Invasive pulmonary aspergillosis in oncological setting with use of newer vascular endothelial growth factor receptor inhibitor
Invasive pulmonary aspergillosis and pazopanib, any association
Keywords:
Autologous stem cell transplant, high-resolution computed tomography, human immunodeficiency virus, invasive pulmonary aspergillosis, vascular endothelial growth factor receptorAbstract
Background: Invasive pulmonary aspergillosis is a major cause of morbidity and mortality in neutropenic patients. Microbiological and serological tests are of limited value. The diagnosis should be considered in neutropenic patients with fever not responding to antibiotics, and typical findings on thoracic computed tomography scan. Whenever possible, diagnosis should be confirmed by tissue examination. Newer serological techniques like ß-D-Glucan Assay and Galactomannan assay are used in diagnosis and monitoring therapy in such patients. Aim: To early diagnose Invasive pulmonary aspergillosis and to decrease mortality. Methods: A total of 150 patients of hemato-oncological malignancies were prospectively enrolled intostudy. Results: Only 10 (6.6 %) patients developed invasive pulmonary aspergillosis and mortality was 30%.Patients were treated medically with never azoles and echinocandin antifungals, with long term survival in seven patients and early mortality in rest of patients. Conclusion: IPA is a difficult infection to treat in immucompromised state. It needs very high degree of suspicion to diagnose. Sick patients should be treated with combination antifungal of different mechanisms at outset and therapy should be continued for six months.
References
Kwon-Chung KJ, Sugui JA. Aspergillus fumigatus - What makes the species a ubiquitous human fungal pathogen? PLoS Pathog 2013;9:e1003743.
Soubani AO, Chandrasekar PH. The clinical spectrum of pulmonary aspergillosis. Chest 2002;121:1988-99.
Balajee SA, Houbraken J, Verweij PE, Hong SB, Yaghuchi T, Varga J, et al. Aspergillus species identification in the clinical setting. Stud Mycol 2007;59:39-46.
Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: A clinical review. Eur Respir Rev 2011;20:156-74.
De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:1813-21.
Segal BH. Aspergillosis. N Engl J Med 2009;360:1870-84.
Reinwald M, Hummel M, Kovalevskaya E, Spiess B, Heinz WJ, Vehreschild JJ, et al. Therapy with antifungals decreases the diagnostic performance of PCR for diagnosing invasive aspergillosis in bronchoalveolar lavage samples of patients with haematological malignancies. J Antimicrob Chemother 2012;67:2260-7.
Leeflang MM, Debets-Ossenkopp YJ, Visser CE, Scholten RJ, Hooft L, Bijlmer HA, et al. Galactomannan detection for invasive aspergillosis in immunocompromized patients. Cochrane Database Syst Rev 2008;(4):CD007394.
Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, et al. Treatment of aspergillosis: Clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2008;46:327-60.
Limper AH, Knox KS, Sarosi GA, Ampel NM, Bennett JE, Catanzaro A, et al. An official American Thoracic Society statement: Treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med 2011;183:96-128.
Steinbach WJ, Marr KA, Anaissie EJ, Azie N, Quan SP, Meier-Kriesche HU, et al. Clinical epidemiology of 960 patients with invasive aspergillosis from the PATH Alliance registry. J Infect 2012;65:453-64.
Baddley JW, Stephens JM, Ji X, Gao X, Schlamm HT, Tarallo M. Aspergillosis in Intensive Care Unit (ICU) patients: Epidemiology and economic outcomes. BMC Infect Dis 2013;13:29.
Rankin NE. Disseminated aspergillosis and moniliasis associated with agranulocytosis and antibiotic therapy. Br Med J 1953;1:918-9.
McNeil MM, Nash SL, Hajjeh RA, Phelan MA, Conn LA, Plikaytis BD, et al. Trends in mortality due to invasive mycotic diseases in the United States, 1980-1997. Clin Infect Dis 2001;33:641-7.
Chamilos G, Luna M, Lewis RE, Bodey GP, Chemaly R, Tarrand JJ, et al. Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: An autopsy study over a 15-year period (1989-2003). Haematologica 2006;91:986-9.
Groll AH, Shah PM, Mentzel C, Schneider M, Just-Nuebling G, Huebner K. Trends in the postmortem epidemiology of invasive fungal infections at a university hospital. J Infect 1996;33:23-32.
Yeghen T, Kibbler CC, Prentice HG, Berger LA, Wallesby RK, McWhinney PH, et al. Management of invasive pulmonary aspergillosis in hematology patients: A review of 87 consecutive cases at a single institution. Clin Infect Dis 2000;31:859-68.
Fukuda T, Boeckh M, Carter RA, Sandmaier BM, Maris MB, Maloney DG, et al. Risks and outcomes of invasive fungal infections in recipients of allogeneic hematopoietic stem cell transplants after nonmyeloablative conditioning. Blood 2003;102:827-33.
