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Kohli A, Rifai ZJ, Foray N. Exploring a Rare Pulmonary Coinfection: Cryptococcal Pneumonia and Exophiala dermatitidis in an Immunocompetent Host. Cureus 2024; 16:e61085. [PMID: 38919216 PMCID: PMC11197632 DOI: 10.7759/cureus.61085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 06/27/2024] Open
Abstract
Pulmonary cryptococcosis is becoming increasingly common in immunocompetent hosts, manifesting with variable clinical presentations ranging from asymptomatic colonization to severe pneumonia. Radiological findings are non-specific, such as nodular infiltrates, mass-like lesions, and mediastinal lymphadenopathy. We present a case of a 61-year-old woman with Cryptococcus neoformans pneumonia coinfected with Exophiala dermatitidis, an unusual occurrence in an immunocompetent host and the first of its kind. This coinfection posed significant diagnostic challenges due to the rare occurrence of each individual organism in immunocompetent patients as well as the difficulty of their laboratory diagnosis. Treatment regimens, particularly in coinfections, warrant careful consideration to mitigate mortality risk. This case underscores the importance of comprehensive diagnostic strategies and optimized treatment regimens for rare fungal coinfections in immunocompetent hosts.
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Affiliation(s)
- Akshay Kohli
- Pulmonary and Critical Care Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Zeyad J Rifai
- Internal Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Nathalie Foray
- Pulmonary and Critical Care Medicine, Southern Illinois University School of Medicine, Springfield, USA
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2
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Kianipour S, Dehghan P, Emami Ardestani M. Detection of Opportunistic Fungi from the Bronchoalveolar Lavage Specimens of Patients with Pulmonary Diseases. Adv Biomed Res 2023; 12:176. [PMID: 37694245 PMCID: PMC10492593 DOI: 10.4103/abr.abr_297_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/25/2022] [Accepted: 10/29/2022] [Indexed: 09/12/2023] Open
Abstract
Background Opportunistic fungi are a constantly evolving group of pathogens that become active when the immune system is compromised, begin to multiply, and soon overwhelm the weakened immune system. This study was performed to evaluate the number of opportunistic fungi in bronchoalveolar lavage (BAL) samples of patients with pulmonary diseases. Materials and Methods After receiving patients' consent and demographic forms, a total of 120 BAL samples were taken by a pulmonary physician. The etiologic agents were identified by standard morphological and molecular methods. Yeast cells were counted on culture media, and direct smears were precisely examined for the presence of yeasts elements, Pneumocystis, and filamentous fungi. Results In this study, 29 (24.1%) patients showed positive direct smears for yeast elements in their BAL samples. The mean colony count of yeasts was 42,000 (CFU/mL) on culture media. Six (5%) species of filamentous fungi, including three (2.5%) isolates of Penicillium species (P. variabile, P. glabrum, and P. thomii), two (1.67%) Aspergillus species (A. flavus and A. fumigatus), 1 case (0.83%) Pseudallescheria boydii were detected. Seven cases (5.83%) of Pneumocystis cysts were observed in the direct smears stained with Giemsa. Identification of all fungi confirmed by molecular or sequencing methods. Conclusions Due to the presence of a large number of fungi in the BAL samples and possible physical interference with the selected drugs for treatment, we draw the attention of pulmonologists to this important issue. Rapid diagnosis of fungal infections is essential to optimize treatments and outcomes.
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Affiliation(s)
- Sahar Kianipour
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvin Dehghan
- Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Emami Ardestani
- Department of Internal Medicine, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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La Y, Kwon DE, Jeon S, Lee S, Lee KH, Han SH, Song YG. Clinical Implication of Candida Score in Multidrug-Resistant Pneumonia with Airway Candida Colonization. Infect Chemother 2022; 54:287-297. [PMID: 35706075 PMCID: PMC9259915 DOI: 10.3947/ic.2022.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/29/2022] [Indexed: 12/02/2022] Open
Abstract
Background The growth of Candida in respiratory secretions is usually considered colonization, and antifungal therapy is rarely required. The role of Candida colonization in the progression of bacterial pneumonia remains controversial. The aim of this study was to identify the clinical implication of Candida score by analyzinge the relationship with multidrug-resistant (MDR) pneumonia and prognosis in patients with airway Candida colonization. Materials and Methods This study was a retrospective review of patients with airway Candida colonization by bronchial washing or bronchoalveolar lavage. The Candida score was calculated according to the four factors (severe sepsis, surgery at baseline, total parenteral nutrition, and multifocal Candida colonization). Pneumonia related mortality or hopeless discharge expecting death was defined as a poor outcome. Results A total of 148 patients were enrolled in the study. In a multivariate analysis model, Candida score was identified as an independent predictor of poor outcomes (odds ratio 2.23; 95% confidential interval 1.57 – 3.17; P <0.001) in pneumonia patients with airway Candida colonization. With a Candida score of three or higher compared with low score group, it was associated with bacterial pneumonia, especially methicillin-resistant Staphylococcus aureus (MRSA) infection (0.0% vs. 15.2%, P = 0.004). In addition, patients with a high Candida score had a longer hospital stay (13 vs. 38 days, P <0.001), longer duration of intensive care (7 vs. 18 days, P <0.001), and higher pneumonia-related mortality (0.0% vs. 45.5%, P <0.001) as compared to the low Candida score group. The Candida score showed a positive correlation with other pneumonia severity scales such as CURB-65 (Confusion, Urea, Respiratory rate, Blood pressure, and age ≥65 years) (r = 0.461, P <0.001), Pneumonia Severity Index (r = 0.397, P <0.001), and predisposition, insult, response, and organ dysfunction (PIRO) score (r = 0.425, P <0.001). Conclusion This study revealed that Candida is no longer a bystander of airway colonization, and that it affects the progression of bacterial pneumonia, including multidrug-resistant pathogens, particularly MRSA infection. Also Candida score can be used to predict the prognosis of patients with pneumonia.
