scholarly journals Dynamic Monitor of CT Scan Within Short Interval in Invasive Pulmonary Aspergillosis for Nonneutropenic Patients

2021 ◽  
Author(s):  
Fei Chen ◽  
Yonghong Zhong ◽  
Na Li ◽  
Huijie Wang ◽  
Yanbin Tan ◽  
...  
Keyword(s):  
Ct Scan ◽  
Respiratory Diseases ◽  
Short Interval ◽  
Invasive Pulmonary Aspergillosis ◽  
Host Factors ◽  
Antifungal Treatment ◽  
Ct Scans ◽  
Pulmonary Aspergillosis ◽  
Life Threatening ◽  
American Society

Abstract Background: In nonneutropenic patients with underlying respiratory diseases (URD), invasive pulmonary aspergillosis (IPA) is a life-threatening disease. Yet establishing early diagnosis in those patients remains quite a challenge. Methods :A retrospective series of nonneutropenic patients with probable or proven IPA were reviewed from January 2014 to May 2018 in Department of Respiratory Medicine of two Chinese hospitals. Refer to the relevant diagnostic criteria in the 《American Society of Infectious Diseases Guidelines for Invasive Aspergillus 2008》1. Those patients were suspected of IPA and underwent lung computed tomography (CT) scans twice within 5-21 days. The items required for IPA diagnosis were assessed by their host factors, mycological findings and CT scans according to EORTC/ MSG criteria. Results: Together with the risk factors, mycological findings and nonspecific radiological signs on first CT, ten patients were suspected of IPA. With the appearance of cavities on second CT scan in following days, all patients met the criteria of probable or possible IPA. Except one patient who refused antifungal treatment, nine patients received timely antifungal treatment and recovered well. One of the nine treated IPA cases was further confirmed by pathology, one was confirmed by biopys. Conclusions: Dynamic monitor of CT scan provided specific image evidences for IPA diagnosis. This novel finding might provide a noninvasive and efficient strategy in IPA diagnosis with URD.

scholarly journals Dynamic monitor of CT scan within short interval in invasive pulmonary aspergillosis for nonneutropenic patients: a retrospective analysis in two centers

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fei Chen ◽  
Yonghong Zhong ◽  
Na Li ◽  
Huijie Wang ◽  
Yanbin Tan ◽  
...  
Keyword(s):  
Ct Scan ◽  
Respiratory Diseases ◽  
Short Interval ◽  
Invasive Pulmonary Aspergillosis ◽  
Host Factors ◽  
Antifungal Treatment ◽  
Ct Scans ◽  
Pulmonary Aspergillosis ◽  
European Organization ◽  
Life Threatening

Abstract Background In nonneutropenic patients with underlying respiratory diseases (URD), invasive pulmonary aspergillosis (IPA) is a life-threatening disease. Yet establishing early diagnosis in those patients remains quite a challenge. Methods A retrospective series of nonneutropenic patients with probable or proven IPA were reviewed from January 2014 to May 2018 in Department of Respiratory Medicine of two Chinese hospitals. Those patients were suspected of IPA and underwent lung computed tomography (CT) scans twice within 5–21 days. The items required for IPA diagnosis were assessed by their host factors, mycological findings and CT scans according to the European Organization for Research and Treatment of Cancer (EORTC) and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (MSG) criteria (EORTC/MSG criteria). Results Together with the risk factors, mycological findings and nonspecific radiological signs on first CT, ten patients were suspected of IPA. With the appearance of cavities on second CT scan in the following days, all patients met the criteria of probable or possible IPA. Except one patient who refused antifungal treatment, nine patients received timely antifungal treatment and recovered well. One of the nine treated IPA cases was further confirmed by pathology, one was confirmed by biopsy. Conclusions Dynamic monitor of CT scan provided specific image evidences for IPA diagnosis. This novel finding might provide a noninvasive and efficient strategy in IPA diagnosis with URD.