Denning DW, Follansbee SE, Scolaro M, Norris S, Edelstein H, Stevens DA. Pulmonary aspergillosis in the acquired immunodeficiency syndrome. N Engl J Med 1991;324:654-62.
Gerson SL, Talbot GH, Hurwitz S, Strom BL, Lusk EJ, Cassileth PA. Prolonged granulocytopenia: The major risk factor for invasive pulmonary aspergillosis in patients with acute leukemia. Ann Intern Med 1984;100:345-51.
Segal BH, Walsh TJ. Current approaches to diagnosis and treatment of invasive aspergillosis. Am J Respir Crit Care Med 2006;173:707-17.
Kotloff RM, Ahya VN, Crawford SW. Pulmonary complications of solid organ and hematopoietic stem cell transplantation. Am J Respir Crit Care Med 2004;170:22-48.
Soubani AO, Miller KB, Hassoun PM. Pulmonary complications of bone marrow transplantation. Chest 1996;109:1066-77.
Morgan J, Wannemuehler KA, Marr KA, Hadley S, Kontoyiannis DP, Walsh TJ, et al. Incidence of invasive aspergillosis following hematopoietic stem cell and solid organ transplantation: Interim results of a prospective multicenter surveillance program. Med Mycol 2005;43 Suppl 1:S49-58.
Wald A, Leisenring W, van Burik JA, Bowden RA. Epidemiology of Aspergillus infections in a large cohort of patients undergoing bone marrow transplantation. J Infect Dis 1997;175:1459-66.
Marr KA, Carter RA, Crippa F, Wald A, Corey L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis 2002;34:909-17.
Albelda SM, Talbot GH, Gerson SL, Miller WT, Cassileth PA. Pulmonary cavitation and massive hemoptysis in invasive pulmonary aspergillosis. Influence of bone marrow recovery in patients with acute leukemia. Am Rev Respir Dis 1985;131:115-20.
Ruhnke M, Böhme A, Buchheidt D, Donhuijsen K, Einsele H, Enzensberger R, et al. Diagnosis of invasive fungal infections in hematology and oncology - Guidelines of the infectious diseases working party (AGIHO) of the German society of hematology and oncology (DGHO). Ann Hematol 2003;82 Suppl 2:S141-8.
Horvath JA, Dummer S. The use of respiratory-tract cultures in the diagnosis of invasive pulmonary aspergillosis. Am J Med 1996;100:171-8.
Soubani AO, Qureshi MA. Invasive pulmonary aspergillosis following bone marrow transplantation: Risk factors and diagnostic aspect. Haematologia (Budap) 2002;32:427-37.
Yu VL, Muder RR, Poorsattar A. Significance of isolation of Aspergillus from the respiratory tract in diagnosis of invasive pulmonary aspergillosis. Results from a three-year prospective study. Am J Med 1986;81:249-54.
Tang CM, Cohen J. Diagnosing fungal infections in immunocompromised hosts. J Clin Pathol 1992;45:1-5.
Duthie R, Denning DW. Aspergillus fungemia: Report of two cases and review. Clin Infect Dis 1995;20:598-605.
Libshitz HI, Pagani JJ. Aspergillosis and mucormycosis: Two types of opportunistic fungal pneumonia. Radiology 1981;140:301-6.
Kuhlman JE, Fishman EK, Siegelman SS. Invasive pulmonary aspergillosis in acute leukemia: Characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis. Radiology 1985;157:611-4.
Caillot D, Casasnovas O, Bernard A, Couaillier JF, Durand C, Cuisenier B, et al. Improved management of invasive pulmonary aspergillosis in neutropenic patients using early thoracic computed tomographic scan and surgery. J Clin Oncol 1997;15:139-47.
Caillot D, Mannone L, Cuisenier B, Couaillier JF. Role of early diagnosis and aggressive surgery in the management of invasive pulmonary aspergillosis in neutropenic patients. Clin Microbiol Infect 2001;7 Suppl 2:54-61.
Curtis AM, Smith GJ, Ravin CE. Air crescent sign of invasive aspergillosis. Radiology 1979;133:17-21.
Albelda SM, Talbot GH, Gerson SL, Miller WT, Cassileth PA. Role of fiberoptic bronchoscopy in the diagnosis of invasive pulmonary aspergillosis in patients with acute leukemia. Am J Med 1984;76:1027-34.
Kahn FW, Jones JM, England DM. The role of bronchoalveolar lavage in the diagnosis of invasive pulmonary aspergillosis. Am J Clin Pathol 1986;86:518-23.
Levy H, Horak DA, Tegtmeier BR, Yokota SB, Forman SJ. The value of bronchoalveolar lavage and bronchial washings in the diagnosis of invasive pulmonary aspergillosis. Respir Med 1992;86:243-8.
Reichenberger F, Habicht J, Matt P, Frei R, Solèr M, Bolliger CT, et al. Diagnostic yield of bronchoscopy in histologically proven invasive pulmonary aspergillosis. Bone Marrow Transplant 1999;24:1195-9.