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Affiliation(s)
- Yeonju La
- Division of Infectious Diseases, Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Da Eun Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soyoung Jeon
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Sujee Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Hwa Lee
- Division of Infectious Diseases, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Han
- Division of Infectious Diseases, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Goo Song
- Division of Infectious Diseases, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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4
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Scharf S, Bartels A, Kondakci M, Haas R, Pfeffer K, Henrich B. fuPCR as diagnostic method for the detection of rare fungal pathogens, such as Trichosporon, Cryptococcus and Fusarium. Med Mycol 2021; 59:1101-1113. [PMID: 34379780 DOI: 10.1093/mmy/myab045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/21/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Fungal respiratory tract colonisation is a common finding in patients with hematologic neoplasms due to immunosuppression inherent in the diseases and exacerbated by therapy. This greatly increases the risk of fungal infections of the lungs, which is associated with significant mortality. Therefore, reliable diagnostic methods with rapidly available results are needed to administer adequate antifungal therapy.We have established an improved method for fungal DNA extraction and amplification that allows simultaneous detection of fungal families based on a set of multiplexed real time PCR reactions (fuPCR). We analysed respiratory rinses and blood of 94 patients with haematological systemic diseases by fuPCR and compared it with the results of culture and serological diagnostic methods. 40 healthy subjects served as controls.Regarding Candida species, the highest prevalence resulted from microbiological culture of respiratory rinses and from detection of antibodies in blood serum in patients (61% and 47%, respectively) and in the control group (29% and 51%, respectively). Detection of other pathogenic yeasts, such as Cryptococcus and Trichosporon, and moulds, such as Fusarium, was only possible in patients by fuPCR from both respiratory rinses and whole blood and serum. These fungal species were found statistically significantly more frequent in respiratory rinses collected from patients after myeloablative therapy for stem cell transplantation compared to samples collected before treatment (p<<0.05i>).The results show that fuPCR is a valuable complement to culturing and its inclusion in routine mycological diagnostics might be helpful for early detection of pathophysiologically relevant respiratory colonisation for patients with hematologic neoplasms. LAY ABSTRACT We validated a set of PCR reactions (fuPCR) for use in routine diagnostic. In contrast to culture and serological methods, only by fuPCR pathogenic yeasts (Cryptococcus and Trichosporon) and moulds (Aspergillus and Fusarium) were detected in respiratory rinses and blood of haematological patients.
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Affiliation(s)
- Sebastian Scharf
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Anna Bartels
- Department of Haematology, Oncology and Clinical Immunology, Heinrich-Heine University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Mustafa Kondakci
- Department of Haematology, Oncology and Clinical Immunology, Heinrich-Heine University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Rainer Haas
- Department of Haematology, Oncology and Clinical Immunology, Heinrich-Heine University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Klaus Pfeffer
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Birgit Henrich
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
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MacIntyre AT, Hirst A, Duttagupta R, Hollemon D, Hong DK, Blauwkamp TA. Budget Impact of Microbial Cell-Free DNA Testing Using the Karius ® Test as an Alternative to Invasive Procedures in Immunocompromised Patients with Suspected Invasive Fungal Infections. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:231-241. [PMID: 32944831 PMCID: PMC7497859 DOI: 10.1007/s40258-020-00611-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Invasive fungal infection is a major source of morbidity and mortality. The usage of microbial cell-free DNA for the detection and identification of invasive fungal infection has been considered as a potential alternative to invasive procedures allowing for rapid results. OBJECTIVE This analysis aimed to assess the budget implications of using the Karius® Test in patients suspected of invasive fungal infection in an average state in the USA from a healthcare payer perspective. METHODS The analysis used a decision tree to capture key stages of the patient pathway, from suspected invasive fungal infection to either receiving treatment for invasive fungal infection or being confirmed as having no invasive fungal infection. The analysis used published costs and resource use from a targeted review of the literature. Because of the paucity of published evidence on the reduction of diagnostic tests displaced by the Karius Test, the analysis used a 50% reduction in the use of bronchoscopy and/or bronchoalveolar lavage. The impact of this reduction was tested in a scenario analysis. RESULTS The results of the analysis show that the introduction of the Karius Test is associated with a cost saving of US$2277 per patient; when multiplied by the estimated number of cases per year, the cost saving is US$17,039,666. The scenario analysis showed that the Karius Test only had an incremental cost of US$87 per patient when there was no reduction in bronchoscopy and bronchoalveolar lavage. CONCLUSIONS The Karius Test may offer a valuable and timely option for the diagnosis of invasive fungal infection through its non-invasive approach and subsequent cost savings.