Comparison of Sensitivity of Low-Dose CT Scan and Serum Galactomannan in Patients with Hematologic Malignancies and Positive Bronchoalveolar Lavage for Invasive Pulmonary Aspergillosis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1490-1490 ◽  
Author(s):  
Sita Bhella ◽  
Narinder Paul ◽  
Shahid Husain ◽  
Joseph M. Brandwein
Keyword(s):  
Acute Leukemia ◽  
Ct Scan ◽  
Low Dose ◽  
Invasive Pulmonary Aspergillosis ◽  
Hematologic Malignancies ◽  
Ct Scans ◽  
Pulmonary Aspergillosis ◽  
Low Dose Ct ◽  
Radiologic Findings ◽  
Positive Serum

Abstract Abstract 1490 Background: Invasive pulmonary aspergillosis (IPA) is associated with considerable morbidity and mortality in patients with acute leukemia and those undergoing hematopoietic stem cell transplantation (HSCT). Timely diagnosis of IPA is crucial, but difficult. Strategies for early detection of IPA include serum galactomannan (GM), bronchoalveolar lavage (BAL) GM and characteristic radiologic abnormalities on CT scan; however, the relative sensitivity of these diagnostic tests is unclear. We sought to determine the utility of serum GM and characteristic CT radiologic abnormalities in diagnosing IPA in patients with hematologic malignancies who had a positive BAL for Aspergillus. Methods: We performed a single center retrospective cohort study from 2010 to 2012 to determine the sensitivity serum GM (OD > 0.5) and low dose CT scan in patients with hematologic malignancies. All positive BAL GM samples and Aspergillus isolates from BAL fluid cultures from patients with acute leukemia and those undergoing HSCT were reviewed; all patients had abnormal chest CT scans consistent with pulmonary infection. IPA was classified as proven, probable or possible according to EORTC/MSG criteria. Recent low dose CT scans correlating to the date of the positive BAL GM or Aspergillus isolation were reviewed and graded: halo signs, cavities, crescents and nodules were deemed to be consistent with IPA, while other changes (e.g. ground-glass changes, consolidation) were considered non-specific. Results: A total of 49 BAL samples were included; of these, 31 were considered probable IPA and 18 possible IPA (on the basis of non-specific radiologic findings). Most patients had either no prior or 1–2 days of mold-active antifungal agents. There were 43 cases with positive BAL GM and 11 cases of positive Aspergillus BAL isolates; 5 patients had both. Of the positive BAL GM cases, 27 (63%) were associated with radiologic findings consistent with IPA. The remaining cases were associated with non-specific radiologic findings. Of the patients with Aspergillus isolates on BAL, 55% (6/11) had radiologic features consistent with IPA, while the remaining cases had non-specific radiologic findings. We next evaluated the sensitivity of serum GM. Of 34 patients with BAL GM positivity who had concomitant serum GM testing, 4 (12%) had positive serum GM. Of 8 patients with Aspergillus species isolated on BAL who had serum GM performed, only 1 (12.5%) had positive serum GM. In contrast, 5/8 patients (63%) with Aspergillus isolates on BAL had a positive BAL GM. The combined sensitivity of serum GM was 12% (5/42). Conclusions: Although the majority of patients with positive BAL for Aspergillus (+GM and/or isolates) had characteristic radiologic findings on CT scan, the absence of such findings did not exclude this diagnosis, as over one third had only non-specific radiologic findings. Serum GM had very low sensitivity in this population and should not be used in isolation to diagnose IPA. Disclosures: No relevant conflicts of interest to declare.

scholarly journals 1147. Short Course of Voriconazole Therapy as a Risk Factor for Relapse of Invasive Pulmonary Aspergillosis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S600-S601
Author(s):  
Dong Hoon Shin ◽  
Seung-Jin Yoo ◽  
Jongtak Jung ◽  
Kang Il Jun ◽  
Hyungjin Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Tertiary Care ◽  
Invasive Pulmonary Aspergillosis ◽  
Care Hospital ◽  
Pulmonary Aspergillosis ◽  
Treatment Termination ◽  
Duration Of Therapy ◽  
Short Course ◽  
Life Threatening

Abstract Background Invasive pulmonary aspergillosis (IPA) is a life-threatening opportunistic infection which usually occurs in immunocompromised patients. Recommended duration of voriconazole therapy is a minimum of 6-12 weeks for IPA, despite the lack of any firm evidence. In addition, risk factors for relapse of IPA are still unclear. Here, we explored risk factors for IPA relapse after initial treatment. Methods All patients with proven or probable IPA who had finished voriconazole treatment between 2005 and 2019 in a tertiary-care hospital were reviewed. IPA relapse was defined as re-diagnosis of proven or probable IPA at the same site within 1 year after treatment termination. Short course of voriconazole treatment was defined as a treatment less than 9 weeks, which is a median of the recommended minimum duration of therapy from the Infectious Disease Society of America. The radiological response was defined as a reduction in IPA burden by more than 50% on chest computed tomography (CT). Results Of 87 patients who had completed voriconazole treatment, 14 (16.1%) experienced IPA relapse. Multivariable Cox regression identified that short voriconazole treatment duration (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.1–12.3; P=0.033) and radiological non-response (aHR, 4.6; 95% CI, 1.2–17.5; P=0.026) were independently associated with relapse of IPA after adjusting for several clinical risk factors. Conclusion Less improvement in CT, and short duration of voriconazole therapy were the independent risk factors for relapse after treatment of IPA. Longer duration of therapy should be considered for those at higher risk of relapse. Disclosures All Authors: No reported disclosures

