stern
- Infectious Diseases institute, Rambam Health Care Campus, 3109601 Haifa, Israel;
| | - Barbora Weinbergerová
- Department of Internal Medicine–Hematology and Oncology, Masaryk University and University Hospital Brno, 62500 Brno, Czech Republic;
| | - Aline El Zakhem
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon;
| | - Oliver A. Cornely
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; (C.B.); (S.C.M.); (O.A.C.); (P.K.)
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
- German Centre for Infection Research, Partner Site Bonn-Cologne, 50937 Cologne, Germany
- Clinical Trials Centre Cologne, ZKS Köln, 50935 Cologne, Germany
| | - Philipp Koehler
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; (C.B.); (S.C.M.); (O.A.C.); (P.K.)
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50931 Cologne, Germany
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Zhang L, Che C. Clinical manifestations and outcome analysis of invasive pulmonary aspergillosis infection: a retrospective study in 43 nonneutropenic patients. J Int Med Res 2019; 47:5680-5688. [PMID: 31566035 PMCID: PMC6862873 DOI: 10.1177/0300060519874901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To investigate clinical characteristics of early-onset invasive pulmonary aspergillosis (IPA) in nonneutropenic patients. Methods Retrospective analysis was used to investigate clinical manifestations and auxiliary examination characteristics in 43 patients with IPA and 51 patients with community-acquired pneumonia in the early stage. Results Risk factors of IPA were dust and mold exposure, bronchiectasis, old pulmonary tuberculosis, and nasosinusitis. The incidence rate of complex clinical manifestations was 60.47% during the first week of IPA. The incidence rate of white blood cell (WBC) count >20.0 × 109/L was 51.16%. Lung CT findings indicated incidence rates of single or multiple nodules with a halo sign and central airway expansion with ground glass opacity were 27.9% and 37.21%, respectively. Mortality rates of patients with IPA given empirical and targeted antifungal treatments were 12.0% and 42.9%, respectively. Conclusions Bronchiectasis, old pulmonary tuberculosis, nasosinusitis, and dust and mold exposure may increase the risk of IPA. Single or multiple nodules with a halo sign and central airway expansion with ground glass opacity may be early-stage lung CT findings in patients with IPA. A WBC count >20.0 × 109/L may aid in early diagnosis, and empirical antifungal therapy may reduce mortality in patients with IPA.
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Affiliation(s)
- Lihong Zhang
- Department of Radiology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Chunli Che
- Department of Respiratory Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
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Marchesi F, Cattaneo C, Criscuolo M, Delia M, Dargenio M, Del Principe MI, Spadea A, Fracchiolla NS, Melillo L, Perruccio K, Alati C, Russo D, Garzia M, Brociner M, Cefalo M, Armiento D, Cesaro S, Decembrino N, Mengarelli A, Tumbarello M, Busca A, Pagano L. A bronchoalveolar lavage-driven antimicrobial treatment improves survival in hematologic malignancy patients with detected lung infiltrates: A prospective multicenter study of the SEIFEM group. Am J Hematol 2019; 94:1104-1112. [PMID: 31321791 DOI: 10.1002/ajh.25585] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/08/2019] [Accepted: 07/13/2019] [Indexed: 12/15/2022]
Abstract
Bronchoalveolar lavage (BAL) is recommended for diagnosing lung infiltrates (LI) in patients with hematologic malignancy (HM). Prospective data on the impact of BAL on survival are still lacking. We conducted a prospective observational study on patients who performed BAL for LI among 3055 HM patients hospitalized from January to September 2018. The BAL was performed in 145 out of 434 patients who developed LI, at a median time of four days from LI detection. The median age was 60 (1-83). Most patients had an acute myeloid leukemia/myelodisplastic syndrome (81), followed by lymphoma (41), acute lymphoblastic leukemia (27), and other types of HM (36). A putative causal agent was detected in 111 cases (76%), and in 89 cases (61%) the BAL results provided guidance to antimicrobial treatment. We observed a significantly improved outcome of LI at day +30 in patients who could receive a BAL-driven antimicrobial treatment (improvement/resolution rate: 71% vs 55%; P = .04). Moreover, we observed a significantly improved outcome in 120-day overall survival (120d-OS) (78% vs 59%; P = .009) and 120-day attributable mortality (120d-AM) (11% vs 30%; P = 0.003) for patients who could receive a BAL-driven treatment. The multivariate analysis showed that BAL-driven antimicrobial treatment was significantly associated with better 120d-OS and lower 120d-AM. We did not observe any severe adverse events. In conclusion BAL allows detection of a putative agent of LI in about 75% of cases, it is feasible and well tolerated in most cases, demonstrating that a BAL-driven antimicrobial treatment allows improvement of clinical outcome and survival.