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Affiliation(s)
- Ann T MacIntyre
- Karius, Inc., 975 Island Drive, Suite 101, Redwood City, CA, 94065, USA.
| | | | - Radha Duttagupta
- Karius, Inc., 975 Island Drive, Suite 101, Redwood City, CA, 94065, USA
| | - Desiree Hollemon
- Karius, Inc., 975 Island Drive, Suite 101, Redwood City, CA, 94065, USA
| | - David K Hong
- Karius, Inc., 975 Island Drive, Suite 101, Redwood City, CA, 94065, USA
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Zaidi A, Kaur H, Gupta P, Gupta N, Srinivasan R, Dey P, Rohilla M, Rajwanshi A, Bal A, Agarwal R. Role of bronchoalveolar lavage in diagnosing pulmonary infections and malignancies: Experience from a tertiary care center. Diagn Cytopathol 2020; 48:1290-1299. [PMID: 32770787 DOI: 10.1002/dc.24574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/29/2020] [Accepted: 07/20/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bronchoalveolar lavage (BAL), is a safe, minimally invasive procedure to sample the terminal airways and the lung parenchyma. Although frequently used, there is lack of contemporary literature regarding the diagnostic utility of BAL for various pulmonary diseases. This study was conducted to evaluate the utility of BAL in diagnosis of various pulmonary pathologies, both infectious and neoplastic. METHODS This was a retrospective study performed over a period of 2 years. All the BAL samples reported on cytology were studied, their clinical details were retrieved, and the corresponding smears were reviewed. Cyto-histopathologic correlation was done, wherever possible. RESULTS There were a total of 1835 cases (1153 men, 682 women; age, 8 months to 78 years). Of these, 19 (1%) cases were assessed as inadequate for opinion. In 348 (19%) cases, specific infective cause could be identified on BAL cytology alone. Tuberculosis and fungal infections could be diagnosed in 165 (9%) and 178 (9.7%) cases respectively. There were 46 (2.5%) neoplasms, including adenocarcinoma (n = 20), squamous cell carcinoma (n = 5), small cell carcinoma (n = 2), Langerhans cell histiocytosis (n = 1), suspicious for malignancy (n = 15) and metastatic carcinoma (n = 3). Some rare diagnoses were also reported on BAL cytology, including sarcoidosis, actinomycosis, leishmaniasis, pulmonary alveolar proteinosis and metastatic papillary carcinoma of the thyroid. CONCLUSION BAL is a safe and useful procedure for primary diagnosis of infections such as tuberculosis and fungal infections, which has special significance in developing nations where prevalence of such infections is high. In addition, BAL has the potential to diagnose both primary as well as secondary malignant lung lesions.
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Affiliation(s)
- Ariba Zaidi
- Department of Pathology, PGIMER, Chandigarh, India
| | | | - Parikshaa Gupta
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Manish Rohilla
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Amanjit Bal
- Department of Pathology, PGIMER, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, PGIMER, Chandigarh, India
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7
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Utility of bronchoscopy in immunocompromised paediatric patients: Systematic review. Paediatr Respir Rev 2020; 34:24-34. [PMID: 32247829 DOI: 10.1016/j.prrv.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE The objective of this study was to describe the diagnostic yield and safety of bronchoalveolar lavage (BAL) in the evaluation of pulmonary lesions in immunocompromised children. METHODS We conducted a systematic review of literature published during the past 20 years, searching Medline, Medline EPub, EMBASE, and Scopus. Studies included involved paediatric patients (<18 years) on treatment for an oncological diagnosis or other immune compromise who underwent BAL for evaluation of pulmonary lesions. Only English language publications were included. RESULTS In all, 272 studies were screened and 19 included. All were observational studies with moderate (11/19) or serious (8/19) risk of bias. BAL yielded a potential pathogen in 43% of cases (496/1156). Two papers reported improved diagnostic yield with early BAL (less than 3 days of presentation). A change in patient management after BAL was reported in 53% of cases (275/519). Adverse events were reported in 19% of cases following BAL (193/993) but were generally mild with no procedure-related mortality reported. CONCLUSION BAL appears to be useful for evaluation of pulmonary lesions in immunocompromised children with generally acceptable safety, though included studies had at least moderate risk of bias. Future prospective studies may provide more definitive estimates of benefit, timing and risk of BAL in this population.
