Computed Tomography in Invasive Pulmonary Aspergillosis

1989 ◽  
Vol 30 (6) ◽  
pp. 587-590 ◽  
Author(s):  
G. Potente
Keyword(s):  
Computed Tomography ◽  
Early Recognition ◽  
Invasive Pulmonary Aspergillosis ◽  
Central Area ◽  
Chest Ct ◽  
Target Feature ◽  
Pulmonary Aspergillosis ◽  
Peripheral Ring ◽  
Immunocompromised Hosts ◽  
Peripheral Enhancement

Early recognition of invasive pulmonary aspergillosis and of other similar angiotrophic fungal pneumonias has been claimed in previous reports to be possible with computed tomography (CT) and may improve survival of immunocompromised hosts. Chest CT was performed, in the course of fungal pneumonia, in 11 leukemia patients with chemotherapy-induced neutropenia, either with (n=8) or without (n=5) contrast enhancement. Early (n=5, before the 7th day from the beginning of the clinical setting) chest CT always demonstrated one or more nodules or mass-like infiltrates surrounded by a halo of low attenuation. This halo was absent in middle (n=4, after 7 days) and later (n=4, after 15 days) CT examinations. The contrast-enhanced nodules or mass-like infiltrates showed a peripheral enhancement in 4/8 cases with a target feature (hyperdense peripheral ring and isodense central area). CT showed a non-specific enlargement of liver and spleen in 2 patients. Early chest CT should be used in the management of opportunistic pneumonias.

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.

Increasing Volume and Changing Characteristics of Invasive Pulmonary Aspergillosis on Sequential Thoracic Computed Tomography Scans in Patients With Neutropenia

2001 ◽  
Vol 19 (1) ◽  
pp. 253-259 ◽  
Author(s):  
Denis Caillot ◽  
Jean-Francois Couaillier ◽  
Alain Bernard ◽  
Olivier Casasnovas ◽  
David W. Denning ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Approach ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Involvement ◽  
Median Number ◽  
Pulmonary Aspergillosis ◽  
Halo Sign ◽  
Thoracic Computed Tomography ◽  
Computed Tomography Scans ◽  
Median Volume

PURPOSE: In patients with neutropenia, thoracic computed tomography (CT) halo and air-crescent signs are recognized as major indicators of invasive pulmonary aspergillosis (IPA). Nevertheless, the exact timing of CT images is not well known.PATIENTS AND METHODS: Seventy-one thoracic CT scans were analyzed in 25 patients with neutropenia with surgically proven IPA.RESULTS: On the first day of IPA diagnosis with early CT scan (d0), a typical CT halo sign was observed in 24 of 25 patients. At that time, the median number of thoracic lesions was two (range, one to six), and pulmonary involvement was bilateral in 12 cases. The halo sign was present in 68%, 22%, and 19% of cases on d3, d7, and d14, respectively. Similarly, the air-crescent sign was seen in 8%, 28%, and 63% of cases on the same days. Otherwise, a nonspecific air-space consolidation aspect was seen in 31%, 50%, and 18% of cases on the same days. The analysis of calculated aspergillary volumes on CT showed that, despite antifungal treatment, the median volume of lesions increased four-fold from d0 to d7, whereas it remained stable from d7 to d14. Overall, 21 patients (84%) were cured by the medical-surgical approach.CONCLUSION: In patients with neutropenia, CT halo sign is a highly effective modality for IPA diagnosis. The duration of the halo sign is short, and it demonstrates the value of early CT. The increase of the aspergillosis size on CT in the first days after IPA diagnosis is not correlated with a pejorative immediate outcome when using a combined medical-surgical approach.

