The protected environment for high-risk haematology patients: as safe as we think?

2016 ◽  
Vol 92 (3) ◽  
pp. 295
Author(s):  
J.W. Gray ◽  
L.J. Ludman
Keyword(s):  
High Risk ◽  
Haematology Patients

scholarly journals A Novel Strategy to Identify Haematology Patients at High Risk of Developing Aspergillosis

2021 ◽  
Vol 12 ◽  
Author(s):  
James S. Griffiths ◽  
P. Lewis White ◽  
Aiysha Thompson ◽  
Diogo M. da Fonseca ◽  
Robert J. Pickering ◽  
...  
Keyword(s):  
High Risk ◽  
Disease Risk ◽  
Low Risk ◽  
Fungal Resistance ◽  
Haematopoietic Stem Cell ◽  
Cell Transplant ◽  
Negative Results ◽  
Risk Patients ◽  
Haematology Patients ◽  
Anti Fungal

Invasive Aspergillosis (IA), typically caused by the fungus Aspergillus fumigatus, is a leading cause of morbidity and mortality in immunocompromised patients. IA remains a significant burden in haematology patients, despite improvements in the diagnosis and treatment of Aspergillus infection. Diagnosing IA is challenging, requiring multiple factors to classify patients into possible, probable and proven IA cohorts. Given the low incidence of IA, using negative results as exclusion criteria is optimal. However, frequent false positives and severe IA mortality rates in haematology patients have led to the empirical use of toxic, drug-interactive and often ineffective anti-fungal therapeutics. Improvements in IA diagnosis are needed to reduce unnecessary anti-fungal therapy. Early IA diagnosis is vital for positive patient outcomes; therefore, a pre-emptive approach is required. In this study, we examined the sequence and expression of four C-type Lectin-like receptors (Dectin-1, Dectin-2, Mincle, Mcl) from 42 haematology patients and investigated each patient’s anti-Aspergillus immune response (IL-6, TNF). Correlation analysis revealed novel IA disease risk factors which we used to develop a pre-emptive patient stratification protocol to identify haematopoietic stem cell transplant patients at high and low risk of developing IA. This stratification protocol has the potential to enhance the identification of high-risk patients whilst reducing unnecessary treatment, minimizing the development of anti-fungal resistance, and prioritising primary disease treatment for low-risk patients.

Choice and duration of antifungal prophylaxis and treatment in high-risk haematology patients

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Julien Coussement ◽  
Julian Lindsay ◽  
Benjamin W. Teh ◽  
Monica Slavin
Keyword(s):  
High Risk ◽  
Antifungal Prophylaxis ◽  
Haematology Patients

scholarly journals Is a biomarker-based diagnostic strategy for invasive aspergillosis cost effective in high-risk haematology patients?

2017 ◽  
pp. myw141 ◽  
Author(s):  
N. Macesic ◽  
C.O. Morrissey ◽  
D. Liew ◽  
M.A. Bohensky ◽  
S.C.-A. Chen ◽  
...  
Keyword(s):  
High Risk ◽  
Invasive Aspergillosis ◽  
Cost Effective ◽  
Diagnostic Strategy ◽  
Haematology Patients

scholarly journals The misleading effect of serum galactomannan testing in high-risk haematology patients receiving prophylaxis with micafungin

2017 ◽  
Vol 23 (12) ◽  
pp. 1000.e1-1000.e4 ◽  
Author(s):  
A. Vena ◽  
E. Bouza ◽  
A. Álvarez-Uría ◽  
J. Gayoso ◽  
P. Martín-Rabadán ◽  
...  
Keyword(s):  
High Risk ◽  
Haematology Patients

scholarly journals Use of Aspergillus fumigatus real-time PCR in bronchoalveolar lavage samples (BAL) for diagnosis of invasive aspergillosis, including azole-resistant cases, in high risk haematology patients: the need for a combined use with galactomannan

2019 ◽  
Vol 57 (8) ◽  
pp. 987-996 ◽  
Author(s):  
Malgorzata Mikulska ◽  
Elisa Furfaro ◽  
Elena De Carolis ◽  
Enrico Drago ◽  
Ilaria Pulzato ◽  
...  
Keyword(s):  
High Risk ◽  
Invasive Aspergillosis ◽  
Aspergillus Fumigatus ◽  
Real Time ◽  
Quantitative Polymerase Chain Reaction ◽  
Lung Lesions ◽  
Combined Use ◽  
Risk Patients ◽  
Haematology Patients ◽  
Resistant Strains

Abstract Diagnosis of invasive aspergillosis (IA) is challenging, particularly in high-risk patients with lung lesions other than typical according to 2008-EORTC/MSG criteria. Even if microbiology is positive, they still remain unclassified according to 2008-EORTC/MSG. Quantitative polymerase chain reaction (qPCR) provides new mycological documentation of IA. This retrospective study assessed Aspergillus fumigatus real time qPCR (MycoGENIE®) in BAL to diagnose IA and identify azole-resistant strains. Clinical, radiological, and microbiological data from 114 hematology patients (69% HSCT recipients; 29% on mould active agents) from years 2012-2017 were collected; and 123 BAL samples were tested with qPCR (cutoff: Ct < 40) and galactomannan (GM, Platelia®, cutoff: 0.5 ODI). Patients were classified as proven/probable, possible, and no-IA. "Atypical-IA" referred to patients with lesions other than typical according to 2008-EORTC/MSG and positive mycology. Proven IA was diagnosed in two cases (1.6%), probable in 28 (22.8%), possible in 27 (22%), atypical in 14 (11.4%). qPCR was positive in 39 samples (31.7%). Sensitivity and specificity of qPCR for proven/probable IA (vs no-IA; atypical-IA excluded) were 40% (95% confidence interval [CI]: 23–59) and 69% (95%CI: 55–81), respectively. Sensitivity of qPCR was higher when combined with GM (83%, 95%CI: 65–94) and in those receiving mould-active agents at BAL (61%, 95%CI: 32–86). One sample had TR34/L98H mutation. In conclusion, in high-risk hematology patients with various lung lesions, A. fumigatus qPCR in BAL contributes to diagnosing IA, particularly if combined with GM and in patients receiving mould-active agents might allow detecting azole-resistant mutations in culture negative samples.

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