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8
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Reply: The Reversed Halo Sign and the Bronchus Sign: The Eyes See Only What the Mind Knows. Ann Am Thorac Soc 2019; 16:1204. [PMID: 31260635 PMCID: PMC6812165 DOI: 10.1513/annalsats.201906-455le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Rossoff J, Locke M, Helenowski IB, Batra S, Katz BZ, Hijiya N. Cost analysis of bronchoalveolar lavage and respiratory tract biopsies in the diagnosis and management of suspected invasive fungal infection in children with cancer or who have undergone stem cell transplant. Pediatr Blood Cancer 2019; 66:e27598. [PMID: 30609253 DOI: 10.1002/pbc.27598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/26/2018] [Accepted: 12/14/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Identification of an organism is the gold standard for the diagnosis of fungal infection; however, we have previously shown that invasive procedures infrequently lead to a change in management in children with cancer or who have undergone stem cell transplant with suspected respiratory tract invasive fungal infection (RT-IFI). There is also a paucity of data on the cost of RT-IFI in this population. We therefore compared the costs of RT-IFI diagnosed based on CT scan alone versus those who underwent a bronchoalveolar lavage (BAL) or respiratory tract biopsy (RTB). PROCEDURE We collected cost data on patients at a single center undergoing chemotherapy or who were post-hematopoietic stem cell transplant (HSCT) and were suspected of having RT-IFI between 2007 and 2012. Cost data were included for 14 days from the day of their diagnostic CT scan or procedure. RESULTS Cost data were available for 76 patients. Thirty-six patients were diagnosed with suspected RT-IFI based on CT only, and 40 patients underwent BAL or RTB. Costs related to chest X-rays (CXRs), inpatient/intensive care unit (ICU) beds, anesthesia, operating room (OR) time, and procedures were significantly higher in the BAL/RTB group versus CT scan group (all P < 0.01). Costs related to CT scans were significantly higher in the CT scan group (P = 0.0002). Overall costs were significantly higher for patients who underwent BAL or RTB versus CT scan only (P < 0.0001). CONCLUSION Our previous data showed that BAL and RTB infrequently led to a change in management in this population. We now demonstrate that this strategy is costly as well.
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Affiliation(s)
- Jenna Rossoff
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Margaret Locke
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Irene B Helenowski
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Surabhi Batra
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ben Z Katz
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Infectious Disease, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nobuko Hijiya
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Baldassarri RJ, Kumar D, Baldassarri S, Cai G. Diagnosis of Infectious Diseases in the Lower Respiratory Tract: A Cytopathologist's Perspective. Arch Pathol Lab Med 2018; 143:683-694. [PMID: 30203986 DOI: 10.5858/arpa.2017-0573-ra] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Respiratory cytology continues to play an important role in the diagnosis of lower respiratory tract infections. Prompt, accurate diagnosis of causative organisms is of paramount importance, particularly in immunosuppressed patients. In addition, a rapidly expanding arsenal of ancillary testing is now available, aiding tremendously in organism identification. OBJECTIVE.— To provide an updated review on the cytomorphologic features of common organisms in lower respiratory tract infection. Relevant ancillary tests, differential diagnoses, and potential pitfalls of organism identification will also be discussed. DATA SOURCES.— Data for this review were gathered from PubMed searches of infectious diseases of the lower respiratory tract, especially related to the diagnoses. CONCLUSIONS.— The lower respiratory tract is subject to infection by a wide variety of infectious agents. Pathologists should be familiar with common organisms, including their general clinical characteristics, cytomorphologic features, differential diagnoses, and ancillary methods of detection. Above all, correlation with microbiologic and clinical information is necessary to make a confident diagnosis of infection.
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Affiliation(s)
- Rebecca J Baldassarri
- From the Departments of Pathology (Drs R. J. Baldassarri, Kumar, and Cai) and Internal Medicine (Dr S. Baldassarri), Yale School of Medicine, New Haven, Connecticut
| | - Deepika Kumar
- From the Departments of Pathology (Drs R. J. Baldassarri, Kumar, and Cai) and Internal Medicine (Dr S. Baldassarri), Yale School of Medicine, New Haven, Connecticut
| | - Stephen Baldassarri
- From the Departments of Pathology (Drs R. J. Baldassarri, Kumar, and Cai) and Internal Medicine (Dr S. Baldassarri), Yale School of Medicine, New Haven, Connecticut
| | - Guoping Cai
- From the Departments of Pathology (Drs R. J. Baldassarri, Kumar, and Cai) and Internal Medicine (Dr S. Baldassarri), Yale School of Medicine, New Haven, Connecticut
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11
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Arshad H, Garcia S, Khaja M. Case report of invasive, disseminated candidiasis with peripheral nodular cavitary lesions in the lung. Respir Med Case Rep 2016; 20:34-37. [PMID: 27909682 PMCID: PMC5124354 DOI: 10.1016/j.rmcr.2016.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 11/24/2022] Open
Abstract
We report a case of invasive candidiasis presenting as multiple lung nodules and cavitary lesions with minimal pleural effusion. Candida infections of the lung are rare but can occur after hematologic dissemination of the yeast from other body sites, such as the skin and the gastrointestinal and genitourinary tracts. Here, we describe the case of a 56-year-old female with a history of end-stage renal disease (ESRD) who presented with fever, productive cough, and pulmonary nodules and cavitary lesions seen on a chest computed tomography (CT). The patient's blood cultures were positive for Candida zeylanoides.