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Affiliation(s)
- Francesco Marchesi
- Hematology and Stem Cell Transplant UnitIRCCS Regina Elena National Cancer Institute Rome Italy
| | - Chiara Cattaneo
- Hematology DivisionASST‐Spedali Civili di Brescia Brescia Italy
| | - Marianna Criscuolo
- Fondazione Policlinico Universitario Agostino Gemelli – IRCCS Rome Italy
| | - Mario Delia
- Hematology and Bone Marrow Transplantation Unit, Department of Emergency and Organ TransplantationUniversity of Bari Bari Italy
| | - Michelina Dargenio
- Hematology and Stem Cell Transplantation Unit'Vito Fazzi' Hospital Lecce Italy
| | | | - Antonio Spadea
- Hematology and Stem Cell Transplant UnitIRCCS Regina Elena National Cancer Institute Rome Italy
| | | | - Lorella Melillo
- UO of Hematology, Foundation IRCSS Casa Sollievo della Sofferenza Hospital San Giovanni Rotondo Italy
| | - Katia Perruccio
- Pediatric Hematology OncologyUniversity Hospital Santa Maria della Misericordia Perugia Italy
| | - Caterina Alati
- Hematology UnitBianchi‐Melacrino‐Morelli Hospital Reggio Calabria Italy
| | - Domenico Russo
- Bone Marrow Transplant UnitUniversity of Brescia and ASST‐Spedali Civili Brescia Italy
| | | | - Marco Brociner
- Division of HematologyFoundation IRCCS Policlinico San Matteo, University of Pavia Pavia Italy
| | | | - Daniele Armiento
- Hematology and Stem Cell Transplantation UnitUniversity Campus Bio‐Medico Rome Italy
| | - Simone Cesaro
- Pediatric Hematology OncologyAzienda Ospedaliera Universitaria Integrata Verona Italy
| | - Nunzia Decembrino
- Pediatric Hematology OncologyIRCCS Policlinico San Matteo, University of Pavia Pavia Italy
| | - Andrea Mengarelli
- Hematology and Stem Cell Transplant UnitIRCCS Regina Elena National Cancer Institute Rome Italy
| | - Mario Tumbarello
- Fondazione Policlinico Universitario Agostino Gemelli – IRCCS Rome Italy
- Istituto di Malattie Infettive, Università Cattolica del Sacro Cuore Rome Italy
| | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e Della Scienza Turin Italy
| | - Livio Pagano
- Fondazione Policlinico Universitario Agostino Gemelli – IRCCS Rome Italy
- Istituto di Ematologia, Università Cattolica del Sacro Cuore Rome Italy
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9
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Girmenia C. New hematologic populations at risk of invasive aspergillosis: focus on new targeted, biological, and cellular therapies. F1000Res 2019; 8. [PMID: 31372213 PMCID: PMC6662679 DOI: 10.12688/f1000research.17836.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2019] [Indexed: 12/14/2022] Open
Abstract
The introduction of new targeted, biological, and cellular therapies in patients with hematologic malignancies has improved the outcomes of patients but in parallel has changed the frequency and epidemiology of infections, including invasive aspergillosis (IA). In this article, recent literature on the epidemiology and clinical findings of IA in patients who have lymphoproliferative and myeloproliferative diseases and are undergoing novel targeted treatment with kinase inhibitors, agents targeting cell surface antigens, chimeric antigen receptor-modified T cells, and antibodies to immune checkpoint molecules is reviewed and the clinical impact of IA on the overall management of the underlying disease is discussed. Overall, IA represents a variable and uncommon complication in these populations, but given the increasing eligibility criteria of these novel treatments (particularly in patients with relapsed or refractory hematologic malignancies) and the prolonged periods of therapy, a considerable number of unusual cases of
Aspergillus infections can be expected in clinical practice.