Invasive pulmonale Aspergillose

2019 ◽  
Vol 144 (17) ◽  
pp. 1218-1222
Author(s):  
Hanna Matthews ◽  
Holger Rohde ◽  
Dominic Wichmann ◽  
Stefan Kluge
Keyword(s):  
Influenza Infection ◽  
Invasive Pulmonary Aspergillosis ◽  
Organ Transplant ◽  
Severe Neutropenia ◽  
Solid Organ ◽  
First Line ◽  
Pulmonary Aspergillosis ◽  
Hematopoietic Stem ◽  
Severe Influenza ◽  
Life Threatening

AbstractInvasive pulmonary aspergillosis is a life-threatening disease occurring in patients with severe immunosuppression. It is classically associated with severe neutropenia following hematopoietic stem cell transplantation, but other risk factors include COPD, corticosteroid therapy, solid organ transplant, liver failure and preceding severe influenza infection. Due to the high mortality of the disease, rapid diagnosis and treatment are crucial. Diagnosis is based on CT scan and bronchoscopy including microscopy, culture and galactomannan detection in BAL. Histopathology remains the gold standard diagnosis but is not feasible in many cases. First line treatment is voriconazole, new recommendations also support the triazole isavuconazole.

Mycological Diagnosis of Invasive Pulmonary Aspergillosis Should Depend on Both the Underlying Condition and the Neutropenia Status of Patients with Hematologic Malignancies

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1243-1243
Author(s):  
Anne Bergeron ◽  
Raphaël Porcher ◽  
Annie Sulahian ◽  
Cédrid de Bazelaire ◽  
Karine Chagnon ◽  
...  
Keyword(s):  
Ct Scan ◽  
Invasive Pulmonary Aspergillosis ◽  
Severe Neutropenia ◽  
Diagnostic Strategy ◽  
Cell Transplant ◽  
Pulmonary Aspergillosis ◽  
Exact Test ◽  
Underlying Condition ◽  
Fisher's Exact Test ◽  
Fisher’S Exact Test

Abstract Abstract 1243 Background. Accurate identification of the causative organism in invasive pulmonary aspergillosis (IPA) is important for both epidemiological reasons and optimal management of patients (pts); therefore, it is now recommended. The most efficient strategy to isolate the fungus, however, is not well-established. The reported mycological yield of bronchoscopy, the most commonly used noninvasive approach, does not exceed 40–60%. In the context of IPA, we investigated whether a mycological diagnostic strategy could be optimized based on pt characteristics. Methods. We used a database of 57 pts with IPA enrolled between May 2005 and February 2007 in a prospective multicenter study primarily designed to determine the performance of several microbiological tools in predicting the outcome of IPA. The study protocol was approved by the ethics committee of Saint-Louis Hospital, and all pts provided informed consent. Statistical methods: Predictive factors of positive microbiological results (cytology and/or culture) were analyzed by Fisher's exact test and multiple regression models. Whenever necessary, groups of pts were compared by Fisher's exact test. Analyses were carried out using R version 2.6.2 statistical software (the R Foundation for Statistical Computing, Vienna, Austria). Pt and IPA characteristics according to the underlying condition. Results. The presence of Aspergillus in respiratory samples was significantly more frequent in non-acute leukemia (AL) pts (83%) than in AL pts (25%) (p=0.0003), and in pts with ANC > 100/mm3 (p=0.0002). In a logistic regression model, these 2 factors appeared independent, with an adjusted OR of 7.27 (95% CI 1.42 to 37.3) for non-AL pts and an adjusted OR of 7.20 (95% CI 1.38 to 37.7) for ANC > 100/mm3. A positive mycological yield was detected in 95% of the non-AL pts with ANC > 100/mm3 vs. 23% of the AL pts with ANC < 100/mm3 (p=0.0002). A positive mycological result was also more frequent among pts with lung CT scan signs of invasive airway disease than among other patients (p=0.026). Furthermore, the CT scan findings were strongly associated with the underlying condition and ANC counts of the pt. In particular, invasive airway signs were significantly more frequent among non-AL pts (p=0.049), whereas angioinvasive disease was significantly more frequent among both AL pts (p=0.01) and patients with ANC < 100/mm3 (p=0.0001). Steroid therapy (yes/no and > or < 1 mg/kg) and previous anti-mold therapy had no significant effect on the results. Notably, a concomitant pulmonary infection was identified with bronchoscopy more frequently among non-AL pts (p=0.0009). Conclusions. We strongly recommend bronchoscopy for a specific diagnosis of aspergillosis among non-AL patients, particularly among allogeneic stem cell transplant recipients. Among AL pts with severe neutropenia, another diagnostic strategy should be considered. Disclosures: No relevant conflicts of interest to declare.