scholarly journals Invasive pulmonary aspergillosis in COVID-19 patients

2021 ◽  
Vol 13 (1) ◽  
pp. 38-49
Author(s):  
V. G. Gusarov ◽  
M. N. Zamyatin ◽  
D. A. Kamyshova ◽  
V. S. Fomina ◽  
Yu. A. Abovich ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Distress Syndrome ◽  
Scientific Literature ◽  
Invasive Pulmonary Aspergillosis ◽  
Tracheal Aspirate ◽  
Medical Data ◽  
Chest Ct ◽  
Laboratory Examination ◽  
Pulmonary Aspergillosis ◽  
Chest Ct Scan

A retrospective analysis of the medical data of 12 patients with COVID-19 was performed. For the diagnosis of invasive aspergillosis the international criteria ECMM/ISHAM 2020 were used. We analyzed the scientific literature data on the diagnosis and treatment of invasive aspergillosis in patients with COVID-19.Results. Among the 12 examined patients with a severe course of COVID-19, invasive aspergillosis was diagnosed in 5 patients. Four patients (80%) were treated in the ICU. Steroids or interleukin-6 inhibitors were used in 80% patients. Severe lymphocytopenia was in 80% patients, neutropenia 20%. A fever refractory to antibiotic therapy was noted in 80% patients, an increase in respiratory failure – 60%, acute respiratory distress syndrome – 60%. All patients showed negative dynamics of changes in the chest CT scan. Invasive aspergillosis was confirmed with a positive test for galactomannan in bronchoalveolar lavage and / or serum in 100% of cases. All patients received antifungal therapy with voriconazole and/or caspofungin. The overall 12-week survival rate was 80%.Conclusion. In ICU patients with severe COVID-19 and progressive pulmonary symptoms invasive aspergillosis should be excluded. Examination of substrates from the lower respiratory tract (BAL, tracheal aspirate, or nonbronchoscopic lavage) is necessary. Laboratory examination should include microscopy, culture and test for galactomannan. Voriconazole and isavuconazole are drugs of choice for the treatment of invasive aspergillosis in patients with COVID-19.

scholarly journals Case Report: Diagnostic challenge of COVID-19 associated pulmonary aspergillosis (CAPA)

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 58
Author(s):  
Hanan Albasata ◽  
Maha M. Alamri ◽  
Saud A. Almuhaidb ◽  
Abdullah M. Aljebreen ◽  
Reem S. Almaghrabia
Keyword(s):  
Mechanical Ventilation ◽  
Fungal Infection ◽  
Fungal Infections ◽  
Early Recognition ◽  
Invasive Pulmonary Aspergillosis ◽  
Antimicrobial Treatment ◽  
World Health ◽  
Main Diagnosis ◽  
Diagnostic Challenge ◽  
Pulmonary Aspergillosis

Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic in March 2020 by the World Health Organization (WHO). Severe COVID-19 is represented with acute respiratory distress syndrome (ARDS) that requires mechanical ventilation. Moreover, recent studies are reporting invasive fungal infection associated with severe COVID-19. It is unclear whether the prescription of immunotherapies such as corticosteroids, or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection itself is risk factor for COVID-19-associated invasive pulmonary aspergillosis (CAPA). Hence, fungal infections present an additional uncertainty in managing COVID-19 patients and further compromise the outcome. Case study: Here we report a case of SARS-CoV-2 complicated by invasive pulmonary aspergillosis (IPA) in a patient with no traditional risk factors for IPA. Admitted to ICU due to ARDS on mechanical ventilation, the patient deteriorated clinically with unexplained increased of fraction of inspired oxygen (FiO2) requirement from 50% to 80%. Investigations showed borderline serum galactomannan, nonspecific radiological findings reported to be atypical for COVID-19, and the respiratory sample grew Aspergillus spp. Main diagnosis: COVID-19 related fungal infection. The patient was treated with antifungal therapy for four weeks. He improved clinically after one week of starting antimicrobial treatment. After a prolonged ICU stay (87 days) due to infection control precaution, he was discharged from the ICU and moved to a long-term facility for further management and support. Conclusions: This case highlights the diagnostic challenge in such cases. and the importance of early recognition of CAPA which can optimize therapy by administration of appropriate antifungal agents that may impact mortality.

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