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Affiliation(s)
- Corrado Girmenia
- Dipartimento di Ematologia, Oncologia, e Dermatologia, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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10
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Rotjanapan P, Chen YC, Chakrabarti A, Li RY, Rudramurthy SM, Yu J, Kung HC, Watcharananan S, Tan AL, Saffari SE, Tan BH. Epidemiology and clinical characteristics of invasive mould infections: A multicenter, retrospective analysis in five Asian countries. Med Mycol 2018; 56:186-196. [PMID: 28525619 DOI: 10.1093/mmy/myx029] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 04/03/2017] [Indexed: 12/12/2022] Open
Abstract
Formal, large-scale, multicenter studies of invasive mould infection (IMI) in Asia are rare. This 1-year, retrospective study was designed to assess the incidence and clinical determinants of IMI in centers in five countries (Thailand, Taiwan, Singapore, China, India). Patients treated in a single year (2012) were identified through discharge diagnoses, microbiology, and histopathology logs, and entered based on published definitions of IMI. A total of 155 cases were included (median age 54 years; 47.7% male). Of these, 47.7% had proven disease; the remainder had probable IMI. The most frequent host factors were prolonged steroid use (39.4%) and recent neutropenia (38.7%). Common underlying conditions included diabetes mellitus (DM; 30.9%), acute myeloid leukemia (19.4%), and rheumatologic conditions (11.6%). DM was more common in patients with no recent history of neutropenia or prolonged steroid use (P = .006). The lung was the most frequently involved site (78.7%), demonstrating a range of features on computed tomography (CT). Aspergillus was the most common mould cultured (71.6%), primarily A. fumigatus and A. flavus, although proportions varied in different centers. The most often used antifungal for empiric therapy was conventional amphotericin. Ninety-day mortality was 32.9%. This is the first multicenter Asian study of IMI not limited to specific patient groups or diagnostic methods. It suggests that DM and rheumatologic conditions be considered as risk factors for IMI and demonstrates that IMI should not be ruled out in patients whose chest features on CT do not fit the conventional criteria.
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Affiliation(s)
- P Rotjanapan
- Division of Infectious Diseases, Ramathibodi Hospital, Bangkok, Thailand
| | - Y C Chen
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - A Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Y Li
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | - S M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - J Yu
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | - H C Kung
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - S Watcharananan
- Division of Infectious Diseases, Ramathibodi Hospital, Bangkok, Thailand
| | - A L Tan
- Department of Pathology, Singapore General Hospital, Singapore, Singapore
| | - S E Saffari
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - B H Tan
- Department of Infectious Disease, Singapore General Hospital, Singapore, Singapore
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11
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Xiao W, Gong DY, Mao B, Du XM, Cai LL, Wang MY, Fu JJ. Sputum signatures for invasive pulmonary aspergillosis in patients with underlying respiratory diseases (SPARED): study protocol for a prospective diagnostic trial. BMC Infect Dis 2018; 18:271. [PMID: 29890956 PMCID: PMC5996557 DOI: 10.1186/s12879-018-3180-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 05/30/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Invasive pulmonary aspergillosis (IPA) has been increasingly reported in patients with underlying respiratory diseases (URD). Early diagnosis of IPA is crucial for mortality reduction and improved prognosis, yet remains difficult. Existing diagnostic tools for IPA largely rely on the detection of biomarkers based on serum or bronchoalveolar lavage fluid (BALF), both of which have their limitations. The use of sputum sample is non-invasive, and Aspergillus detection is feasible; however, the usefulness of sputum biomarkers for the diagnosis of IPA, especially in patients with URD, has not been systematically studied. METHODS This is a prospective diagnostic trial. At least 118 participants will be recruited from respiratory wards and intensive care units. IPA is defined according to the EORTC/MSG criteria modified for patients with URD. Induced sputum and blood will be collected, and BALF will be obtained by bronchoscopy. Sputum biomarkers, including galactomannan, Aspergillus DNA, triacetylfusarinine and bis(methylthio)gliotoxin will be determined, and the presence of a JF5 antigen will be examined with a lateral fluid device. The sensitivity, specificity, negative predictive value, positive predictive value and diagnostic odds ratio will be computed for different biomarkers and compared using the McNemar χ2 test. Receiver operating characteristic analyses will be performed, and the cut-off values will be established. Participants will receive follow-up evaluations at 3 months and 6 months after recruitment. The difference in hospital stay and survival will be analysed, and the relationships between the levels of biomarkers and hospital stay and survival will be analysed via regression models. DISCUSSION We have developed and verified the feasibility of Aspergillus-related biomarker assays for sputum. The study findings will contribute to a novel look at the diagnostic performance of sputum biomarkers in IPA and provide important insight into the improvement of the early diagnosis of IPA, particularly in patients with URD. TRIAL REGISTRATION This study has been registered with the Chinese Clinical Trial Registry ( ChiCTR-DPD-16009070 ) on 24th of August 2016.
