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Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology
Published on: March 22, 2012
The relationship between organising pneumonia and invasive mould disease in patients with haematologic malignancy
Moonsuk Bae1,2, Joon Seon Song3, Ji Yeun Kim2
1Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Background:
Organising pneumonia (OP) is reported in patients with haematologic malignancy suspected of having invasive mould disease, yet little is known about this relationship.
Objective:
To investigate molecular evidence of invasive mould pneumonia in paraffin-embedded lung tissues from histologically diagnosed OP patients with suspected invasive mould pneumonia.
Patients/Methods:
Patients with haematologic malignancy suspected to have invasive pulmonary mould disease who underwent lung biopsy at a tertiary hospital, Seoul, South Korea, between 2008 and 2020, were retrospectively reviewed. To find molecular evidence of fungal infection, PCR assay was used to detect Aspergillus- and Mucorales-specific DNA within OP lung tissue sections.
Results:
Forty-seven patients with suspected invasive mould pneumonia underwent lung biopsy and 15 (32%) were histologically diagnosed as OP without any evidence of fungal hyphae. Of these 15 patients, 3 (20%) received allogenic haematopoietic stem cell transplantation prior to developing OP. Before biopsy, 2 and 13 patients had probably and possible invasive mould disease, respectively. The median antifungal treatment length was 81 [8-114] days, and the median steroid treatment dosage was 0.35 mg/kg/day for 36 days (methylprednisolone equivalent doses), respectively. After biopsy, three patients with possible invasive mould infection revealed probable invasive pulmonary aspergillosis. From the 15 paraffin-embedded lung tissues, 6 (40%) exhibited positive PCR assay results for detecting Aspergillus- and Mucorales-specific DNA.
Conclusions:
More than one third of OP cases in patients with suspected invasive mould pneumonia exhibited molecular evidence of invasive mould infection by fungus-specific PCR in lung tissues, likely associated with concurrent or prior fungal infection.
Insights
Molecular tests detected invasive mould infection in over a third of organising pneumonia cases in patients with haematologic malignancy. This suggests a link between fungal infections and this lung condition in immunocompromised individuals.
Area of Science:
- Medical Mycology
- Pulmonary Medicine
- Hematology
Background:
- Organising pneumonia (OP) is observed in hematologic malignancy patients with suspected invasive mould disease.
- The relationship between OP and invasive mould disease requires further investigation.
Purpose of the Study:
- To identify molecular evidence of invasive mould pneumonia in lung tissues of patients diagnosed with OP.
- To explore the association between OP and fungal infections in immunocompromised patients.
Main Methods:
- Retrospective review of patients with hematologic malignancy and suspected invasive pulmonary mould disease who underwent lung biopsy.
- Utilized PCR assays to detect Aspergillus- and Mucorales-specific DNA in paraffin-embedded OP lung tissue sections.
Main Results:
- Fifteen of 47 patients (32%) were histologically diagnosed with OP; 3 had undergone allogeneic hematopoietic stem cell transplantation.
- Fungus-specific PCR detected Aspergillus- and Mucorales-specific DNA in 6 of 15 OP lung tissue samples (40%).
- Three patients initially suspected of possible invasive mould disease were confirmed to have probable invasive pulmonary aspergillosis post-biopsy.
Conclusions:
- Molecular evidence of invasive mould infection was found in over one-third of OP cases in patients with suspected invasive mould pneumonia.
- These findings suggest a likely association with concurrent or prior fungal infections in this patient group.
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