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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. Clinical features of 35 proven cases at a single institution
L Kaiser1, T Huguenin, P D Lew
1Division of Infectious Diseases, University of Geneva Hospitals, Switzerland.
Abstract:
Thirty-five patients with clinical features and histologically or microbiologically proven infection met predetermined stringent criteria for invasive aspergillosis over a 5-year period at our institution. Underlying conditions included hematologic malignancy, solid tumor, bone marrow and solid organ transplantation, and immunosuppressive therapy. The majority of patients (94%) presented with respiratory symptoms and abnormal pulmonary chest radiography; only 40% had neutropenia at time of infection. Invasive aspergillosis was suspected in only 21 cases (60%). Concomitant infections were present in 83% of patients. Half of patients had pathogenic or potentially pathogenic microorganisms other than Aspergillus spp. isolated from pulmonary specimens at time of aspergillosis. Aspergillus spp. were recovered from sputum in 75% of patients and from bronchoalveolar lavage in only 52%. Invasive aspergillosis is an unexpectedly unrecognized disease with poor outcome; overall mortality was 94% in our series. The lack of sensitivity of diagnostic procedures, together with the high frequency of concomitant infections, delays the time of diagnosis. Early diagnostic tests are needed, and presumptive antifungal therapy among high-risk patients is mandatory.
Insights
Invasive aspergillosis is a frequently unrecognized infection, often missed by diagnostic tests. Early diagnosis and antifungal treatment are crucial due to its high mortality rate.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pulmonology
Background:
- Invasive aspergillosis is a serious fungal infection, particularly in immunocompromised patients.
- Diagnosis is often delayed due to non-specific symptoms and limitations of diagnostic tests.
- High mortality rates underscore the need for improved diagnostic and therapeutic strategies.
Purpose of the Study:
- To evaluate the clinical characteristics, diagnostic challenges, and outcomes of invasive aspergillosis.
- To highlight the underdiagnosis and high mortality associated with this infection.
- To emphasize the need for early diagnostic methods and prompt antifungal therapy.
Main Methods:
- Retrospective analysis of 35 patients diagnosed with invasive aspergillosis over a 5-year period.
- Inclusion criteria: clinical, histological, or microbiological confirmation of infection.
- Review of patient demographics, underlying conditions, clinical presentation, diagnostic procedures, and outcomes.
Main Results:
- Most patients (94%) had respiratory symptoms and abnormal chest radiography; neutropenia was present in only 40%.
- Invasive aspergillosis was suspected in only 60% of cases, with 83% having concomitant infections.
- Mortality was high at 94%, with diagnostic delays attributed to low sensitivity of tests and frequent co-infections.
Conclusions:
- Invasive aspergillosis is an under-recognized and often fatal disease.
- Diagnostic procedures lack sensitivity, and frequent co-infections complicate timely diagnosis.
- Early diagnostic tests and presumptive antifungal therapy in high-risk individuals are essential.
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