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Affiliation(s)
- Hafiza Arshad
- Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, 1650 Grand Concourse, Bronx, NY 10457, United States
| | - Silvia Garcia
- Department of Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, 1650 Grand Concourse, Bronx, NY 10457, United States
| | - Misbahuddin Khaja
- Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, 1650 Grand Concourse, Bronx, NY 10457, United States
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12
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Hakamifard A, Khorvash F, Raisi A. Isolated pulmonary candidiasis in a patient with diabetes mellitus: A rare case report. Adv Biomed Res 2016; 5:146. [PMID: 27656615 PMCID: PMC5025916 DOI: 10.4103/2277-9175.187377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/26/2015] [Indexed: 11/04/2022] Open
Abstract
Fungal infections are as a cause of morbidity and mortality in immunocompromise patients. Because the respiratory tract is colonized with Candida, the presence of this agent in respiratory specimens makes the diagnosis of Candida pneumonia problematic. Candida pneumonia is a rare infection, and the majority of cases are secondary to hematogenous dissemination. Furthermore isolated Candida pneumonia originating from endotracheal inoculation is an extremely rare entity. We describe a case of isolated pulmonary candidiasis in the form multiple nodular lesions in a patient with long-term history of diabetes mellitus without evidence of fungemia or systemic involvement who responded to antifungal therapy.
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Affiliation(s)
- Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzin Khorvash
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Raisi
- Department of Hematology, Isfahan University of Medical Sciences, Isfahan, Iran
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13
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Batra S, Li B, Underhill N, Maloney R, Katz BZ, Hijiya N. Clinical utility of bronchoalveolar lavage and respiratory tract biopsies in diagnosis and management of suspected invasive respiratory fungal infections in children. Pediatr Blood Cancer 2015; 62:1579-86. [PMID: 25940202 DOI: 10.1002/pbc.25570] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/09/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Bronchoscopy with bronchoalveolar lavage (BAL) and respiratory tract biopsies are important tools for diagnosing fungal infections in children with cancer and hematopoietic stem cell transplant (HSCT) recipients. Our objective was to evaluate the impact of BAL and respiratory tract biopsies on the management of suspected fungal infections in oncology and HSCT patients. PROCEDURE We retrospectively reviewed the medical records of oncology and HSCT patients with possible, probable, or proven fungal infection of the respiratory tract and determined whether BAL or biopsy following computed tomography (CT) prompted a change in management. RESULTS Among 101 patients (0.5-29 years of age), 24 underwent a BAL and 31 had biopsies (27 lung and 4 sinus). The remaining 46 patients had CT scans only. Of these, there were radiographic findings suggestive of a fungal infection in 38 patients (83%). Thirty of these 38 patients (79%) had a change in management. BAL provided a diagnosis in 6 of 24 patients (25%). There was a change in management in 2 of the 6 (33%). Respiratory tract biopsy provided a diagnosis in 12 of 31 patients (39%). Biopsy results led to a change in management in 4 of the 12 patients (33%). Significant postoperative morbidity attributed to biopsy occurred in 3 of 31 patients (10%); 2 patients had pneumothorax requiring chest tube and intubation and a patient had prolonged intubation. CONCLUSION BAL and biopsy in children with an oncological diagnosis or those undergoing HSCT only infrequently lead to changes in management in the era of empiric therapy with broad-spectrum anti-fungal agents.
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Affiliation(s)
- Surabhi Batra
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Betty Li
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nicole Underhill
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Rebekah Maloney
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ben Z Katz
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Division of Infectious Disease, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nobuko Hijiya
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
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14
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Mohammadi S, Khalilzadeh S, Goudarzipour K, Hassanzad M, Mahdaviani A, Aarabi N, Pourabdollah M, Sigari N. Bronchoalveolar galactomannan in invasive pulmonary aspergillosis: a prospective study in pediatric patients. Med Mycol 2015; 53:709-16. [DOI: 10.1093/mmy/myv053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/03/2015] [Indexed: 11/12/2022] Open
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15
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Abstract
Candida pneumonia is a rare infection of the lungs, with the majority of cases occurring secondary to hematological dissemination of Candida organisms from a distant site, usually the gastrointestinal tract or skin. We report a case of a 77-year-old male who is life-long smoker with a history of rheumatoid arthritis and polymyalgia rheumatica, but did not take immunosuppressants for those conditions. Here, we present an extremely rare case of isolated pulmonary parenchymal Candida infection in the form pulmonary nodules without evidence of systemic disease which has only been described in a few previous reports.