Thoax CT Scan as Invasive Fungal Infection (IFI) Screening In Neutropenic Patients, a Prospective-Retrospective Experience of It Impact on Therapeutic Intervention.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4554-4554
Author(s):  
Sebastian Sevilla ◽  
Gustavo Daniel Kusminsky ◽  
Mario Atilio Damiano ◽  
Miguel Rizzo ◽  
Jose Trucco
Keyword(s):  
Ct Scan ◽  
Conflicts Of Interest ◽  
Antimicrobial Treatment ◽  
Antifungal Treatment ◽  
Ct Scans ◽  
Diagnostic Tools ◽  
Persistent Fever ◽  
Pulmonary Infiltrates ◽  
Neutropenic Patients ◽  
Thorax Ct

Abstract Abstract 4554 Introduction: Persistent fever in high risk neutropenic patients (HRNF) after day 5 of empiric treatment is a sign of high susceptibility for IFI with elevated morbidity and mortality. Diagnostic tools in this setting are inaccurate to determine the occurrence of IFI and most patients start with empiric antifungal agents. Drugs are usually associated with increasing costs and toxicity. It is challenging to establish the population of patients in whom in spite of persistent fever and neutropenia, avoidance of antifungal treatment is a reasonable strategy. Methods: We have prospectively allocated 229 HRNF patients in different empiric antimicrobial regimens over a 4.5 year period. In a retrospective revision, there were 33 patients with persistent fever on day 5 of empirical antimicrobial treatment and no evident new infection episode or clinical impairment. In 28 patients, a thorax CT scan was performed as part of the evaluation of persistent fever. The clinical outcome was evaluated regarding the presence or absence of pulmonary infiltrates in the CT scans. Initial empiric antifungal treatment, transfusions, days in hospital, days with neutropenia, antimicrobial treatment, and days with fever were evaluated. Results: Nineteen patients (68%) of 28 presented with pulmonary infiltrates. All of them received antifungal treatment. In 9 patients with normal CT scan antifungal treatment was deferred. The difference of the decision in not giving antifungals according CT scans was highly significant (p <0,0001). Transfusions of red blood cells and platelets were significantly less in the group of normal scans (p 0,0004 and 0,005 respectively). Antimicrobial treatment, days in hospital and days with fever were not significantly different in both groups. There was one death in the normal scan group due to relapse. Mortality was not significantly different in both groups. Conclusion: In HRNP, normal thorax CT scan changed the clinical decision in not starting antifungal treatment in spite of persistent fever. There was no difference in mortality with patients under antifungal treatment, allowing continuing with this strategy in more patients in the future. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Comparison of efficacy of CT scan and ultrasound in patients with blunt abdominal trauma

2017 ◽  
Vol 4 (2) ◽  
pp. 370
Author(s):  
M. L. Ravindernath ◽  
G. Mahender Reddy
Keyword(s):  
Ct Scan ◽  
Abdominal Trauma ◽  
Diagnostic Tool ◽  
Blunt Abdominal Trauma ◽  
Ct Scans ◽  
Patient Needs ◽  
Common Cause ◽  
The Past ◽  
Appropriate Treatment ◽  
Life Threatening

Background: Trauma has become one of the most common cause of hospitalization. The main reason for imaging and screening the patients is to identify the life-threatening injuries as soon as possible so that appropriate treatment can be given immediately.  In the past few years, both USG and CT have been widely used to detect the abdominal trauma and have replaced the older methods. This study was undertaken to compare the efficacy of CT scans and Ultrasound in the patients with blunt abdominal trauma.Methods: Patients who had come to our hospital with blunt abdominal trauma and who were stable enough to undergo both USG and CT scans were included into the study. Apart from routine tests, both USG and CT scans were performed for all the patients.Results: The most common cause of trauma was road or vehicular accidents (58.9%) followed by fall from heights (32.1%). Of the organs which were affected, the most one was liver (73.2%), followed by spleen (51.8%), 46.4% of kidneys and 12.5% of the pancreas. Hemoperitoneum was identified in all the 56 patients with CT scan while the same was identified only in 47 cases (83.9%) with USG.Conclusions: CT scan is a superior diagnostic tool for the detection of Blunt abdominal trauma compared to USG. However, the patient needs to be hemodynamically stable for CT to be performed.