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Affiliation(s)
- Wei Xiao
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - De-ying Gong
- Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Bing Mao
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xin-miao Du
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lin-Li Cai
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Min-yu Wang
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Juan-juan Fu
- Respiratory Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
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12
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Marchesi F, Spadea A, Pimpinelli F, Prignano G, Paglia MG, Forcella D, Gumenyuk S, Renzi D, Palombi F, Vulcano A, Pisani F, Romano A, Papa E, Facciolo F, Ensoli F, Girmenia C, Mengarelli A. The predictive value of Aspergillus PCR testing on bronchoalveolar lavage fluid for early diagnosis of invasive pulmonary aspergillosis in hematologic patients. Leuk Lymphoma 2017; 58:2943-2946. [PMID: 28482726 DOI: 10.1080/10428194.2017.1315116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Francesco Marchesi
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Antonio Spadea
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Fulvia Pimpinelli
- b Molecular Virology, Pathology and Microbiology Laboratory , San Gallicano Dermatological Institute , Italy
| | - Grazia Prignano
- b Molecular Virology, Pathology and Microbiology Laboratory , San Gallicano Dermatological Institute , Italy
| | - Maria Grazia Paglia
- c Microbiology and Infectious Diseases Biorepository Laboratory , National Institute of Infectious Diseases "L. Spallanzani" , Italy
| | - Daniele Forcella
- d Thoracic Surgery Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Svitlana Gumenyuk
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Daniela Renzi
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Francesca Palombi
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Antonella Vulcano
- c Microbiology and Infectious Diseases Biorepository Laboratory , National Institute of Infectious Diseases "L. Spallanzani" , Italy
| | - Francesco Pisani
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Atelda Romano
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Elena Papa
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Francesco Facciolo
- d Thoracic Surgery Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Fabrizio Ensoli
- b Molecular Virology, Pathology and Microbiology Laboratory , San Gallicano Dermatological Institute , Italy
| | | | - Andrea Mengarelli
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
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13
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Case Series Study of Invasive Pulmonary Aspergillosis. Mycopathologia 2016; 182:505-515. [DOI: 10.1007/s11046-016-0097-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
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14
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Pagano L, Busca A, Candoni A, Cattaneo C, Cesaro S, Fanci R, Nadali G, Potenza L, Russo D, Tumbarello M, Nosari A, Aversa F. Risk stratification for invasive fungal infections in patients with hematological malignancies: SEIFEM recommendations. Blood Rev 2016; 31:17-29. [PMID: 27682882 DOI: 10.1016/j.blre.2016.09.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/05/2016] [Accepted: 09/09/2016] [Indexed: 11/17/2022]
Abstract
Invasive fungal infections (IFIs) are an important cause of morbidity and mortality in immunocompromised patients. Patients with hematological malignancies undergoing conventional chemotherapy, autologous or allogeneic hematopoietic stem cell transplantation are considered at high risk, and Aspergillus spp. represents the most frequently isolated micro-organisms. In the last years, attention has also been focused on other rare molds (e.g., Zygomycetes, Fusarium spp.) responsible for devastating clinical manifestations. The extensive use of antifungal prophylaxis has reduced the infections from yeasts (e.g., candidemia) even though they are still associated with high mortality rates. This paper analyzes concurrent multiple predisposing factors that could favor the onset of fungal infections. Although neutropenia is common to almost all hematologic patients, other factors play a key role in specific patients, in particular in patients with AML or allogeneic HSCT recipients. Defining those patients at higher risk of IFIs may help to design the most appropriate diagnostic work-up and antifungal strategy.
