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Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology
Published on: March 22, 2012
Invasive aspergillosis and endocarditis
K Chevalier1, F Barde1, S Benhamida1
1Department of Intensive Care Unit, Groupe Hospitalier Nord Essonne, Site Longjumeau, 159, rue du Président François Mitterrand, 91160 Longjumeau, France.
Introduction:
Aspergillusfumigatus can cause a systemic infection called invasive aspergillosis causing pulmonary and extra-pulmonary damage. Aspergillus endocarditis (AE) is a relatively rare disease but can be life-threatening.
Case Reports:
We report here on five cases of endocarditis due to invasive aspergillosis: a 58-year-old man receiving immunosuppressive medication following a kidney graft, a 58-year-old man undergoing chemotherapy for chronic lymphocytic leukaemia, a 55-year-old man receiving corticosteroids for IgA vasculitis, a 52-year-old HIV-infected woman under no specific treatment and a 17-year-old boy under immunosuppressive therapy for auto-immune chronic neutropenia.
Discussion:
Aspergillus accounts for 25-30% of fungal endocarditis and 0.25% to 8.5% of all cases of infectious endocarditis. Aspergillus endocarditis results from invasion of the lung arterioles by hyphae and blood dissemination. It is associated with a very high mortality rate (42-68%). Diagnosing Aspergillus endocarditis is mainly problematic because blood cultures are almost always negative, and fever may be absent. Immunosuppression, haematological malignancies, recent cardiothoracic surgery, negative blood cultures with endocarditis and/or systemic or pulmonary emboli are predictors of AE. In the setting of endocarditis, some clinical characteristics may raise early suspicions of aspergillosis rather than a non-fungal agent: no fever, vegetations affecting the mitral valve, non-valve or aortotomy sites, aortic abscess or pseudo-aneurysm. The identification of invasive aspergillosis is based on a chest CT scan, microscopy/culture or other serological and molecular tests. The treatment of Aspergillus endocarditis requires triazole antifungal drugs, and frequently additional surgical debridement.
Conclusion:
Aspergillus endocarditis is rare but is associated with a very high mortality rate. Knowledge of its predictive factors and key clinical features can help to differentiate aspergillosis from non-fungal endocarditis and may enable improved survival rates.
Insights
Aspergillus endocarditis (AE) is a rare but life-threatening fungal infection. Early recognition of predictive factors and clinical signs is crucial for timely diagnosis and improved survival rates in patients with invasive aspergillosis.
Area of Science:
- Infectious Diseases
- Mycology
- Cardiology
Background:
- Invasive aspergillosis, caused by Aspergillus fumigatus, can lead to severe systemic infections with significant pulmonary and extra-pulmonary damage.
- Aspergillus endocarditis (AE) is a rare but highly lethal manifestation of invasive aspergillosis.
Observation:
- This report details five cases of endocarditis attributed to invasive aspergillosis in diverse patient populations, including those with immunosuppression (kidney graft, chemotherapy, corticosteroids, HIV, autoimmune neutropenia).
- Aspergillus species constitute a significant proportion of fungal endocarditis cases (25-30%) and a small percentage of all infectious endocarditis cases (0.25-8.5%).
Findings:
- Aspergillus endocarditis is characterized by a high mortality rate (42-68%) and diagnostic challenges, including frequently negative blood cultures and the absence of fever.
- Key predictors for AE include immunosuppression, hematological malignancies, recent cardiothoracic surgery, negative blood cultures, and embolic events.
- Distinct clinical features suggestive of AE over non-fungal endocarditis include lack of fever, specific vegetation locations (mitral valve, non-valve, aortotomy sites), and the presence of aortic abscess or pseudo-aneurysm.
Implications:
- Early suspicion of aspergillosis in endocarditis cases, guided by specific clinical indicators, is vital for prompt diagnosis.
- Diagnostic methods for invasive aspergillosis involve chest CT scans, microscopy, culture, serological, and molecular tests.
- Effective treatment necessitates triazole antifungal drugs, often combined with surgical intervention for debridement.
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