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Pulmonary fungal infections in patients with hematological malignancies — Diagnostic approaches

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Abstract

In a retrospective study of 56 patients with hematological malignancies and fungal pneumonia we have analyzed the value of different diagnostic procedures. In all patients (Candida n=29,Aspergillus n=23, mixed fungal infectionn=4) bronchoscopy and/or high-resolution computed tomography of the lungs was performed. Cultural detection of fungi in bronchoalveolar lavage was successful in 23/32Candida and 11/23Aspergillus pneumonias. Other relevant pathogens were identified by bronchoscopy in 21 cases. Thorax CT scans showed diagnostic evidence of fungal pneumonia in 10/13Candida and in 16/18Aspergillus infections. Blood cultures were positive in 9/33Candida pneumonias and in none of aspergillosis cases. Serological testing and surveillance cultures had only limited value for the early diagnosis of pulmonary mycosis. Our data suggest that bronchoscopy and high resolution CT scans are mutually complementary diagnostic tools with high sensitivity in patients with hematological malignancies and new pulmonary infiltrates. These procedures facilitate the early and reliable recognition of invasive fungal disease which may have a bearing on the initiation, length, and differential therapy of antimycotic drugs.

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References

  1. Aisner J, Schimpff SC, Wiernik PH (1977) Treatment of invasive aspergillosis: relation of early diagnosis and treatment to response. Ann Intern Med 86:539–543

    PubMed  Google Scholar 

  2. Albelda SM, Talbot GH, Gerson SL, Miller WT, Cassileth PA (1984) Role of fiberoptic bronchoscopy in the diagnosis of invasive pulmonary aspergillosis in patients with acute leukemia. Am J Med 6:1027–1034

    Google Scholar 

  3. Anaissie E (1992) Opportunistic mycoses in the immunocom-promised host: experience at a cancer center. Clin Infect Dis 14:43–53

    Google Scholar 

  4. Armstrong D (1989) Problems in management of opportunistic fungal diseases. Rev Infect Dis 2 [Suppl 7]: 1591–1599

    Google Scholar 

  5. Buff SJ, McLelland R, Gallis HA, Matthay R, Putman CE (1982)Candida albicans pneumonia: radiographic appearance. Am J Radiol 138:645–648

    Google Scholar 

  6. Burnie JP (1991) Developments in the serological diagnosis of opportunistic fungal infections. J Antimicrob Chemother 28 [Suppl A]: 23–33

    PubMed  Google Scholar 

  7. Davies SF (1988) Diagnosis of pulmonary fungal infections. Semin Respir Infect 3:162–171

    PubMed  Google Scholar 

  8. Donhuijsen K, Samandari S (1985) Tiefe Mykosen bei Leukämien und malignen Lymphomen. Dtsch Med Wochenschr 110:903–907

    PubMed  Google Scholar 

  9. Fisher BD, Armstrong D, Yu B, Gold JW (1981) Invasive aspergillosis. Progress in early diagnosis and treatment. Am J Med 71:571–577

    PubMed  Google Scholar 

  10. Harvey RL, Myers JP (1987) Nosocomial fungemia in a large community teaching hospital. Arch Intern Med 147:2117–2120

    Google Scholar 

  11. Hopwood V, Warnock DW (1986) New developments in the diagnosis of opportunistic fungal infection. Eur J Clin Microbiol 5:379–388

    PubMed  Google Scholar 

  12. Horn R, Wong B, Kiehn TE, Armstrong D (1985) Fungemia in a cancer hospital: changing frequency, earlier onset, and results of therapy. Rev Infect Dis 7:646–655

    PubMed  Google Scholar 

  13. Hruban RH, Meziane MA, Zerhouni EA, Wheeler PS, Dumler JS, Hutchins GM (1987) Radiologie-pathologie correlation of the CT halo sign in invasive pulmonary aspergillosis. J Comput Assist Tomogr 11:534–536

    Google Scholar 

  14. Kahn FW, Jones JM (1988) Analysis of bronchoalveolar lavage specimens from immunocompromised patients with a protocol applicable in the microbiology laboratory. J Clin Microbiol 26:1150–1155

    PubMed  Google Scholar 

  15. Kassner EG, Kauffman SL, Yoon JJ, Semiglia M, Kozinn PJ, Goldberg PL (1981) Pulmonary candidiasis in infants: Clinical, radiologie, and pathologic features. Am J Radiol 137:707–716