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Affiliation(s)
- Livio Pagano
- Istituto di Ematologia, Università Cattolica S. Cuore, Roma, Italy.
| | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy
| | - Anna Candoni
- Clinica Ematologica, Azienda Ospedaliero-Universitaria Santa Maria Misericordia, Udine, Italy
| | | | - Simone Cesaro
- Oncoematologia Pediatrica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Rosa Fanci
- Unità Funzionale di Ematologia, Azienda Ospedaliero-Universitaria Careggi e Università di Firenze, Italy
| | - Gianpaolo Nadali
- Unità Operativa Complessa di Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Leonardo Potenza
- UOC Ematologia, Dipartimento di Scienze Mediche e Chirurgiche Materno Infantili e dell'Adulto, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Domenico Russo
- Cattedra di Ematologia, Unità di Malattie del Sangue e Trapianto di Midollo Osseo, Dipartimento di Scienze Cliniche e Sperimentali, Università di Brescia e ASST Spedali Civili, Brescia, Italy
| | - Mario Tumbarello
- Istituto di Malattie Infettive, Università Cattolica S. Cuore, Roma, Italy
| | - Annamaria Nosari
- Divisione di Ematologia e Centro Trapianti Midollo, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Franco Aversa
- Hematology and BMT Unit, Department of Clinical and Experimental Medicine, University of Parma, Italy
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15
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Maccioni F, Vetere S, De Felice C, Al Ansari N, Micozzi A, Gentile G, Foà R, Girmenia C. Pulmonary fungal infections in patients with acute myeloid leukaemia: is it the time to revise the radiological diagnostic criteria? Mycoses 2016; 59:357-64. [PMID: 26865204 DOI: 10.1111/myc.12480] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/19/2015] [Accepted: 01/17/2016] [Indexed: 11/27/2022]
Abstract
The definition of pulmonary fungal infections (PFI) according to the EORTC-MSG criteria may lack diagnostic sensitivity due to the possible presentation of PFI with different radiological pictures. We evaluated the hypothesis to apply less restrictive radiological criteria to define PFI in patients with acute myeloid leukaemia (AML) submitted to chemotherapy. Overall, 73 consecutive episodes of pulmonary infiltrates associated to positive serum galactomannan test or fungal isolation or galactomannan detection from respiratory specimens were considered. CT scans acquired at the onset of symptoms (time-0) and within 4 weeks (time-1) were analysed to identify specific (group A) or aspecific radiological signs (group B). Pulmonary infiltrates fulfilled the EORTC-MSG criteria in 49 patients (group A), whereas in 24 patients (group B) they did not reach the criteria due to aspecific CT findings at time-0. Eleven of 21 (52.4%) patients of the group B evaluable for the evolution of the radiological findings fulfilled EORTC-MSG criteria at time-1. All the analysed clinical and mycological characteristics, response to antifungal therapy and survival were comparable in the two groups. Our study seems to confirm the possibility to extend the radiological suspicion of PFI to less restrictive chest CT findings when supported by microbiological criteria in high-risk haematological patients.