A Case Report of Pediatric Laryngeal Fracture

2020 ◽  
Author(s):  
Mojtaba Ahmadinejad ◽  
Pouria Chaghamirzayi
Keyword(s):  
Case Report ◽  
Ct Scan ◽  
Sports Injuries ◽  
Rapid Diagnosis ◽  
Ct Scans ◽  
Radiology Department ◽  
Cervical Trauma ◽  
Direct Damage ◽  
Damage Imaging ◽  
Life Threatening

Background: Laryngeal fractures are one of the complications of direct damage to the neck, which can lead to airway obstruction and life-threatening conditions. Other causes of laryngeal fractures include injuries during fights, sports injuries, hangings, and iatrogenic causes. In this study, we introduce a child with a laryngeal fracture following an accidental hanging. Case Report: A 9-year-old girl was presented to the emergency department with respiratory distress and inability to speak after being hanged by her scarf. We secured the cervical spine with a hard collar and provided two intravenous (IV) lines. Then, the patient was transferred to the radiology department to perform cervical and thoracic computerized tomography (CT) scans. In the cervical CT scan, the fracture of laryngeal cartilage was detected. We repaired the fracture by prolene sutures. Then the patient was transferred to the intensive care unit (ICU) ward. After 2 days, she was transferred to ward and discharged without any complications. Conclusion: The cervical trauma is a critical condition that must be managed carefully and urgently. For the rapid diagnosis of possible damage, imaging is necessary. Among all modalities, CT scan is the best choice for detection of the vertebral injuries and airway competence in emergent conditions.

Diving Suit: Sterile, Ambulatory, Personnal Device for Protective and Preventive Isolation of Nosocomial Invasive Fungal Infections (IFI) in Neutropenic Patients Hospitalised in Laminar Air Flow Room Who Need a Disruption of Isolation.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5569-5569
Author(s):  
Anne Thiebaut ◽  
Michel Perraud ◽  
Denis Lyonnet ◽  
Samuel Ozil
Keyword(s):  
Ct Scan ◽  
Fungal Infections ◽  
Invasive Pulmonary Aspergillosis ◽  
Hematologic Malignancies ◽  
Severe Neutropenia ◽  
Inform Consent ◽  
Pulmonary Aspergillosis ◽  
Air Contamination ◽  
Neutropenic Patients ◽  
Pulmonary Ct

Abstract BACKGROUND : Patients with long neutropenia present high risk to develop invasive pulmonary aspergillosis (API) of poor prognosis. Pulmonary computed tomographic Scan (CT scan) allows earlier diagnosis of API and improve management in these patients (D. Caillot, JCO, 1997). However, CT scan need an isolation breaking which is potentially dangerous. We propose a diving suit to maintain the preventive isolation. MATERIAL AND METHODS : The diving suit is sterile, personnal, ambulatory and transparent to permit monitoring, visual and conversational contact. It is supplied with air with a self-contained station of ventilation (12 hours). The Air contamination is controlled with 2 HEPA filters. Fithteen patients treated for hematologic malignancies like acute leukaemia have tested it after giving inform consent. RESULTS : The diving suit has been validated for air contamination, physiological (CO2), CT scan feasibility and patients acceptation. All patients (5 male, 10 females) presented a severe neutropenia (PMN < 0.5 G/l during more than 10 days) at time of CT scan. Three patients have had already pulmonary CT scan before using diving suit and 2 claimed to be claustrophobic. No patient describe dyspnea, either pain nor discomfort. All patients feelt reassured and agreed for a new CT scan with this clothing. Two patients have had another CT scan with diving suit for suspicion of pulmonary aspergillosis. Diving suit was very easy to manipulate and did not disrupt monitoring or treatments administration. Diving suit was also compatible with Doppler and Radio Magnetic Nuclear. CONCLUSION : Pulmonary CT scan needs very often to be performed in neutropenic patients to assess API diagnosis. An ambulatory, personnal protective clothing allows no disruption of isolation for immunocompromized patients during a CT scan. It can also be proposed for medical staff protection when treating patients with SARS or other highly contagious agents.

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