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Affiliation(s)
- Yousef Shweihat
- Marshall University, Joan. C. Edwards School of Medicine, USA
| | - James Perry
- Marshall University, Joan. C. Edwards School of Medicine, USA
| | - Darshana Shah
- Marshall University, Joan. C. Edwards School of Medicine, USA
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16
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Strenge KS, Kunkel JE, George AA, Mailhiot T, Butler SL. Utility of Reflexive Gomori Methenamine Silver and Acid-Fast Bacillus Staining on Bronchoalveolar Lavage Specimens. Lab Med 2015; 46:4-7. [DOI: 10.1309/lmljhg4e2uzkd7rg] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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17
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Pfeifer K, Kalra V, Adebowale A, Juthani-Mehta M, Soo-Shin M. Apical Pneumocystis jiroveci as an AIDS defining illness: A case report illustrating a change in the paradigm. J Radiol Case Rep 2014; 8:15-24. [PMID: 25926907 DOI: 10.3941/jrcr.v8i11.1772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pneumocystis jiroveci pneumonia is a common acquired immune deficiency syndrome defining illness. Pneumocystis jiroveci pneumonia is classically described as having symmetrical bilateral perihilar ground-glass opacities on chest radiographs. We present an "atypical" case of Pneumocystis jiroveci pneumonia presenting as symmetric biapical cystic spaces with relative sparing of the remainder of the lungs in a 22 year-old male, previously undiagnosed with acquired immune deficiency syndrome. Our case illustrates that formerly unusual presentations of Pneumocystis jiroveci pneumonia are becoming more common as acquired immune deficiency syndrome defining illnesses as more patients are being imaged with further imaging such as high resolution computed tomography.
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Affiliation(s)
- Kyle Pfeifer
- Department of Radiology, Yale New Haven hospital, New Haven, CT, USA
| | - Vivek Kalra
- Department of Radiology, Yale New Haven hospital, New Haven, CT, USA
| | | | | | - Myung Soo-Shin
- Department of Radiology, Yale New Haven hospital, New Haven, CT, USA
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18
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Crumley S, Hull A, Cernoch P, Mody D, Sneige N. Comparison between cytologic examination of fungi in bronchial washings and bronchoalveolar lavage specimens and culture: a review of 100 cases with emphasis on diagnostic pitfalls. J Am Soc Cytopathol 2014; 3:211-217. [PMID: 31051688 DOI: 10.1016/j.jasc.2014.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/04/2014] [Accepted: 03/04/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Microbiology culture is the "gold standard" for diagnosis of fungal infections; however, culture has a lengthy turnaround time. A more timely assessment is possible with cytology and Gomori-methamine silver (GMS) staining. MATERIALS AND METHODS A total of 100 respiratory tract specimens with a positive fungal Gomori-methamine silver stain and corresponding culture were selected. The cytology slides were reviewed for factors contributing to discrepant results. Specimens were classified as 2 types of variances: interpretative and sampling. Concordant diagnoses were also evaluated. RESULTS Eighty-two cases had fungal organisms that grew in culture. The remaining 18 cases were composed solely of fungal organisms that did not grow in culture (17 cases with Pneumocystis jirovecii; 1 case with Pityrosporum ovale). These 18 cases were excluded from the variance analysis. Thirty-three of 82 cases (40%) had concordant cytology and microbiology results, whereas 49 cases were discrepant. Variances were both sampling (41 cases) and interpretive (8 cases). Interpretive variances were predominantly Aspergillus species misinterpreted as Candida. Difficulty identifying true septate hyphae was the major contributing factor for misinterpretation. CONCLUSIONS Cytologic evaluation of respiratory specimens remains a useful preemptive diagnostic tool in the rapid diagnosis of fungal infection. Cytology samples significantly contribute to the diagnosis of respiratory fungi. However, interpretive variances between Aspergillus and Candida organisms are common. Awareness of the characteristic features that distinguish fungal organisms can further improve the diagnostic utility of cytology.
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Affiliation(s)
- Suzanne Crumley
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas
| | - April Hull
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas
| | - Pat Cernoch
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas
| | - Dina Mody
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas
| | - Nour Sneige
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, 6565 Fannin Street, Houston, Texas.
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19
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Saha K, Sit NK, Maji A, Jash D. Recovery of fluconazole sensitive Candida ciferrii in a diabetic chronic obstructive pulmonary disease patient presenting with pneumonia. Lung India 2013; 30:338-40. [PMID: 24339494 PMCID: PMC3841693 DOI: 10.4103/0970-2113.120614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) exacerbations admitted in intensive care units (ICUs) occur rarely due to fungal respiratory tract infections, but may occur when associated co-morbidities like diabetes mellitus coexist. Candida ciferrii is a new agent, recently was isolated from lung infections but usually resistant to fluconazole. Here, we report a rare case of pneumonia due to fluconazole sensitive Candida ciferrii in a COPD patient with known diabetes, admitted in our ICU.