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Affiliation(s)
- Francesca Maccioni
- Dipartimento di Scienze Radiologiche, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
| | - Simone Vetere
- Dipartimento di Scienze Radiologiche, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
| | - Carlo De Felice
- Dipartimento di Scienze Radiologiche, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
| | - Najwa Al Ansari
- Dipartimento di Scienze Radiologiche, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
| | - Alessandra Micozzi
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
| | - Giuseppe Gentile
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
| | - Robin Foà
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
| | - Corrado Girmenia
- Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerativa, Azienda Policlinico Umberto I 'Sapienza' University of Rome, Rome, Italy
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16
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Nucci M, Nouér SA, Cappone D, Anaissie E. Early diagnosis of invasive pulmonary aspergillosis in hematologic patients: an opportunity to improve the outcome. Haematologica 2014; 98:1657-60. [PMID: 24186309 DOI: 10.3324/haematol.2013.094359] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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17
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Ahmad S, Al-Shaikh AA, Khan Z. Development of a novel inhalational model of invasive pulmonary aspergillosis in rats and comparative evaluation of three biomarkers for its diagnosis. PLoS One 2014; 9:e100524. [PMID: 24955575 PMCID: PMC4067343 DOI: 10.1371/journal.pone.0100524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 05/28/2014] [Indexed: 11/19/2022] Open
Abstract
Aspergillus fumigatus, a thermotolerant fungus, is the main causative agent of invasive pulmonary aspergillosis (IPA) in immunocompromised patients that is associated with high mortality rates. Early diagnosis of IPA is crucial for mortality reduction and improved prognosis. An experimental inhalational model of IPA was developed in rats and the efficacy of three biomarkers, namely β-D-glucan (BDG), a panfungal marker, galactomannan (GM), a genus-specific marker, and A. fumigatus DNA, a species-specific marker was evaluated in serum and bronchoalveolar lavage (BAL) specimens at different time points postinfection for early diagnosis of IPA. BDG and GM were detected by using commercial Fungitell and Platelia Aspergillus EIA kits, respectively. A. fumigatus DNA was detected by developing a sensitive, single-step PCR assay. IPA was successfully developed in immunosuppressed rats and all animals until 5 days post-infection were positive for A. fumigatus by culture and KOH-calcofluor microscopy also showed A. fumigatus in 19 of 24 (79%) lung tissue samples. Fourteen of 30 (47%) and 27 of 30 (90%) serum and BAL specimens, respectively, were positive for all three biomarkers with 100% specificity (none of sera or BAL specimens of 12 control rats was positive for biomarkers). Our data show that BAL is a superior specimen than serum and combined detection of BDG, GM and A. fumigatus DNA provide a sensitive diagnosis of IPA in an experimental animal model. Moreover, combined detection of GM and DNA in BAL and detection of either GM or DNA in serum was also positive in 27 of 30 (90%) animals. For economic reasons and considering that the positive predictive value of BDG is low, the detection of GM and/or DNA in serum and BAL samples has the potential to serve as an integral component of the diagnostic-driven strategy in high-risk patients suspected for IPA.
