The early diagnostic value of serum galactomannan antigen test combined with chest computed tomography for invasive pulmonary aspergillosis in pediatric patients after hematopoietic stem cell transplantation

2019 ◽  
Vol 33 (8) ◽  
Author(s):  
Kun‐yin Qiu ◽  
Xiong‐yu Liao ◽  
Ke Huang ◽  
Hong‐gui Xu ◽  
Yang Li ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pediatric Patients ◽  
Invasive Pulmonary Aspergillosis ◽  
Diagnostic Value ◽  
Antigen Test ◽  
Pulmonary Aspergillosis ◽  
Hematopoietic Stem ◽  
Chest Computed Tomography ◽  
Galactomannan Antigen ◽  
Early Diagnostic

Invasive Pulmonary Aspergillosis

2020 ◽  
Vol 41 (01) ◽  
pp. 080-098 ◽  
Author(s):  
Marie-Pierre Ledoux ◽  
Blandine Guffroy ◽  
Yasmine Nivoix ◽  
Célestine Simand ◽  
Raoul Herbrecht
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Immunosuppressive Agents ◽  
Invasive Pulmonary Aspergillosis ◽  
Solid Organ ◽  
Pulmonary Aspergillosis ◽  
Hematopoietic Stem

AbstractInvasive pulmonary aspergillosis (IPA) remains difficult to diagnose and to treat. Most common risk factors are prolonged neutropenia, hematopoietic stem cell or solid organ transplantation, inherited or acquired immunodeficiency, administration of steroids or other immunosuppressive agents including monoclonal antibodies and new small molecules used for cancer therapy. Critically ill patients are also at high risk of IPA. Clinical signs are unspecific. Early computed tomography (CT)-scan identifies the two main aspects, angioinvasive and airway invasive aspergillosis. Although CT-scan findings are not fully specific they usually allow early initiation of therapy before mycological confirmation of the diagnosis. Role of 18F-fludeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) is discussed. Confirmation is based on microscopy and culture of respiratory samples, histopathology in case of biopsy, and importantly by detection of Aspergillus galactomannan using an immunoassay in serum and bronchoalveolar lavage fluid. Deoxyribonucleic acid detection by polymerase chain reaction is now standardized and increases the diagnosis yield. Two point of care tests detecting an Aspergillus glycoprotein using a lateral flow assay are also available. Mycological results allow classification into proven (irrespective of underlying condition), probable or possible (for cancer and severely immunosuppressed patients) or putative (for critically ill patients) IPA. New antifungal agents have been developed over the last 2 decades: new azoles (voriconazole, posaconazole, isavuconazole), lipid formulations of amphotericin B (liposomal amphotericin B, amphotericin B lipid complex), echinocandins (caspofungin, micafungin, anidulafungin). Results of main trials assessing these agents in monotherapy or in combination are presented as well as the recommendations for their use according to international guidelines. New agents are under development.

Baseline Chest Computed Tomography for Early Diagnosis of Invasive Pulmonary Aspergillosis in Hemato-oncological Patients: A Prospective Cohort Study

2019 ◽  
Vol 69 (10) ◽  
pp. 1805-1808 ◽  
Author(s):  
Roni Bitterman ◽  
Emilia Hardak ◽  
Marina Raines ◽  
Anat Stern ◽  
Tzila Zuckerman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Myeloid Leukemia ◽  
Early Diagnosis ◽  
Myeloid Leukemia ◽  
Invasive Pulmonary Aspergillosis ◽  
Newly Diagnosed ◽  
Pulmonary Aspergillosis ◽  
Chest Computed Tomography ◽  
Oncological Patients ◽  
Acute Myeloid

Abstract Invasive pulmonary aspergillosis (IPA) has dire consequences in hemato-oncological patients. We report our experience with performing routine baseline chest computed tomography for early diagnosis of IPA. We found high rates of proven or probable IPA diagnosed on admission among patients with newly diagnosed acute myeloid leukemia.

scholarly journals Utility of serum galactomannan antigen testing combined with chest computed tomography for early diagnosis of invasive pulmonary aspergillosis in patients with hematological malignancies with febrile neutropenia after antifungal drug treatment

2018 ◽  
Vol 47 (2) ◽  
pp. 783-790 ◽  
Author(s):  
Xiaoning Wang ◽  
Guili Guo ◽  
Ruibo Cai ◽  
Pengcheng He ◽  
Mei Zhang
Keyword(s):  
Early Diagnosis ◽  
Febrile Neutropenia ◽  
Hematological Malignancies ◽  
Invasive Pulmonary Aspergillosis ◽  
Chest Ct ◽  
Antifungal Drugs ◽  
Control Group ◽  
Pulmonary Aspergillosis ◽  
Galactomannan Antigen ◽  
Observational Group

Objective To investigate the value of serum galactomannan antigen (GM) testing combined with chest computed tomography (CT) as a noninvasive method for early diagnosis of invasive pulmonary aspergillosis (IPA) in patients with hematological malignancies with febrile neutropenia after antifungal drug treatment. Methods We retrospectively analyzed the data of 376 patients with febrile neutropenia from January 2015 to August 2017. All patients were given broad-spectrum antibiotics and divided into the control group (effective antibiotic treatment, no antifungal drugs given) and the observational group (ineffective antibiotic treatment, antifungal drugs given). The serum GM testing, chest CT, and microbiological examination findings were compared between the two groups. Results The false-positive rates of GM testing for IPA in the control and observational groups were 4.04% and 8.65%, respectively, and the false-negative rates in the two groups were 1.10% and 9.62%, respectively. Sixty-five patients in the observational group and 11 in the control group had typical features of CT imaging. Conclusion Clinical weekly screening of serum GM and chest CT may be an effective combined approach to the early diagnosis of IPA in patients with febrile neutropenia, even if they have undergone antifungal treatment.

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