Maschmeyer G, Beinert T, Buchheidt D, Einsele H, Heussel CP, Kiehl M, et al. Diagnosis and antimicrobial therapy of pulmonary infiltrates in febrile neutropenic patients - guidelines of the infectious diseases working party (AGIHO) of the German society of hematology and oncology (DGHO). Ann Hematol 2003;82 Suppl 2:S118-26.
Boutboul F, Alberti C, Leblanc T, Sulahian A, Gluckman E, Derouin F, et al. Invasive aspergillosis in allogeneic stem cell transplant recipients: Increasing antigenemia is associated with progressive disease. Clin Infect Dis 2002;34:939-43.
Marr KA, Balajee SA, McLaughlin L, Tabouret M, Bentsen C, Walsh TJ. Detection of galactomannan antigenemia by enzyme immunoassay for the diagnosis of invasive aspergillosis: Variables that affect performance. J Infect Dis 2004;190:641-9.
Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: A meta-analysis. Clin Infect Dis 2006;42:1417-27.
Hizel K, Kokturk N, Kalkanci A, Ozturk C, Kustimur S, Tufan M. Polymerase chain reaction in the diagnosis of invasive aspergillosis. Mycoses 2004;47:338-42.
Buchheidt D, Baust C, Skladny H, Ritter J, Suedhoff T, Baldus M, et al. Detection of Aspergillus species in blood and bronchoalveolar lavage samples from immunocompromised patients by means of 2-step polymerase chain reaction: Clinical results. Clin Infect Dis 2001;33:428-35.
Loeffler J, Kloepfer K, Hebart H, Najvar L, Graybill JR, Kirkpatrick WR, et al. Polymerase chain reaction detection of Aspergillus DNA in experimental models of invasive aspergillosis. J Infect Dis 2002;185:1203-6.
Halliday C, Hoile R, Sorrell T, James G, Yadav S, Shaw P, et al. Role of prospective screening of blood for invasive aspergillosis by polymerase chain reaction in febrile neutropenic recipients of haematopoietic stem cell transplants and patients with acute leukaemia. Br J Haematol 2006;132:478-86.
Johnson LB, Kauffman CA. Voriconazole: A new triazole antifungal agent. Clin Infect Dis 2003;36:630-7.
Sambatakou H, Dupont B, Lode H, Denning DW. Voriconazole treatment for subacute invasive and chronic pulmonary aspergillosis. Am J Med 2006;119:527.e17-24.
Ghannoum MA, Kuhn DM. Voriconazole - Better chances for patients with invasive mycoses. Eur J Med Res 2002;7:242-56.
Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002;347:408-15.
Segal BH, Barnhart LA, Anderson VL, Walsh TJ, Malech HL, Holland SM. Posaconazole as salvage therapy in patients with chronic granulomatous disease and invasive filamentous fungal infection. Clin Infect Dis 2005;40:1684-8.
Walsh TJ, Raad I, Patterson TF, Chandrasekar P, Donowitz GR, Graybill R, et al. Treatment of invasive aspergillosis with posaconazole in patients who are refractory to or intolerant of conventional therapy: An externally controlled trial. Clin Infect Dis 2007;44:2-12.
Pitisuttithum P, Negroni R, Graybill JR, Bustamante B, Pappas P, Chapman S, et al. Activity of posaconazole in the treatment of central nervous system fungal infections. J Antimicrob Chemother 2005;56:745-55.
Spanakis EK, Aperis G, Mylonakis E. New agents for the treatment of fungal infections: Clinical efficacy and gaps in coverage. Clin Infect Dis 2006;43:1060-8.
Cohen-Wolkowiez M, Benjamin DK Jr., Steinbach WJ, Smith PB. Anidulafungin: A new echinocandin for the treatment of fungal infections. Drugs Today (Barc) 2006;42:533-44.
Aliff TB, Maslak PG, Jurcic JG, Heaney ML, Cathcart KN, Sepkowitz KA, et al. Refractory Aspergillus pneumonia in patients with acute leukemia: Successful therapy with combination caspofungin and liposomal amphotericin. Cancer 2003;97:1025-32.
Kontoyiannis DP, Hachem R, Lewis RE, Rivero GA, Torres HA, Thornby J, et al. Efficacy and toxicity of caspofungin in combination with liposomal amphotericin B as primary or salvage treatment of invasive aspergillosis in patients with hematologic malignancies. Cancer 2003;98:292-9.
Marr KA, Boeckh M, Carter RA, Kim HW, Corey L. Combination antifungal therapy for invasive aspergillosis. Clin Infect Dis 2004;39:797-802.
Singh N, Limaye AP, Forrest G, Safdar N, Muñoz P, Pursell K, et al. Combination of voriconazole and caspofungin as primary therapy for invasive aspergillosis in solid organ transplant recipients: A prospective, multicenter, observational study. Transplantation 2006;81:320-6.
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