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Affiliation(s)
- Kaushik Saha
- Department of Pulmonary Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
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20
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Singh L, Jain D, Madan K, Mathur SR, Chatterjee P, Guleria R, Iyer VK. Pulmonary mycoses diagnosed using exfoliative cytology: infection or colonization? Acta Cytol 2013; 57:604-10. [PMID: 24107316 DOI: 10.1159/000354940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/23/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Flexible bronchoscopy with exfoliative cytology is an important tool for the diagnosis of pulmonary fungal infections. The question of colonization versus true fungal infection is of critical importance. STUDY DESIGN A 5-year retrospective analysis of all cases of pulmonary fungal infection diagnosed using exfoliative cytology was performed. Clinical, radiological, bronchoscopy and histopathology findings were recorded. RESULTS A total of 69 cases of mycoses were retrieved. The most common fungal organism identified was Aspergillus followed by Candida and Pneumocystis. Most cases of Aspergillus and Candida in cytological specimens presented as a pulmonary mass or endobronchial growth and were diagnosed as carcinomas in biopsy specimens, thus representing colonization. All cases of Pneumocystis with bilateral ground glass infiltrates and cryptococcosis with parenchymal mass lesion in radiology represented true infection. Histoplasma was identified in pleural fluid from a known case of lung carcinoma. CONCLUSION Aspergillus and Candida species are the most common fungal organisms. Most of these represent colonization of malignant growths. However, true fungal infections may also present as mass lesions and may masquerade malignancy clinically. Fluid cytological examination is an important diagnostic modality for pulmonary mycoses; however, it is important to correlate results with clinical, bronchoscopy and biopsy findings for accurate diagnosis and appropriate management.
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Affiliation(s)
- Lavleen Singh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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21
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Abstract
Fiberoptic bronchoscopy is a valuable diagnostic tool in solid-organ and hematopoietic stem cell transplant recipients presenting with a range of pulmonary complications. This article provides a comprehensive overview of the utility and potential adverse effects of diagnostic bronchoscopy for transplant recipients. Recommendations are offered on the selection of patients, the timing of bronchoscopy, and the samples to be obtained across the spectrum of suspected pulmonary complications of transplantation. Based on review of the literature, the authors recommend early diagnostic bronchoscopy over empiric treatment in transplant recipients with evidence of certain acute, subacute, or chronic pulmonary processes. This approach may be most critical when an underlying infectious etiology is suspected. In the absence of prompt diagnostic information on which to base effective treatment, the risks associated with empiric antimicrobial therapy, including medication side effects and the development of antibiotic resistance, compound the potential harm of delaying targeted management.
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22
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Zarrinfar H, Mirhendi H, Makimura K, Satoh K, Khodadadi H, Paknejad O. Use of Mycological, nested PCR, and Real-time PCR Methods on BAL Fluids for Detection of Aspergillus fumigatus and A. flavus in Solid Organ Transplant Recipients. Mycopathologia 2013; 176:377-85. [DOI: 10.1007/s11046-013-9657-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 01/24/2013] [Indexed: 01/16/2023]
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23
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Izumikawa K, Yamamoto Y, Mihara T, Takazono T, Morinaga Y, Kurihara S, Nakamura S, Imamura Y, Miyazaki T, Nishino T, Tsukamoto M, Kakeya H, Yanagihara K, Mine M, Yasuoka A, Tashiro T, Kohno S. Bronchoalveolar lavage galactomannan for the diagnosis of chronic pulmonary aspergillosis. Med Mycol 2012; 50:811-7. [DOI: 10.3109/13693786.2012.682228] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Diagnosis of invasive aspergillosis by a commercial real-time PCR assay for Aspergillus DNA in bronchoalveolar lavage fluid samples from high-risk patients compared to a galactomannan enzyme immunoassay. J Clin Microbiol 2011; 49:4273-8. [PMID: 22012015 DOI: 10.1128/jcm.05026-11] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Culture-independent molecular techniques such as real-time PCRs offer the potential for early diagnosis of invasive aspergillosis (IA), thereby reducing the disease-associated mortality rate. PCR-based testing is presently excluded from disease-defining consensus criteria due to lack of standardization and clinical validation. A single-center prospective study was conducted to investigate the performance of the commercially available MycAssay Aspergillus test for detecting Aspergillus DNA in patients with suspicion of IA. To this end, a total of 158 bronchoalveolar lavage (BAL) fluid specimens that were consecutively collected from hematology (n = 68) and intensive care unit (n = 90) patients were examined. Sixteen of 17 (94.1%) specimens from patients with proven/probable IA were MycAssay positive, and 15 of these 16 patients were also positive by an "in-house" PCR assay. A total of 139 of 141 (98.6%) specimens from patients without proven/probable IA were MycAssay negative. Fifteen of 16 (94.1%) MycAssay-positive patients were also positive for BAL fluid galactomannan (GM) at an index cutoff of ≥1.0 (index range, 1.1 to 8.3), as were 3 patients without IA but with pulmonary fusariosis. Interestingly, in seven of the PCR-positive BAL specimens that tested culture positive for Aspergillus species, cycle threshold values were earlier than those of specimens with a culture-negative result. In conclusion, the MycAssay Aspergillus PCR appears to be a sensitive and specific molecular test for the diagnosis of IA, and its performance is comparable to that of the GM assay. However, more large studies are necessary to firmly establish its clinical utility in high-risk settings.