    Google Scholar 

  16. Kuhlman JE, Fishman EK, Burch PA, Karp JE, Zerhouni EA, Siegelman SS (1987) Invasive pulmonary aspergillosis in acute leukemia. The contribution of CT to early diagnosis and aggressive management. Chest 92:95–99

    Google Scholar 

  17. Kuhlman JE, Fishman EK, Bursh PA, Karp JE, Zerhouni EA, Siegelman SS (1988) CT of invasive pulmonary aspergillosis. Am J Radiol 150:1015–1020

    Google Scholar 

  18. Marra R, Pagano L, Pagliari G, Frigieri L, Storti S, Morace G (1993) The yield of bronchoalveolar lavage in the etiologic diagnosis of pneumonia in leukemia and lymphoma patients. Eur J Haematol 51:256–258

    PubMed  Google Scholar 

  19. Myerowitz RL, Pazin GJ, Allen CM (1977) Disseminated candidiasis. Changes in incidence, underlying disease and pathology. Am J Clin Pathol 68:29–38

    PubMed  Google Scholar 

  20. Pagani JJ, Libshitz HI (1981) Opportunistic fungal pneumonias in cancer patients. Am J Radiol 137:1033–1039

    Google Scholar 

  21. Pannuti CS, Gingrich RD, Pfaller MA, Wenzel RP (1991) Nosocomial pneumonia in adult patients undergoing bone marrow transplantation: a 9 year study. J Clin Oncol 9:77–84

    PubMed  Google Scholar 

  22. Pfaffenbach B, Donhuijsen K, Pahnke J, Bug R, Adamek R, Wegener M, Ricken D (1994) Systemische Pilzinfektion bei hämatologischen Neoplasien. Med Klin 89:299–304

    PubMed  Google Scholar 

  23. Pisani RJ, Wright AJ (1992) Clinical utility of bronchoalveolar lavage in immunocompromised hosts. Mayo Clin Proc 67:221–227

    PubMed  Google Scholar 

  24. Potente G (1989) CT findings in fungal opportunistic pneumonias: Body and brain involvement. Comput Med Imag Graph 13:423–428

    Google Scholar 

  25. Roos N, Vassallo P, Fahrenkamp A, von Eiff M, Erlemann R, Peters PE (1990) Pulmonary candidiasis and aspergillosis: differentiation with CT. Radiol [Suppl] 177:359

    Google Scholar 

  26. Roos N, von Eiff M, Montag M, Bick U, Vassallo P, Fahrenkamp A, Lenzen H, Peters PE (1990) Pulmonale Kandidiasis: Beziehung zwischen Pathogenese und Röntgenmorphologie. Zentralbl Radiol 141:366

    Google Scholar 

  27. Saito H, Anaissie EJ, Morice RC, Dekmezian R, Bodey GP (1988) Bronchoalveolar lavage in the diagnosis of pulmonary infiltrates in patients with acute leukemia. Chest 94:745–749

    PubMed  Google Scholar 

  28. von Eiff M, Steimann R, Roos N., van Husen N, Walger P, Baumgart P, Fegeier W, Junge E, Baumeister H, Wilms B, Heinicke A, van de Loo J (1990) Pneumonien bei abwehrgeschwächten Patienten: Stellenwert nicht bioptischer bronchoskopischer Untersuchungsverfahren in der Erregerdiagnostik. Klin Wochenschr 68:372–379

    PubMed  Google Scholar 

  29. von Eiff M, Essink M, Roos N, Hiddemann W, Büchner T, van de Loo J (1990) Hepatosplenic candidiasis — a late manifestation ofCandida septicaemia in neutropenic patients with hematologic malignancies. Blut 60:242–248

    PubMed  Google Scholar 

  30. Young RC, Bennett JE, Vogel CL, Carbone PP, DeVita VT (1970) Aspergillosis: the spectrum of disease in 98 patients. Medicine 49:147–173

    PubMed  Google Scholar 

  31. Yu VL, Muder RR, Poorsattar A (1986) Significance of isolation of aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergillosis. Results from a 3 year prospective study. Am J Med 81:249–254

    PubMed  Google Scholar 

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von Eiff, M., Zühlsdorf, M., Roos, N. et al. Pulmonary fungal infections in patients with hematological malignancies — Diagnostic approaches. Ann Hematol 70, 135–141 (1995). https://doi.org/10.1007/BF01682033

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  • DOI: https://doi.org/10.1007/BF01682033

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