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Affiliation(s)
- Suhail Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Ali A. Al-Shaikh
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Ziauddin Khan
- Department of Microbiology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- * E-mail:
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18
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Invasive aspergillosis in patients with hematological malignancies in the Czech and Slovak republics: Fungal InfectioN Database (FIND) analysis, 2005–2009. Int J Infect Dis 2013; 17:e101-9. [DOI: 10.1016/j.ijid.2012.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 08/21/2012] [Accepted: 09/02/2012] [Indexed: 10/27/2022] Open
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19
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Ostrosky-Zeichner L, Vitale RG, Nucci M. New serological markers in medical mycology: (1,3)-(-D-glucan and Aspergillus galactomannan. INFECTIO 2012. [DOI: 10.1016/s0123-9392(12)70028-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Diagnostic accuracy of PCR alone compared to galactomannan in bronchoalveolar lavage fluid for diagnosis of invasive pulmonary aspergillosis: a systematic review. J Clin Microbiol 2012; 50:3652-8. [PMID: 22952268 DOI: 10.1128/jcm.00942-12] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PCR in bronchoalveolar lavage (BAL) fluid has not been accepted as a diagnostic criterion for invasive pulmonary aspergillosis (IPA). We conducted a systematic review assessing the diagnostic accuracy of PCR in BAL fluid with a direct comparison versus galactomannan (GM) in BAL fluid. We included prospective and retrospective cohort and case-control studies. Studies were included if they used the EORTC/MSG consensus definition criteria of IPA and assessed ≥80% of patients at risk for IPA. Two reviewers abstracted data independently. Risk of bias was assessed using QUADAS-2. Summary sensitivity and specificity values were estimated using a bivariate model and reported with a 95% confidence interval (CI). Nineteen studies published between 1993 and 2012 were included. The summary sensitivity and specificity values (CIs) for diagnosis of proven or probable IPA were 90.2% (77.2 to 96.1%) and 96.4% (93.3 to 98.1%), respectively. In nine cohort studies strictly adherent to the 2002 or 2008 EORTC/MSG criteria for reference standard definitions, the summary sensitivity and specificity values (CIs) were 77.2% (62 to 87.6%) and 93.5% (90.6 to 95.6%), respectively. Antifungal treatment before bronchoscopy significantly reduced sensitivity. The diagnostic performance of PCR was similar to that of GM in BAL fluid using an optical density index cutoff of 0.5. If either PCR or GM in BAL fluid defined a positive result, the pooled sensitivity was higher than that of GM alone, with similar specificity. We conclude that the diagnostic performance of PCR in BAL fluid is good and comparable to that of GM in BAL fluid. Performing both tests results in optimal sensitivity with no loss of specificity. Results are dependent on the reference standard definitions.
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21
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Johnson GL, Bibby DF, Wong S, Agrawal SG, Bustin SA. A MIQE-compliant real-time PCR assay for Aspergillus detection. PLoS One 2012; 7:e40022. [PMID: 22808087 PMCID: PMC3393739 DOI: 10.1371/journal.pone.0040022] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 05/30/2012] [Indexed: 01/06/2023] Open
Abstract
The polymerase chain reaction (PCR) is widely used as a diagnostic tool in clinical laboratories and is particularly effective for detecting and identifying infectious agents for which routine culture and microscopy methods are inadequate. Invasive fungal disease (IFD) is a major cause of morbidity and mortality in immunosuppressed patients, and optimal diagnostic criteria are contentious. Although PCR-based methods have long been used for the diagnosis of invasive aspergillosis (IA), variable performance in clinical practice has limited their value. This shortcoming is a consequence of differing sample selection, collection and preparation protocols coupled with a lack of standardisation of the PCR itself. Furthermore, it has become clear that the performance of PCR-based assays in general is compromised by the inadequacy of experimental controls, insufficient optimisation of assay performance as well as lack of transparency in reporting experimental details. The recently published "Minimum Information for the publication of real-time Quantitative PCR Experiments" (MIQE) guidelines provide a blueprint for good PCR assay design and unambiguous reporting of experimental detail and results. We report the first real-time quantitative PCR (qPCR) assay targeting Aspergillus species that has been designed, optimised and validated in strict compliance with the MIQE guidelines. The hydrolysis probe-based assay, designed to target the 18S rRNA DNA sequence of Aspergillus species, has an efficiency of 100% (range 95-107%), a dynamic range of at least six orders of magnitude and limits of quantification and detection of 6 and 0.6 Aspergillus fumigatus genomes, respectively. It does not amplify Candida, Scedosporium, Fusarium or Rhizopus species and its clinical sensitivity is demonstrated in histological material from proven IA cases, as well as concordant PCR and galactomannan data in matched broncho-alveolar lavage and blood samples. The robustness, specificity and sensitivity of this assay make it an ideal molecular diagnostic tool for clinical use.
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Affiliation(s)
- Gemma L Johnson
- Blizard Institute of Cell and Molecular Science, Queen Mary University, London, United Kingdom.
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