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25
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Abstract
Fungal infections are becoming more frequent because of expansion of at-risk populations and the use of treatment modalities that permit longer survival of these patients. Because histopathologic examination of tissues detects fungal invasion of tissues and vessels as well as the host reaction to the fungus, it is and will remain an important tool to define the diagnostic significance of positive culture isolates or results from PCR testing. However, there are very few instances where the morphological characteristics of fungi are specific. Therefore, histopathologic diagnosis should be primarily descriptive of the fungus and should include the presence or absence of tissue invasion and the host reaction to the infection. The pathology report should also include a comment stating the most frequent fungi associated with that morphology as well as other possible fungi and parasites that should be considered in the differential diagnosis. Alternate techniques have been used to determine the specific agent present in the histopathologic specimen, including immunohistochemistry, in situ hybridization, and PCR. In addition, techniques such as laser microdissection will be useful to detect the now more frequently recognized dual fungal infections and the local environment in which this phenomenon occurs.
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26
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Lee JH, Lee JY, Shin MR, Ahn HK, Kim CW, Kim I. Immunohistochemical Identification of Pneumocystis jiroveciiin Liquid-based Cytology of Bronchoalveolar Lavage - Nine Cases Report -. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.1.115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jeong Hyeon Lee
- Department of Pathology, Korea University Medical College, Seoul, Korea
| | - Ji Young Lee
- Department of Pathology, Korea University Medical College, Seoul, Korea
| | - Mi Ran Shin
- Department of Pathology, Korea University Medical College, Seoul, Korea
| | - Hyeong Kee Ahn
- Department of Pathology, Korea University Medical College, Seoul, Korea
| | - Chul Whan Kim
- Department of Pathology, Korea University Medical College, Seoul, Korea
| | - Insun Kim
- Department of Pathology, Korea University Medical College, Seoul, Korea
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27
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Nguyen MH, Leather H, Clancy CJ, Cline C, Jantz MA, Kulkarni V, Wheat LJ, Wingard JR. Galactomannan testing in bronchoalveolar lavage fluid facilitates the diagnosis of invasive pulmonary aspergillosis in patients with hematologic malignancies and stem cell transplant recipients. Biol Blood Marrow Transplant 2010; 17:1043-50. [PMID: 21087680 DOI: 10.1016/j.bbmt.2010.11.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Accepted: 11/09/2010] [Indexed: 10/18/2022]
Abstract
Invasive pulmonary aspergillosis (IPA) is a major cause of mortality in patients with stem cell transplants and hematologic malignancies. Timely diagnosis of IPA improves survival but is difficult to make. We evaluated the effectiveness of bronchoalveolar lavage (BAL) galactomannan (GM) in diagnosing IPA in these populations by retrospectively reviewing records of 67 consecutive patients, in whom 89 BAL GM tests were performed. For patients with IPA, only the first BAL sample linked to the IPA episode was analyzed. Eighty samples were associated with proven, 12 with probable, and 32 with possible invasive fungal infections (IFI), and 37 were associated with no IFI. Among patients with IFIs, 4 had proven, 11 probable, and 32 possible IPA. Using BAL GM ≥ 0.5 (cutoff for serum GM) and ≥ 0.85 (optimal cutoff identified by receiver-operating characteristic curve), the sensitivity in diagnosing proven or probable IPA was 73% (11/15) and 67% (10/15), respectively, and specificity was 89% (33/37) and 95% (35/37). At these cutoffs, positive and negative predictive values were 73% (11/15) and 83% (10/12), and 89% (33/37) and 87% (35/40), respectively. BAL GM was more sensitive than cytology (0%, 0/14), BAL culture (27%, 4/15), transbronchial biopsy (40%, 2/5), or serum GM (67%, 10/15) for diagnosing IPA. BAL GM was ≥ 0.85 and ≥ 0.5 in 86% (6/7) and 100% (7/7) of patients with proven or probable IPA who received a mold-active agent for ≤ 3 days. BAL GM added sensitivity to serum GM and other means of diagnosing IPA, and was not impacted by short courses of mold-active agents.
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Affiliation(s)
- M Hong Nguyen
- University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
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28
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Martínez-Girón R. Images in cytology. Sporangia, sporangium-like spherules and mimicking structures in respiratory cytopathology. Diagn Cytopathol 2009; 38:897-9. [PMID: 20014313 DOI: 10.1002/dc.21284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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