Diagnosing filamentous fungal infections in immunocompromised patients applying computed tomography-guided percutaneous lung biopsies: a 12-year experience.
Background: Invasive fungal diseases (IFD) are an important cause of morbidity and mortality in immunocompromised patients, and early diagnosis and management are a challenge. We evaluated the clinical utility of computed tomography (CT)-guided percutaneous lung biopsies in diagnosing IFD. Methods:...
| Publicado en: | Infection Vol. 45; no. 6; pp. 867 - 876 |
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| Autores principales: | , , , , , , , , , , , |
| Formato: | diagnostic images research tables/charts Journal Article |
| Publicado: |
Springer Nature
Dec2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126332502&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 126332502 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03008126 NXO jtl: Infection issn: 03008126 maglogo: N pubinfo: dt: Dec2017 vid: 45 iid: 6 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 126332502 126332502 144053338 126332502 10.1007/s15010-017-1072-6 126332502 ppf: 867 ppct: 9 formats: fmt: @attributes: type: P tig: atl: Diagnosing filamentous fungal infections in immunocompromised patients applying computed tomography-guided percutaneous lung biopsies: a 12-year experience. aug: au: Lass-Flörl, Cornelia Aigner, Maria Nachbaur, David Eschertzhuber, Stephan Bucher, Brigitte Geltner, Christian Bellmann, Romuald Lackner, Michaela Orth-Höller, Dorothea Würzner, Reinhard Weiss, Günter Glodny, Bernhard affil: Division of Hygiene and Medical Microbiology , Medical University of Innsbruck , Schöpfstraße 41/III 6020 Innsbruck Austria sug: subj: Mycoses Diagnosis Immunocompromised Host Tomography, X-Ray Computed Utilization Lung Pathology Biopsy Human Mycoses Prevention and Control Staining and Labeling Methods Polymerase Chain Reaction Methods Aspergillus Microbial Culture and Sensitivity Tests Sensitivity and Specificity Predictive Value of Tests Necrosis Pneumothorax ab: Background: Invasive fungal diseases (IFD) are an important cause of morbidity and mortality in immunocompromised patients, and early diagnosis and management are a challenge. We evaluated the clinical utility of computed tomography (CT)-guided percutaneous lung biopsies in diagnosing IFD. Methods: Between 2003 and 2014, we analyzed 2671 CT-guided lung biopsies, from which 157 were IFD associated; we aimed to determine microbiological-based diagnostic accuracy of calcofluor white staining (CFWS), culture, Aspergillus antigen detection (GM), broad-range fungal PCR, and Aspergillus PCR per sample. Results: 127 (81%) specimens were microscopically positive for any fungal elements, 30 (19%) negative. Aspergillus and non- Aspergillus like hyphae were obtained in 85 (67%) and 42 (33%) specimens, respectively. CFWS positivity was defined as proof of infection. Sensitivity, specificity, and positive (PPV) and negative predictive (NPV) values for CT scan were 100, 44, 80, and 100%, for Aspergillus PCR 89, 58, 88, and 58%, for broad-range fungal PCR 90, 83, 95, and 90%, and for GM 94, 83, 95, and 90%. The most common CT features were patchy opacifications with central necrosis (78%) or cavern defects (50%), less common were air bronchograms (39%) or ground glass halos (39%), and all other features were rare. The overall pneumothorax rate subsequent to biopsy was 19%, but in only 2% of all cases the placement of a chest tube was indicated. One case of fatal air embolism occurred. Conclusions: CT-guided lung biopsies have high diagnostic accuracy in terms of microscopic examination, and complication rates are low. Molecular-based and antigen tests applied on fungal hyphae-positive specimens showed comparable results. pubtype: Academic Journal doctype: diagnostic images research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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